Signed

by:Reliance
General Insurance
Company Limited
Date:2024.04.08

Reliance Travel Care Policy - Corporate Short Term

Policy Issuing Office : Policy Servicing Office Name & Address - CORPORATE OFFICE
(SERVICING)
Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, 6th Floor, Oberoi Commerz, Oberoi Garden City, Off. Western Express Highway,
International Business Park,Oberoi Garden City, Off Western Express Goregaon (East), MUMBAI, MUMBAI, MAHARASHTRA - 400063 Phone No. : 022-
Highway, Goregaon (East), Mumbai – 400 063. 41732000
Branch Contact No. : 022-41732000
Certificate No. - 920292428221142728 Master Policy No. - 920292228220000333
Br. Code- DIRECT-990553-92021 PSO No. - MTMINFIF41524472 Dept. - TRAVEL Intermediary Code - Direct
604356
Tax Invoice No & Date : Y040724016386 & 07-Apr-2024
Details of the Insured
Name of the Policy Holder MAKE MY TRIP (INDIA) PVT LTD-NEW TRAVEL

Address of the policy holder 19TH TOWER A,B,C EPITOME BUILDING NO 5, DLF CYBER CITY, PHASE 2, GURUGRAM 122002

Details of the Insured Person

Name of the Insured Person Passport No. Gender Nominee Relationship of the Date of Birth
Name Nominee with the Insured
Person
KALLA REVANTH B8546170 MALE LEGAL LEGAL HEIR
HEIR
Communication Address & Place of Supply DLF CYBER CITY, GURGAON , HARYANA, DLF CYBER CITY, GURGAON , HARYANA, GURGAON, HARYANA - 122002
E mail id REVANTHKALLA94@GMAIL.COM
Telephone Number 9133195208
GSTIN / UIN Of Insured :
Geographical Coverage ASIA
Country Visiting UNITED ARAB EMIRATES
Policy Period From 05-May-2024 time to 09-May-2024 time 5 Days
Name of the Plan opted MMT ASIA PLAN 1
Any Pre existing disease NO

POLICY COVERAGE Sum Insured ( in USD ) Deductible ( in USD )

Emergency Medical Expenses 2,50,000 USD 50
Emergency Medical Evacuation 5000 USD
Repatriation of Mortal Remains 7,500 USD
Dental Treatment Expenses 300 USD 50
Personal Accident - Death + PTD + PPD 25000 USD
Total Loss of Checked in Baggage 500 USD
Delay of Checked in baggage 500 USD 12 hours
Loss of Passport and documents 200 USD 25
Trip Cancellation and/or Interruption 2,500 USD
Trip Delay 50 USD 6 hours
Hijack Distress Allowance 250 USD 12 hour
Visa Cancellation 3,000 USD USD100*
#Limits of Indemnity
Any one illness*** 15000 USD
Any one Accident*** 30000 USD
*** IS APPLICABLE ONLY FOR PEOPLE IN THE AGE GROUP OF 61 TO 70
Consolidated Stamp duty Paid vide Letter of Authorization No. NO LOA/ENF-1/CSD/62/2024/(Validity Period Dt.01/03/2024 to Dt.01/12/2025)/1501 Date 28-02-
2024 dated : 28 Feb 2024 at General Stamp Office, Mumbai.
** Not Applicable for the State of Jammu & Kashmir.
#Warranted that:

