This Document is Digitally Signed
Signer: RASHMI RAMAN SINGH
Date: Thu, Nov 10, 2022 08:12:24 IST
Location: NOIDA
Reason: Signing Policy for OICL
OVERSEAS MEDICLAIM POLICY (BUSINESS AND HOLIDAY) POLICY SCHEDULE
UIN: OICTIOP21581V022021
Policy No. : 211200/48/2023/4707 Prev. Policy No. : -
Cover Note No : - Cover Note Date : -
: 166578400 Issue Office code : 211200
Insured's Code
Insured's Name : Kumaresan Ravi (GSTIN: ) Issue Office Name : DO II NEW DELHI (GSTIN:
07AAACT0627R1Z1)
Address : 34/4, MARIYAMMAN KOVIL Address : 16/20, WEA, FIRST FLOOR,NEAR
STREET , ADIRAMPATTINAM SHASTRI PARK,
PADAM SINGH ROAD, KAROL BAGH
NEW DELHI
THANJAVUR TAMIL NADU 614701 NEW DELHI DELHI 110005
Tele/Fax/Email : / / 8111096387 / Tele/Fax/Email : 011-41052050, 41062050, 8851779656 /
ravikumaresan97@gmail.com 011-41052050 /
vkrithika@orientalinsurance.co.in
Agent/Broker Details
Dev.Off.Code :
Agent/Broker : LC0000000660 M/S POLICYBAZAAR INSURANCE BROKERS PRIVATE LIMITED
Address : Plot No. 119, Sector-44, Gurgaon,, Gurgaon, Haryana, 12200,Tel - 1800-258-
5970,GURGAON,HARYANA,122002
Tel/Fax/Email : 1800-258-5970/1800-258-5970//
Period of Insurance : FROM 00:00 ON 06/01/2023 TO MIDNIGHT OF 10/01/2023
Collection No & Dt : CC 2005204283 - 10/11/2022 GST INVOICE NO :0721672570 UIN :0
Gross Premium : 251 GST 45 Stamp Duty : .5 Total : 296
Coinsurance Details : NIL
Channel of Sale Yes/No
1.Online NO
2.Fresh YES
3.Renewal NO
Traveller Details
Name of Person : Kumaresan Ravi
Date of Birth : 10/06/1991
Age : 31
Sex : M
Passport No : W6681606
Occupation : -
Place : NEW DELHI For and on behalf of
Date : 10/11/2022 The Oriental Insurance Company Limited
This is an electronically generated document (Policy
Schedule).The Policy document duly stamped will be sent by post.
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
Signer: RASHMI RAMAN SINGH
Date: Thu, Nov 10, 2022 08:12:24 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 211200/48/2023/4707
Travel Details
Plan Type (Plan A Plan B) : PLAN A
Type of Trip (Single or Annual Multi Trip : SINGLE
Sub Plan (Silver or Gold Plan) : GOLD
OMP Serial No : 1
First Day of Insurance : 06/01/2023
No of days outside India : 5
Original copy of physician's report attached : NO
Adverse medical History : NIL
Medical Report attached : NOT-ATTACHED
Place : NEW DELHI For and on behalf of
Date : 10/11/2022 The Oriental Insurance Company Limited
This is an electronically generated document (Policy
Schedule).The Policy document duly stamped will be sent by post.
