KIINGZ ENTERTAINMENT PTE LTD

16th October 2024

To Whom It May Concern ;

No Objection Certificate

This is to certify that Arpit Saini (M0215811J), holding the position of Trainee in Kiingz
Entertainment Pte Ltd, has been granted leave from 23rd October 2024 to 27th October
2024.

Yours faithfully

Timothy Tan Sze Yuen

Director of
Kiingz Entertainment Pte Ltd

KIINGZ ENTERTAIANMENT PTE LTD

REG. NO. 202109522Z
304 ORCHARD ROAD #01-48 LUCKY PLAZA SINGAPORE 238863
 S/N: EN05010803517356
Consolidated Statement
, "%

%)
)
,
ARPIT SAINI
BLK 17 JOO SENG ROAD
#08-123
SINGAPORE 360017
./-.0-./0--00--00-/.0-0-0/./.0

Account Summary as at 31 Jul 2024

Deposits

Current and Savings Account Total: SGD Equivalent 4.35

Summary of Currency Breakdown:

SGD 4.35

Account Account No. Balance Balance

(Base Currency) (SGD Equivalent)

DBS Multiplier Account 271-834851-8 SGD 4.35 4.35

SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

Account Summary as of 31 Jul 2024 Page 1 of 5

PDS_MMCON_X_ONSH_0dad014100000043_00298
 Transaction Details as at 31 Jul 2024
Deposits

DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

CURRENCY: SINGAPORE DOLLAR

Balance Brought Forward SGD 0.04

07/07/2024 Advice FAST Payment / Receipt 50.00 50.04

INCOMING PAYNOW REF 7002485
FROM: MALHOTRA CHAKSHU
PAYNOW TRANSFER
OTHER
08/07/2024 Advice Outward Telegraphic Transfer 50.01 0.03
MB146564735433J78
0016OT1069183
VALUE DATE : 08/07/2024
10/07/2024 Advice FAST Payment / Receipt 1,152.00 1,152.03
INCOMING PAYNOW REF 3168470
FROM: TIMOTHY TAN TSE YUEN
SALARY JUNE
OTHER
13/07/2024 Advice FAST Payment / Receipt 800.00 352.03
PAYNOW TRANSFER 6796736
TO: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
16/07/2024 Advice FAST Payment / Receipt 72.00 424.03
INCOMING PAYNOW REF 9528988
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

FROM: THAKUR DEEPAK CHETANSINGH

MOHIT
OTHER
17/07/2024 Advice FAST Payment / Receipt 72.00 352.03
PAYNOW TRANSFER 6676481
TO: MOHIT
PAYNOW TRANSFER
OTHER
18/07/2024 Advice FAST Payment / Receipt 350.00 702.03
INCOMING PAYNOW REF 7697719
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
18/07/2024 Advice Outward Telegraphic Transfer 100.00 602.03
MB147158009026E84
0016OT1567587
VALUE DATE : 18/07/2024
Balance Carried Forward SGD 602.03

Transaction Details as of 31 Jul 2024 Page 2 of 5

PDS_MMCON_X_ONSH_0dad014100000043_00298
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 602.03

19/07/2024 Advice FAST Payment / Receipt 1,560.00 2,162.03

INCOMING PAYNOW REF 7324476
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
20/07/2024 Advice FAST Payment / Receipt 30.00 2,132.03
PAYNOW TRANSFER 7923583
TO: KUMAR ANMOL
PAYNOW TRANSFER
OTHER
20/07/2024 Advice FAST Payment / Receipt 6.00 2,126.03
PAYNOW TRANSFER 8484558
TO: MJ FRUITS
PAYNOW TRANSFER
OTHER
20/07/2024 ATM Cash Withdrawal 2,000.00 126.03
65874209,BUFFALO RD662B
20/07/2024 ATM Cash Withdrawal 100.00 26.03
65874209,BUFFALO RD662B
21/07/2024 Advice Point-Of-Sale Transaction or Proceeds 10.20 15.83
NETS QR PAYMENT 420310313676423
TO: CHEERS HOLDINGS (
VALUE DATE : 21/07/2024
24/07/2024 Debit Card Transaction 2.38 13.45
BUS/MRT 471049758 SI NG 18JUL
4628-4500-6587-4209
24/07/2024 Advice FAST Payment / Receipt 50.00 63.45
INCOMING PAYNOW REF 8294593
FROM: SINGH KHUSHPREET
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