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 1 of 10
 1) Warranted that insured is a citizen of India and has a permanent place of residence in India and is not a NRI
or OCI or foreign national and was within the territory of India at the time of issuance of the certificate and
before the commencement of the trip.
2) ) Warranted that Purpose of visit will be for leisure or personal business purpose only
3) Warranted that the Insured / Insured Person(s) has no past history of any illness / hospitalization
4) If Point No. 3 is "Yes" Warranted that Declaration of any Pre existing Condition, using words / terms which
mean any disease/illness which are same or similar to - Cancer / Leukemia / Malignant Tumor, Cardiac ailments,
COPD, HIV /AIDS, Insulin Dependent Diabetes, Kidney Ailment, Liver Disease, Neurological Disorder / Stroke
/Paralysis, Thalasemia will render this policy null and Void-ab-initio and the Company shall have no liability
under the policy clean health history
5)Any expenses related to pre existing illness/ disability/diseases and its related complications/ consequences
are not payable under the certificate.
6) Warranted that maximum amount payable per checked-in baggage in case more than one bag has been
checked in, is 50% (100% for only one checked-in baggage) of applicable Sum Insured and per item in baggage
max 10%.
7) Repatriation of Mortal remains USD 7,500
8)In case of Financial emergency occuring in Asian countries the maximum Sum Insured applicable would be
USD 300
9) Any claim arising out of sporting activities in so far as they involve the training or participation in
competitions of professional or semiprofessional sports persons is excluded.
10) Kindly refer policy wordings for complete details of coverages and deductibles.
11) For details on coverage, exclusion, terms and conditions the certificate should be read with master policy
issued to MAKEMYTRIP OFFLINE vide policy no.920292328220000224
12) Single Trip shall mean one trip to any destination within the Republic of India starting from the Insured
Person's departure of flight from place of origin till disembarking of his/her flight journey at the terminal in India
or Certificate end date in a Single Trip whichever is earlier.
13) The policy covers emergency hospitalisation incurred whilst on the trip including COVID-19. The final
decision on claim will be on the claims team basis the terms and conditions of the policy.
14) The policy covers emergency hospitalisation incurred whilst on the trip including COVID-19. The final
decision on claim will be on the claims team basis the terms and conditions of the policy.
“Please note that the sales process will be reviewed by the Insurer on interval of every quarter as per direction
issued by IRDAI vide its Circular Ref. No. IRDAI/HLT/CIR/MISC/174/09/2019 dated 27th September 2019
Net Premium: Rs. 304.23
IGST : (18.00% ) Rs.54.76
Total Premium: Rs.358.99
In witness whereof this policy has been signed at Mumbai on : 07-Apr-2024
Subject to the terms, conditions and exclusions of the Reliance Travel Care Insurance Policy issued vide Master Policy indicated above.

GSTIN : 27AABCR6747B1ZG SAC : 997142 Description of Services :Freight Insurance & Travel Insurance
As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next
financial year
“In case of a renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be subject
to change”.

Grievance Clause:-
For resolution of any query or grievance, Insured may contact the respective branch office of the Company or may call at 02248903009 or
may write an email at rgicl.services@relianceada.com. In case the insured is not satisfied with the response of the office, insured may
contact the Nodal Grievance Officer of the Company at rgicl.grievances@relianceada.com. In the event of unsatisfactory response from the
Nodal Grievance Officer, insured may email to Head Grievance Officer at rgicl.headgrievances@relianceada.com. In the event of
unsatisfactory response from the Head Grievance Officer, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman
for the redressal of grievance. Details of the offices of the Insurance Ombudsman are available at IRDAI website www.irda.gov.in or on
company website www.reliancegeneral.co.in or on www.gbic.co.in. The insured may also contact the following office of the Insurance
Ombudsman within whose territorial jurisdiction the branch or office of the Company is located. Office of the Insurance Ombudsman,3rd
Floor,Jeevan Seva Annexe,S. V. Road,Santacruz (W), Mumbai - 400 054. Tel.: 022 - 26106552 / 26106960 Fax: 022 - 26106052 Email:
bimalokpal.mumbai@cioins.co.in
For and on behalf of Reliance General Insurance Company Limited.
Category-General Insurance Business Service 00440005

Authorized Signatory
Note : The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 2 of 10
The policy has been issued based on the information provided by you/your representative and the policy is not valid if any of the information provided is
Incorrect.In case of non receipt of the policy terms and conditions, please ensure to obtain the same from the Agent / Our nearest Office / from our Website
http://www.reliancegeneral.co.in
Medical Assistance & Emergency Services are provided by our Service Provider, Europ Assistance who are at your Service 24*7 during trip duration.
Europ Assistance India Pvt Ltd.
7th Floor, Star Hub, Bldg No. 2,Near ITC Maratha Hotel,Sahar, Andheri East, Mumbai – 400 059.