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 2 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
Signer: RASHMI RAMAN SINGH
Date: Thu, Nov 10, 2022 08:12:24 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 211200/48/2023/4707
Limits of Indemnity
sno COVERAGES/DEDUCTIBLE SUM INSURED DEDUCTIBLE
1 MEDICAL EXPENSES $ 100000 $100
2 HOSPITAL DAILY ALLOWANCE Mentioned Below 0
3 DENTAL EMERGENCY EXPENSES $ 300 $100
4 ASSISTANCE (MEDICAL,REPATRIATION,EVACUATION AND LEGAL COVERED IN S.NO. 1 ABOVE
5 PERSONAL ACCIDENT $ 30000 0
6 LOSS OF BAGGAGE $ 1000 0
7 DELAY IN BAGGAGE (PER 12 HOURS) $ 100
8 LOSS OF PASSPORT $ 300 $50
9 EMERGENCY MEDICAL EVACUATION COVERED IN S.NO. 1 ABOVE
10 REPATRIATION OF MORTAL REMAINS $ 7500 0
11 HIJACK DISTRESS ALLOWANCE $ 125 PER DAY WITH A MAXIMUM OF $500 0
12 PERSONAL LIABILITY $ 200000 $200
13 FLIGHT DELAY $50 PER 12 HOUR WITH A MAXIMUM OF $200 0
14 AUTOMATIC EXTENSION OF THE POLICY UPTO 7 DAYS
0
15 TRIP CURTAILMENT $ 500 $100
16 TRIP CANCELLATION $ 500 0
17 MISSED CONNECTIONS/MISSED DEPARTURE (PER 3 HOURS) $ 500 0
18 BOUNCED BOOKING OF HOTEL AND AIRLINE $ 500
19 FINANCIAL EMERGENCY ASSISTANCE COVER $ 1000 0
20 HOME BURGLARY INSURANCE INR 1500000 0
21 ACCIDENTAL DEATH / DISMEMBERMENT (ADD) COVERED IN S.NO.5 ABOVE
22 DIFFERENCE IN AIR FARE DUE TO DELAYED/ EARLY RETURN $ 500 0
23 COMPASSIONATE VISIT/ MEDICAL REUNION $ 5000 $100
24 LOSS OF INTERNATIONAL DRIVING LICENCE $ 250 0
25 LAPTOP / TAB COVER $100
$ 1500
26 ADVENTROUS SPORTS COVER COVERED IN S.NO.1 ABOVE
Place : NEW DELHI For and on behalf of
Date : 10/11/2022 The Oriental Insurance Company Limited
This is an electronically generated document (Policy
Schedule).The Policy document duly stamped will be sent by post.
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 3 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
Signer: RASHMI RAMAN SINGH
Date: Thu, Nov 10, 2022 08:12:24 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 211200/48/2023/4707
COVERAGES/ Plan-A(Worldwide-Excluding USA/CANADA) Plan-B(Worldwide-Including USA/CANADA)
Sections
DEDUCTIBLE Sum Insured Deductible Sum Insured Deductible
HOSPITAL Silver Plan - A daily benifit of $25 Silver Plan - A daily benifit of $25
2 DAILY with a maximum limit of $150 with a maximum limit of $150 Nil
Nil
ALLOWANCE Gold Plan - A daily benifit of $25 Gold Plan - A daily benifit of $25
with a maximum limit of $300 with a maximum limit of $300
Total Premium in words : Indian Rupees Two Hundred Ninety-Six Only
The Insurance under this policy is subject toWarranties & Clauses :
The policy excludes the cover for treatment relating to Mumps, Chicken Pox, Measles, German Measles, Spina Bifida,
Whooping Cough, Diphtheria, Poliomyelitis, Meningitis, and Scarlet Fever and for consequences attributable thereto,
accelerated thereby or arising there from
Cover commences from the time of boarding the aircraft or any other mode of transport from the point of departure.
Subject otherwise to the terms, conditions exceptions, exclusions and limitations of the policy.
In the event of death of Insured Person(s) due to an insured peril all the benefits payable in respect thereof under this insurance,
shall become payable to the assignee declared in the proposal form (incorporated here in the schedule) and assignee's receipt
shall be considered as full final discharge to the company, in respect of all liability under this policy.
It is hereby declared that this policy covers the Air transport expenses for repatriation of mortal remains and Emergency Medical
Evacuation of the insured person from the place of visit as declared to India by Economy Class.
In the event of a claim under the policy exceeding Rs. 1 lac or a claim for refund of premium exceeding Rs. 1 lac,the insured will
comply with the provisions of the AML policy of the Company.The AML policy is available in all our operaing offices as well as
Company's website.
