Datasheet - 'EXPLORE'
Date : 21 Dec 2023
Mr Sakthivel Sithivinayagam
08/1099, Iyyankulam, Vadakarai Melaveethi, Thanjavur, Tamil
Nadu, India - , Thanjavur 613009 , Tamil Nadu 33
SAKTHIVELSITHUS@GMAIL.COM
Dear Mr Sakthivel Sithivinayagam,
This is in reference to information provided by you for Silver-WW Exc US/Canada. In this regard, we would like to confirm that we have
accepted the risk and the policy is issued in accordance with the details shared by you. We are issuing you this Pre-Issuance Form as a proxy
to the details provided by you.
In case there is a discrepancy in this letter vis-à-vis the policy certificate issued to you, the details in the policy certificate shall prevail
The relevant details of your policy are:
Policy Details
Total no. of /n
Geographical Scope Plan Name Sum Insured Type of Trip Policy Period
travel days
Silver WW Exc US and From 29-Jan-2024
Silver-WW Exc US/Canada USD 2,00,000.00 SINGLE 12 days
Canada to 09-Feb-2024
Details of Insured
Sum Passport
Name Relationship Date of Birth Gender Pre-existing diseases Other PED
Insured Number
Sakthivel USD
MEMBER 10-Dec-1989 Male V2065178 NONE NO
Sithivinayagam 2,00,000.00
Additional Details
Have any of the above mentioned person(s) to be insured been diagnosed / hospitalized for any illness / injury during the last 48 months?
Insured 1
Have you ever claimed under any travel policy?
Insured 1
Name of Nominee
Santhi S
Please go through the details as furnished above vis-a-vis provided in the policy certificate.
Should you feel that there are any discrepancies/variations, you are requested to write back to us immediately at https://
www.careinsurance.com/contact-us.html for necessary changes/rectification. In the absence of any communication from you within 15 days
of the risk inception date of the Policy, we would take it that you have accepted the contents and the coverage to be confirming to your
proposal.
The details mentioned in above proposal form has been verified through OTP N
Team Care Health Insurance
Soft copy of the Policy Certificate, Policy Terms and Conditions, Health Card has been sent on your registered e-mail id at
SAKTHIVELSITHUS@GMAIL.COM In case of any change in e-mail id and non-receipt of any of above document, please contact on our
website :- https://www.careinsurance.com/contact-us.html immediately. Request for Policy Extension needs to be made at least one day prior
to policy end date.
Policy Certificate - EXPLORE Policy Details
Mr Sakthivel Sithivinayagam Certificate Of Insurance No. 76485461
08/1099, Iyyankulam, Vadakarai Melaveethi, Thanjavur, Plan Name Silver-WW Exc US/Canada
Tamil
Sum Insured USD 2,00,000.00
Nadu, India - , Thanjavur 613009 , Tamil Nadu 33
SAKTHIVELSITHUS@GMAIL.COM Policy Period - Start Date 00:00 hrs 29-Jan-2024
Policy Period - End Date Midnight 09-Feb-2024
Trip Type SINGLE
Total No. of Travel days 12 days
Geographical scope Silver WW Exc US and Canada
Mobile No:XXXXXX7683 Nominee Name (Relation) Santhi S
Client ID : A6479740 Premium Paid Rs.788.00
Date of Birth : 10-Dec-1989 Premium Rs.668+CGST Rs0.00+IGST
Rs120.20+SGST Rs0.00+UGST Rs0.00
Premium Payment Mode Single Premium
Details of Insured
Passport
Name Relationship Date of Birth Gender Sum Insured Pre-existing diseases
Number
Sakthivel
MEMBER 10-Dec-1989 Male USD 2,00,000.00 V2065178 NONE
Sithivinayagam
*Medical/Hospitalization expenses due to COVID 19 Infection is covered if contracted during the travel as per policy terms and condition.
We will not be covering any expenses incurred due to quarantine in hotel/hospital/Home or any other facility
Schedule of Benefits
S No. Name of Benefits Sum Insured Deductibles
1 In-patient Care Up to SI US $ 100
2 Out-patient Care Up to SI US $ 100
3 Dental Treatment Up to US $ 300 US $ 100
4 Personal Accident US $ 15,000
5 Automatic Trip Extension Up to 7 consecutive days US $ 100
Arrangement of Emergency Medical
6 Up to base SI ( Part of Policy Sum Insure) $100
Evacuation
7 Repatriation of Mortal Remains Up to US $ 50,000 N.A.
8 Life Threatening Condition due to PED Up to 10%; Max. up to $10000 N.A.
Intermediary Details
Name Code Contact Details
POLICYBAZAAR INSURANCE BROKERS PVT LTD 20374491 1800-2585970
Contact for Policy Servicing & Claim Reimbursement Contact for Policy Servicing & Claim Reimbursement
Care Health Insurance Limited Name of the Assistance Service Provider - Falck Global Assistance
Call us : 1800-102-4488 / 1800-102-6655 US and Canada Toll free number : +1 8443013135/ +18443013146
E-mail : travelassistance@careinsurance.com Any other country: +91 124 4498760 (Call Back Facility)
Website: https://www.careinsurance.com/contact-us.html Fax No. : +91 124 4006674
E-mail : travelassistance@careinsurance.com (for claims)
Website : www.careinsurance.com
For Care Health Insurance Limited
Authorized Signatory
Date of Issue : 21 Dec 2023
Place of Issue : Gurgaon, Haryana
Service Branch : Vipul Tech Square TowerC3rd Floor Sector43Golf Course Road Gurgaon Branch Contact No. : Nil
Haryana 122009Gurgaon,Haryana,122009
Consolidated Stamp Duty paid vide E-Challan GRN no. 0107464159 dated 21 Sep 2023, RCM Applicability- N/A
SAC: 997133 and Description of Service: Accident and Health Insurance Services State
GSTIN No.: 06AADCR6281N1ZW
UIN :RHITIOP20134V031920
If the premium so remitted is not realized and credited to the Company's bank a/c, the Company's assumption of liability under this Policy
shall stand void ab initio
Note:
- Attached with this Policy Certificate are the Policy terms and conditions, Optional Covers (if opted) and Annexures. Please ensure that
these documents have been received, read and understood. If any of these documents have not been received, please feel free to write to
us at https://www.careinsurance.com/contact-us.html
- This Policy Certificate in original must be surrendered to the Company in case of cancellation of the Policy. In case this Policy is issued on
"Single Trip" basis, the Policy can be extended as per the provisions of Clause 5.11 of the Policy Terms and Conditions
Sakthivel Sithivinayagam
76485461 10-Dec-1989
29-Jan-2024 To 09-Feb-2024
Signature Not Verified
Digitally signed by Manish Dodeja
Date: 20231221184155
Reason: I'm the author
Location: India