PAYNOW TRANSFER
OTHER
25/07/2024 Advice Point-Of-Sale Transaction or Proceeds 12.00 51.45
NETS QR PAYMENT 420711372179926
TO: NANAK ELECTRONICS
25/07/2024 Advice FAST Payment / Receipt 1.80 49.65
PAYNOW TRANSFER 5802830
TO: MAB MINIMART
U
OTHER
25/07/2024 Advice FAST Payment / Receipt 4.20 45.45
PAYNOW TRANSFER 6918858
TO: ARASI STORE
53328080WCAR HX3408753204
OTHER
26/07/2024 Advice FAST Payment / Receipt 29.90 15.55
PAYNOW TRANSFER 8690162
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 15.55

Transaction Details as of 31 Jul 2024 Page 3 of 5

PDS_MMCON_X_ONSH_0dad014100000043_00298
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 15.55

28/07/2024 Advice FAST Payment / Receipt 30.00 45.55

INCOMING PAYNOW REF 7898160
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
30/07/2024 Debit Card Transaction 11.20 34.35
7-ELEVEN-COMMONWEALTH SI NG 27JUL
4628-4500-6587-4209
30/07/2024 Advice FAST Payment / Receipt 20.00 14.35
PAYNOW TRANSFER 8613420
TO: KHUSH
PAYNOW TRANSFER
OTHER
31/07/2024 Advice FAST Payment / Receipt 10.00 4.35
PAYNOW TRANSFER 6415391
TO: MITHLESH KUMARI
PAYNOW TRANSFER
OTHER

Total Balance Carried Forward in SGD: 3,259.69 3,264.00 4.35

SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

Transaction Details as of 31 Jul 2024 Page 4 of 5

PDS_MMCON_X_ONSH_0dad014100000043_00298
 Messages For You

l Best execution policy for handling of customers’ orders

DBS has made available to you our Best Execution Policy that sets out our policies and procedures to place and/or execute
(i) customers’ orders on the best available terms (commonly referred to as “best execution”) and; (ii) comparable customers’
orders in accordance with the time of receipt of such orders.

When executing orders on our customers’ behalf, we will consider a range of execution factors. The factors may include
price, costs, speed, likelihood of execution and settlement, size and nature of the order, or any other considerations relevant
to the placement and/or execution of the order.

A copy of the DBS Wealth Management & Retail Best Execution Policy is available on our DBS website at
www.dbs.com.sg/bestexecution

l SIBOR Transition to SORA

In line with the discontinuation of the Singapore Interbank Offer Rate (SIBOR), customers with SIBOR-based credit facilities,
including home loans, are encouraged to switch to an alternative home loan package by 30 April 2024. To find out how you
can apply for an alternative home loan package, please visit https://go.dbs.com/sg-hlsibor

l We regularly conduct customer satisfaction surveys to better understand your banking experience with us.
As a valued customer, you may receive a push notification or email invitation to share your feedback via Qualtrics, our
designated digital survey platform. Your response is highly valued and will be treated with absolute confidentiality.

l Update your personal particulars today

Got a new address, passport, mobile number or email? Simply use digibank to update your details. Visit
https://go.dbs.com/sg-ppu to learn more.

For Your Information

DEPOSIT INSURANCE SCHEME
Singapore dollar deposits of non-bank depositors and monies and deposits denominated in Singapore dollars under the
Supplementary Retirement Scheme are insured by the Singapore Deposit Insurance Corporation, for up to S$100,000 in aggregate
per depositor per Scheme member by law. Monies and deposits denominated in Singapore dollars under the CPF Investment
Scheme and CPF Retirement Sum Scheme are aggregated and separately insured up to S$100,000 for each depositor per
Scheme member. Foreign currency deposits, dual currency investments, structured deposits and other investment products are not
insured.
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

GENERAL
Please examine this statement. Subject to any other applicable terms, please notify us of any error or discrepancy within fourteen
(14) days from the date of receipt of this statement.