Name of the Assignee : Divya Kumaresan
Relationship with Insured : Spouse
Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall
be void abinitio (from inception).
Please quote the
OM Policy Number C.O Code Office Code Plan Category Serial Number
OM Policy
Number in all 211200/48/2023/4707 001 211200 - HOLIDAY 1
your Corresponden
Place : NEW DELHI For and on behalf of
Date : 10/11/2022 The Oriental Insurance Company Limited
This is an electronically generated document (Policy
Schedule).The Policy document duly stamped will be sent by post.
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 4 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
Signer: RASHMI RAMAN SINGH
Date: Thu, Nov 10, 2022 08:12:24 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 211200/48/2023/4707
Location of Centre World Travel World Travel Assist - World Travel Assist Heritage Health Insurance
Assist - USA Europe Singapore TPA Pvt.Ltd. - India
Address W.T.A. TRAVEL W.T.A. TRAVEL W.T.A. TRAVEL Heritage Health Insurance TPA
SERVICES, INC. SERVICES, INC. SERVICES, INC. Pvt.Ltd.
1571 Sawgrass Calle Barcas 2, Planta 75 Kim Yan Road Champion Building, Gr.Flr, 15,
Corporate Pkwy 2, Oficina 302, Regus, Singapore 239372 Parsi Panchayat Road, Andheri
Suite 110 Sunrise, 46002, Valencia. (E), Mumbai - 400069. India.
Fl, 33323-2862, Spain
U.S.A.
Toll Free +1 877 822 7386 +34 900 804 116 +65 3163 2058 1800 22 4004
Number for (Toll Free within India)
Assistance +65 8001302100
Other Telephone +1 305 328 3897 +34 911 881 617 +65 315 80234 +91-22-61273891 (24 hrs)
Numbers +91-22-61273892/ 93
Fax Number(s) +1 877 395 1784 +34 915 932 577 - +91-22-6127 3890
E-Mail ID assistance@wtaby assistance@wtabyhas.c assistance@wtabyhas heritagehealthomp@bajoria.in
has.com om .com
www.wta- www.wta- www.wta- www.wta-heritage.com
Website
heritage.com heritage.com heritage.com
Jurisdiction North, Central & Europe, UK & Ireland, Singapore South & South East Asia,
South America Africa, Pakistan Middle East, Australia &
New Zealand
Place : NEW DELHI For and on behalf of
Date : 10/11/2022 The Oriental Insurance Company Limited
This is an electronically generated document (Policy
Schedule).The Policy document duly stamped will be sent by post.
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 5 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
This Document is Digitally Signed
Signer: RASHMI RAMAN SINGH
Date: Thu, Nov 10, 2022 08:12:24 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 211200/48/2023/4707
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at
DO II NEW DELHI (GSTIN: 07AAACT0627R1Z1) on 10TH DAY OF NOVEMBER 2022
" In case of grievance related to any issue related to this policy the same may be addressed to the office In-Charge or the Grievance
Officer at above policy address. If the grievance remains pending, it may be escalated to Grievance Officer of the concerned Regional
Office 10th FLOOR,HANSALAYA BUILDING,15, BARAKHAMBA ROAD, NEW DELHI,. The next escalation in case grievance remains
unresolved is CSD, Head Office, situated at Oriental House, A-25/27, Asaf Ali Road, New Delhi-110002.
If the insured is not satisfied with the resolution/reply provided by the company, he/she may approach the Office of Insurance
Ombudsman, within his/her jurisdiction. The list of offices of Ombudsman is available on Company's portal."
Entered By : POLBZR_1
Policy Printed By: PRTL IP: For and on behalf of
The Oriental Insurance Company Limited
Policy Printed On: 10-NOV-22 08:12:26 MAC:
General Manager
Authorised Signatory
Place : NEW DELHI For and on behalf of
Date : 10/11/2022 The Oriental Insurance Company Limited
This is an electronically generated document (Policy
Schedule).The Policy document duly stamped will be sent by post.
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 6 of 6
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