Please provide Immediate intimation of any claim / requirement for emergency assistance while abroad to ensure that the
Claim is not prejudiced. Please contact the International Toll Free Helpline numbers given below.
In case of any requirement for emergency assistance whilst abroad, please contact the toll free helpline numbers given below:
This document shall be treated as a Tax Invoice as per Rule 46 of the Central Goods and Services Tax Rules 2017
International Toll Free line : Singapore, Thailand, Hongkong is 001 800 10101022, USA – 8774714686, Canada – 8776266511, Australia – 0011 800 10101022, Japan - 0033010 800
10101022, 001010 800 10101022, Israel - 014 800 10101022, South Africa – 09 800 10101022 and for the following countries- Netherlands, Belgium, Italy, Norway, Poland, New Zealand,
Portugal, United Kingdom, Malaysia, China, Taiwan, Sweden, Austria, Czech Republic, Denmark, France, Greece, Hungary, Germany, Spain, Switzerland - 00 800 10101022
Note: Kindly refer our website for updated new toll free numbers with effect from 1st October 2017 onwards.
Dedicated National Toll Free Help Line : 1800 209 5522 Land Line : +91 22 67347843 & +91 22 67347844 Fax Number: +91 22 67347888
Email : reliance@europ-assistance.in Website: www.europ-assistance.com

Intermediary Code/Name : Direct

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 3 of 10
Reliance Travel Care Insurance Policy - Online Proposal Form
Proposal Form No..: Y040724016386

Proposer/Insured Details

1.Name of the Proposer/Insured

KALLA REVANTH
(Mr./Mrs./Ms.)
2.Address DLF CYBER CITY, GURGAON , HARYANA, DLF CYBER CITY, GURGAON , HARYANA, GURGAON, HARYANA - 122002
Residence Number
Gender MALE Passport No. B8546170 Mobile No. 9133195208
PAN No. UID Aadhar No.
REVANTHKALLA94@GM
Email Id Nationality DOB
AIL.COM

Nominee Details

Name of Nominee DOB Relationship with Proposer

LEGAL HEIR LEGAL HEIR

Details of Pre-existing Condition

Pre-existing illness / Injury / Condition if any Suffering Since Under Medication

No

Trip Details

1. Master Policy No. - 920292228220000333

2. Name of Master Policy Holder MAKE MY TRIP (INDIA) PVT LTD-NEW TRAVEL
4. Geographical
3. Sum Insured Opted 2,50,000 USD ASIA
Scope
5. Name of the Plan opted MMT ASIA PLAN 1
6. Date of Journey 05 May 2024 Date of Return 09 May 2024
7. Does the plan trip involve any kind of sporting
activity
8. Countries that you are visiting UNITED ARAB EMIRATES
9. Trip Duration 5

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 4 of 10
 Please go through the details as furnished above and also as provided in the Policy Schedule and confirm that they are in order. Should you feel that
there are any discrepancies / variations, you are requested to write back to us immediately at rgicl.services@relianceada.com.in for necessary changes
/ rectification. In the absence of any written communication from you within 7 days or commencement of Policy Period whichever is earlier , it is
hereby agreed and understood that the above statements, answers and particulars are complete, correct and true in all respects and are the basis on
which this Policy is being granted and that if, after insurance is effected, it is found that the above statements, answers or particulars are incorrect or
untrue in any respect, the policy will be considered Null and Void-ab-initio and the Company shall have no liability under the policy.

