Policy Schedule

Bajaj Allianz General Insurance Company Ltd.

Regd.Office - GE Plaza, Airport Road, Yerwada, Pune - 411006 (India)

TRAVEL COMPANION IDENTIFICATION AND SCHEDULE

Reference No : Y Imdcode : 10041095
Policy No : OG-18-1149-9910-00008304 Subcode:
Insurance Plan Chosen : Travel Elite Gold 96149278
Proposer Name : MR MAHENDER PAL SAWHNEY Partner Id: WORLDWIDE
Date Of Birth: 07-JUN-1958 Geographical Coverage : INCLUDING USA AND
CANADA
Home Address : F1 U 144 2ND FLOOR PITAM PURA DELHI
Pincode : SARITA SAWHNEY
Passport No : 110034 Telephone Nos :

N3806953 Assignee :

BENEFITS Limits (Max for entire policy period) DEDUCTIBLE
Personal Accident USD 25000
AD & D Common Carrier USD 5000
Loss of Checked-in baggage(Per baggage maximum 50% and per item in USD 1000
baggage maximum 10%)
Delay Of Checked Baggage USD 100 12 Hours
Loss Of Passport USD 250 USD 25
Hijack $60 per day to max $360 12 Hours
Trip Delay $30 per 12 hrs to max $180 USD 100
Personal Liability USD 200000
Emergency Cash Advance( would include delivery charges) USD 1000 USD 100
Golfer's Hole-in-one USD 500
Trip Cancellation USD 1000
Home Burglary Insurance Rs. 200000
Trip Curtailment USD 300
Hospitalization Daily Allowance $25 per day to max $125
Medical Expenses, Evacuation & Repatriation of remains (Max limit for USD 200000
emergency dental treatment is US$500(Included in Medical Expenses))

Special Condition: 0

Base Premium (in Rupees) : 2346
328
Service Tax (in Rupees) : 0

Swachh Bharat/Edu. Cess (in Rupees) 2698
: 23-MAY-2017
Or Date of return of Insured.
Total Premium (in Rupees) :

Date of Purchase of Policy :

Policy Period : From 23-MAY-2017 00:00 to 26-JUN-2017

Claims Assistance Department : Health Administration Team

24 hours Helpline : Telephone No +91 20 3030 5858,Fax No: +91 20 3051 2207

Email : [email protected]

Address of Notification of Claims : Bajaj Allianz General Insurance Company Limited,

Ground Floor, Ashoka Plaza, 32/2, Nagar Road, Nr. Weikfield Company, Pune 411014

IMPORTANT : The policy coverages are as per the policy terms and conditions mentioned in the Travel Kit provided with this policy schedule.
You may refer the same on our website as well. Always and COMPULSORILY first contact the 24 hours helpline and obtain prior notification
number from HELP LINE before incurring any expense. For all claims Please quote the claims notification number and submit claim forms with
original medical bills. The coverage provided is subject to details and declaration in the proposal form given prior to taking this policy and
attached policy wordings.

Extension Process :

In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858

(chargeable, add area code before this number in case of mobile call) or email us at '[email protected]'.

For the extension of the policy seven days prior to the expiry date mentioned above. The payment for the extended period of insurance if granted
would be accepted only through credit card. The policy may or may not be extended and is at the sole discretion of the Company as per
applicable underwriting guidelines prevalent.

For & on behalf of Bajaj Allianz General Insurance Cos. Ltd.

Authorized Signatory

Regd Office : GE Plaza,Airport Road,Pune(India)

NF/69560887/2698(INR) (If Premium is paid through cheque the policy is void ab-initio in case of dishonor of chq.)

Declaration by the insured : We understand that this policy has been issued based on the information provided by us/our representative

and the policy is not valid if any of the information provided is incorrect. We also understand that this policy does not cover any pre-existing
illness or disability or conditions arising therefrom.

Policy is valid only if countersigned by the insured in the space above Signature of Insured
accepting this declaration

Service Tax Reg. No. : AABCB5730G-ST-001
" Terms, Conditions and exclusions as per applicable memos and policy clause attached"