Clients Residing in Australia - Limitations to Banking Services and Investment Offering

With effect from 6 February 2023, there will be limitations in banking services and investment offerings to our clients whose
residential address is in Australia. For more information, please visit our website at http://go.dbs.com/sg-auresident.

°rŽŽŽr°1šcJ ®Kl5˜;4‡œ1°rŽŽŽr°
p3Un3j[n{:x‰šH vJœªB57bIIW;Zf For Terms and Codes, Product Disclaimers, and
5RL=€Ž†«}W^`oF—@”8ˆ“~¨Tjdv€©q more information, scan this QR code or visit
pQ___Qp1§]bg—>6¦_Ue°=Z>­–ª
qqqqqqq1qq111q1q111qqqq1q11q1 http://go.dbs.com/sg-products-information. Page 5 of 5

PDS_MMCON_X_ONSH_0dad014100000043_00298
 S/N: EN05300603518757
Consolidated Statement
, "%

%
)
)
,
ARPIT SAINI
BLK 17 JOO SENG ROAD
#08-123
SINGAPORE 360017
./-.0-./0--00--00-/.0-0-0/./.0

Account Summary as at 30 Jun 2024

Deposits

Current and Savings Account Total: SGD Equivalent 0.04

Summary of Currency Breakdown:

SGD 0.04

Account Account No. Balance Balance

(Base Currency) (SGD Equivalent)

DBS Multiplier Account 271-834851-8 SGD 0.04 0.04

SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

Account Summary as of 30 Jun 2024 Page 1 of 5

PDS_MMCON_X_ONSH_0d8d01190000004f_03076
 Transaction Details as at 30 Jun 2024
Deposits

DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

CURRENCY: SINGAPORE DOLLAR

Balance Brought Forward SGD 25.99

04/06/2024 Debit Card Transaction 16.00 9.99

HUP LEONG COMPANY SI NG 03JUN
4628-4500-6587-4209
04/06/2024 Advice FAST Payment / Receipt 10.00 19.99
INCOMING PAYNOW REF 5601306
FROM: RAMANDEEP KAUR
20240604TRBUSGSGBRT5601306
OTHER
04/06/2024 Advice FAST Payment / Receipt 13.32 6.67
PAYNOW TRANSFER 5643077
TO: LAZADA - ALIPAY SINGAPORE INVES
2024060490970000005379528
OTHER
05/06/2024 Debit Card Transaction 2.38 4.29
BUS/MRT 445511316 SI NG 30MAY
4628-4500-6587-4209
06/06/2024 Advice FAST Payment / Receipt 50.00 54.29
INCOMING PAYNOW REF 8513472
FROM: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

06/06/2024 Advice FAST Payment / Receipt 10.00 44.29

PAYNOW TRANSFER 5854648
TO: NISDEEP
PAYNOW TRANSFER
OTHER
08/06/2024 Advice FAST Payment / Receipt 5.00 39.29
PAYNOW TRANSFER 8657101
TO: KHUSH
PAYNOW TRANSFER
OTHER
08/06/2024 Advice FAST Payment / Receipt 0.30 38.99
PAYNOW TRANSFER 9498542
TO: KHUSH
PAYNOW TRANSFER
OTHER
09/06/2024 Advice FAST Payment / Receipt 10.00 48.99
INCOMING PAYNOW REF 7251648
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 48.99

Transaction Details as of 30 Jun 2024 Page 2 of 5

PDS_MMCON_X_ONSH_0d8d01190000004f_03076
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 48.99