Declaration & Warranty by the Proposer

i. Policy has been issued basis Insured Person(s)

1) Is/are not travelling against advice of medical practitioner
2) Is/are not on waiting list for any medical treatment
3) Is/are not travelling for the purpose of obtaining medical treatment
4) Have not received a terminal prognosis for a medical condition before journey
5) Being in India before taking cover & commencement of trip.
6) Being resident Indian.
ii. Declared of any Pre existing Condition, using words / terms which mean any disease/illness which are same or similar to - Cancer / Leukemia /
Malignant Tumor,Cardiac ailments, COPD, HIV /AIDS, Insulin Dependent Diabetes, Kidney Ailment, Liver Disease, Neurological Disorder / Stroke
/ Paralysis, Thalasemia will render this policy null and Void-ab-initio and the Company shall have no liability under the policy (Applicable if
declared PED).
iii. Purpose of visit either Leisure or Business
iv. I have read and understood the brochure, prospectus, sales literature & Policy wordings and confirm to abide by the same.
v. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting
policy of the insurance company and that the policy will come into force only after full receipt of the premium chargeable.
vi. I/We further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured / proposer
after the proposal has been submitted but before communication of the risk acceptance by the Company.
vii. I/We declare and consent to the Company seeking medical information from any Doctor or from a hospital who at anytime has attended on the
life to be insured /proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to
be assured / proposer and seeking information from any insurance company to which an application for insurance on the life to be assured /
proposer has been made for the purpose of underwriting the proposal and / or claim settlement.
viii. I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal
underwriting and/or claims settlement and with any Governmental and / or Regulatory Authority.
ix. Receipt of the Proposal form by the Company shall not be construed as acceptance of proposal. I hereby agree that the insurance coverage shall
commence only on realization of full premium and on receipt of complete medical reports (wherever applicable) and subject to individual
underwriting by the Company. The Company at its sole discretion reserves the right to accept or reject or load any proposal without assigning
any reason thereof.
x. I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement, misrepresentation,
non-description or nondisclosure of any material fact in the Proposal form/personal statement, declaration and connected documents or any
material information having been withheld by me or anyone acting on my behalf.
xi. I hereby declare that the person(s) proposed to be insured would submit to medical examinations, before the nominated doctors of the
Company, or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting.
xii. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company.
xiii I/We consent to receive information from the Company through physical, electronic or telecommunication means from time to time.
xiv I hereby declare on my behalf & on behalf of all persons proposed to be insured that the above statements, answers and/or particulars given by
me in this proposal form are true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on
behalf of these other persons.
xv I/We here by state that the above mentioned address shall be taken as address on record for the purpose of GST.
xvi I/We hereby confirm that the contents of the proposal form and connected documents have been fully explained to me/us and I/We have fully
understood the significance of the proposed contact.
Place CORPORATE OFFICE(SERVICING) Date: 07 Apr 2024 Signature __________________________________

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 5 of 10
AML Guidelines

I/We hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been /will be paid out of proceeds
1.
of crimerelated to any of the offense listed in Prevention of Money Laundering Act,2002.
2. I Understand that the Company has the right to call for document to established sources of funds
The Insurance Company has right to cancel the insurance contract in case I am/have been found guilty by competent court of law under any of
3.
thestatutes, directly or indirectly governing the prevention of money laundering in India.
CORPORATE OFFICE
Signature: ____________________________ Date 07 Apr 2024 Place
(SERVICING)

Vernacular Declaration stating that the contents of this proposal form have been read over & fully explained to me in _ _ _ _ _ _ _ _ _ _language. I
further confirm & declare that contents read over & explained to me have been understood by me.
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Signature/Thumb Impression of the Proposer::________________________
Identified by Name & Signature :________________________
Date: 07 Apr 2024 Place CORPORATE OFFICE(SERVICING)

Prohibition of Rebates - Section 41 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015.

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an
insurance inrespect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any
1.
rebate of the premiumshown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such
rebate as may be allowed inaccordance with the published prospectuses or tables of the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 6 of 10
 CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY
This document provides key information about your policy. You are also advised to go through your policy document.
SI NO Title Description Policy Clause
Number
1 Name of Reliance Travel Care Policy - Corporate Short Term Plan
Insurance
Product/Policy
2 Policy number 920292428221142728

3 Type of Payment on Indemnity and Benefit Basis (As per plan coverage opted)
Insurance
Product/Policy
4 Sum Insured Individual Sum Insured- $ 2,50,000
(Basis)
Along with
amount
5 Policy Coverage POLICY COVERAGE Section 4
(What the policy Emergency Medical Expenses
covers?) Emergency Medical Evacuation
(Policy clause Repatriation of Mortal Remains
Number/s) Dental Treatment Expenses
Personal Accident - Death + PTD + PPD
Total Loss of Checked in Baggage
Delay of Checked in baggage
Loss of Passport and documents
Trip Cancellation and/or Interruption
Trip Delay
Hijack Distress Allowance
Visa Cancellation
#Limits of Indemnity
Any one illness***
Any one Accident***
*** IS APPLICABLE ONLY FOR PEOPLE IN THE AGE GROUP OF 61 TO 70

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 7 of 10
6 Exclusions (What 1) Warranted that insured is a citizen of India and has a permanent place of residence in India Section 5
the policy does and is not a NRI or OCI or foreign national and was within the territory of India at the time of
not covers) issuance of the certificate and before the commencement of the trip.
2) ) Warranted that Purpose of visit will be for leisure or personal business purpose only
3) Warranted that the Insured / Insured Person(s) has no past history of any illness /
hospitalization.
4) If Point No. 3 is "Yes" Warranted that Declaration of any Pre existing Condition, using words
/ terms which mean any disease/illness which are same or similar to - Cancer / Leukemia /
Malignant Tumor, Cardiac ailments, COPD, HIV /AIDS, Insulin Dependent Diabetes, Kidney
Ailment, Liver Disease, Neurological Disorder / Stroke /Paralysis, Thalasemia will render this
policy null and Void-ab-initio and the Company shall have no liability under the policy clean
health history
5)Any expenses related to pre existing illness/ disability/diseases and its related complications/
consequences are not payable under the certificate.
6) Warranted that maximum amount payable per checked-in baggage in case more than one
bag has been checked in, is 50% (100% for only one checked-in baggage) of applicable Sum
Insured and per item in baggage max 10%.
7) Repatriation of Mortal remains USD 7,500
8)In case of Financial emergency occuring in Asian countries the maximum Sum Insured
applicable would be USD 300
9) Any claim arising out of sporting activities in so far as they involve the training or
participation in competitions of professional or semiprofessional sports persons is excluded.
10) Kindly refer policy wordings for complete details of coverages and deductibles.
11) The policy covers emergency hospitalisation incurred whilst on the trip including COVID-19.
The final decision on claim will be on the claims team basis the terms and conditions of the
policy.
*Visa Cancellation-Deductible-USD 100 or 10% of admissible claim amount whichever is higher
12)Warranted that the Policy does not cover Insured Person who is less than 6 months and
more than 70 years of age (as on completed Birthday) and if found otherwise the policy will be
considered Null and Void ab-initio and the Company shall have no liability under the policy.
13) “Single Trip” means only one trip to a destination outside of the Republic of India during the
policy period, the details of which are specified in the Schedule.

“Please note that the sales process will be reviewed by the Insurer on interval of every quarter
as per direction issued by IRDAI vide its Circular Ref. No. IRDAI/HLT/CIR/MISC/174/09/2019
dated 27th September 2019”
7 Waiting period Delay of Checked in baggage - 12 hours -
Time period
during which
specified
diseases/treatme
nts are not
covered
It is counted from
the beginning of
the policy
coverage.
8 Financial limits of POLICY COVERAGE Sum Insured ( in USD )
coverage Emergency Medical Expenses 2,50,000 USD
I Sub-limit (It is a Emergency Medical Evacuation 5000 USD
pre-defined limit Repatriation of Mortal Remains 7,500 USD
and the Dental Treatment Expenses 300 USD
insurance Personal Accident - Death + PTD + PPD 25000 USD
company will not Total Loss of Checked in Baggage 500 USD
pay any amount Delay of Checked in baggage 500 USD
in excess of this Loss of Passport and documents 200 USD
limit) Trip Cancellation and/or Interruption 2,500 USD
Trip Delay 50 USD
Hijack Distress Allowance 250 USD
Visa Cancellation 3,000 USD
#Limits of Indemnity
Any one illness*** 15000 USD
Any one Accident*** 30000 USD
*** IS APPLICABLE ONLY FOR PEOPLE IN THE AGE GROUP OF 61 TO 70

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

Page 8 of 10
 ii Co-payment (It Not applicable
is a specified
amount/percenta
ge of the
admissible claim
amount to be
paid by
policyholder/insur
ed).
iii Deductible (It POLICY COVERAGE Deductible
is a specified Emergency Medical Expenses 50
amount: Dental Treatment Expenses 50
-up to which an Delay of Checked in baggage 12 hours
insurance Loss of Passport and documents 25
company will not Trip Delay 6 hours
pay any claim, Hijack Distress Allowance 12 hour
and Visa Cancellation USD100*
-which will be
deducted from
total claim
amount (if claim
amount is more
than the
specified
amount)
iv. Any other limit Not applicable
(as applicable)
9 Claims/Claims Details of procedure to be followed for cashless service as well as for reimbursement of claim Section 6.11
Procedure including pre and post hospitalization.
Turn Around Time (TAT) for claims settlements
i. TAT for preauthorization of cashless facility – 6 hours from receipt of complete documents.
ii. TAT for cashless final bill authorization – 4 hours from receipt of complete documents.
iii. For reimbursement claims - TAT for Reimbursement Claims – 7 to 10 workings days from the
date of receipt of last necessary document.
Please find below the details /link -
i. Network Hospital details- www.reliancegeneral.co.in / For email correspondence while in
overseas/India customers can write to us at: reliance@europ-assistance.in
ii. Helpline number- (91-22-67347843, 91-22-67347844) / For customers who are calling from
India, National Toll-Free Number (1800 209 5522)
iii. Hospitals which are blacklisted or from where no claims will be accepted by insurer-
www.reliancegeneral.co.in / For email correspondence while in overseas/India customers can
write to us at: reliance@europ-assistance.in
iv. Downloading/getting claim form- www.reliancegeneral.co.in
10 Policy Servicing Any issues related with respect to policy, kindly E-mail us at rgicl.services@relianceada.com
and for correspondence contact us Reliance General Insurance Company Limited
Correspondence Address – Reliance General Insurance., Winway Building 2nd & 3rd Floor,
11/12 Block No-4, Old no-67, South Tukoganj, Indore (M.P) - 452001 Contact No.- 022-
41112600
11 Grievances/Com a. Details of Grievance redressal officer refer the link (https://www.reliancegeneral.co.in/ Section 7.27
plaints Insurance/About-Us/Grievance-Redressal.aspx
b. IRDAI Integrated Grievance Management System-https://igms.irda.gov.in/
c. Insurance Ombudsman - The contact details of the Insurance Ombudsman offices have
been provided as Annexure-B of Policy document.
12 Things to Free Look cancellation: Not Applicable
remember Policy renewal: Not Applicable
Migration and Portability: Not Applicable
Change in Sum Insured:Not Applicable
Moratorium Period: Not Applicable
13 Your Obligations Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure Section 7.1
may affect the claim settlement.
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the
event of misrepresentation, mis description or non-disclosure of any material fact by the
Policyholder
“Material facts” for the purpose of this policy shall mean all relevant information sought by the
Company in the proposal form and other connected documents to enable it to take informed
decision in the context of underwriting the risk

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

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The enclosed Customer Information Sheet bearing reference number CIS\policy number 920292428221142728 is an essential part of your
policy schedule, please acknowledge that you have read and understood the CIS on the communication sent on your registered mobile
number/e-mail ID.
Disclaimer : The information must be read in conjunction with the policy document. In case of any conflict between the CIS and the
policy document, the terms and conditions mentioned in the policy document shall prevail.
Declaration by the Policy Holder:
I have read and understood the benefits and details of the product as mentioned in this sheet.

Place:GURGAON
Date:07 Apr 2024 (Signature of the Policyholder)

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company

Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park,Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai – 400 063.
Corporate Identity No. U66603MH2000PLC128300. UIN No. RELTIOP07004V010607. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures
Private Limited and used by Reliance General Insurance Company Limited under License.RGI/UW/CO/2822/PS/1.0/010218.

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