10/06/2024 Advice FAST Payment / Receipt 40.00 8.99

PAYNOW TRANSFER 8547460
TO: JUNED BHATI
PAYNOW TRANSFER
OTHER
12/06/2024 Advice FAST Payment / Receipt 1,000.00 1,008.99
INCOMING PAYNOW REF 6297948
FROM: TIMOTHY TAN TSE YUEN
MAY SALARY
OTHER
13/06/2024 Advice FAST Payment / Receipt 150.00 858.99
PAYNOW TRANSFER 7283503
TO: SUMIT
PAYNOW TRANSFER
OTHER
13/06/2024 Advice FAST Payment / Receipt 300.00 558.99
PAYNOW TRANSFER 7284494
TO: KUMAR
PAYNOW TRANSFER
OTHER
13/06/2024 Advice FAST Payment / Receipt 56.00 502.99
PAYNOW TRANSFER 7286178
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
13/06/2024 Advice FAST Payment / Receipt 10.00 492.99
PAYNOW TRANSFER 7289240
TO: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

13/06/2024 Advice FAST Payment / Receipt 227.00 265.99

PAYNOW TRANSFER 7293169
TO: MOHIT
PAYNOW TRANSFER
OTHER
13/06/2024 Advice Outward Telegraphic Transfer 200.00 65.99
MB145110190479J53
0016OT9877657
VALUE DATE : 13/06/2024
16/06/2024 Advice FAST Payment / Receipt 12.00 53.99
PAYNOW TRANSFER 7696534
TO: SUN SHINE HAIR & SKIN CAREP
E
OTHER
16/06/2024 Advice Point-Of-Sale Transaction or Proceeds 16.40 37.59
NETS QR PAYMENT 416814335205643
TO: 7-ELEVEN
VALUE DATE : 16/06/2024
Balance Carried Forward SGD 37.59

Transaction Details as of 30 Jun 2024 Page 3 of 5

PDS_MMCON_X_ONSH_0d8d01190000004f_03076
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 37.59

17/06/2024 Advice Point-Of-Sale Transaction or Proceeds 6.00 31.59

NETS QR PAYMENT 416916122940002
TO: VALUEHUB (BT)
VALUE DATE : 17/06/2024
18/06/2024 Advice Point-Of-Sale Transaction or Proceeds 7.20 24.39
NETS QR PAYMENT 417015161277166
TO: VALUEHUB (BT)
19/06/2024 Debit Card Transaction 24.35 0.04
NTUC FP - SILAT AVE SI NG 15JUN
4628-4500-6587-4209
20/06/2024 Advice FAST Payment / Receipt 30.00 30.04
INCOMING PAYNOW REF 6280174
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
20/06/2024 Advice FAST Payment / Receipt 30.00 0.04
PAYNOW TRANSFER 6330675
TO: JUNED BHATI
PAYNOW TRANSFER
OTHER
26/06/2024 Advice FAST Payment / Receipt 50.00 50.04
INCOMING PAYNOW REF 6907523
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
27/06/2024 Advice FAST Payment / Receipt 50.00 0.04
PAYNOW TRANSFER 8190978
TO: JUNED BHATI
PAYNOW TRANSFER
OTHER
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

30/06/2024 0.04

Total Balance Carried Forward in SGD: 1,175.95 1,150.00 0.04

Transaction Details as of 30 Jun 2024 Page 4 of 5

PDS_MMCON_X_ONSH_0d8d01190000004f_03076
 Messages For You

l Best execution policy for handling of customers’ orders

DBS has made available to you our Best Execution Policy that sets out our policies and procedures to place and/or execute
(i) customers’ orders on the best available terms (commonly referred to as “best execution”) and; (ii) comparable customers’
orders in accordance with the time of receipt of such orders.

When executing orders on our customers’ behalf, we will consider a range of execution factors. The factors may include
price, costs, speed, likelihood of execution and settlement, size and nature of the order, or any other considerations relevant
to the placement and/or execution of the order.

A copy of the DBS Wealth Management & Retail Best Execution Policy is available on our DBS website at
www.dbs.com.sg/bestexecution

l SIBOR Transition to SORA

In line with the discontinuation of the Singapore Interbank Offer Rate (SIBOR), customers with SIBOR-based credit facilities,
including home loans, are encouraged to switch to an alternative home loan package by 30 April 2024. To find out how you
can apply for an alternative home loan package, please visit https://go.dbs.com/sg-hlsibor

l We regularly conduct customer satisfaction surveys to better understand your banking experience with us.
As a valued customer, you may receive a push notification or email invitation to share your feedback via Qualtrics, our
designated digital survey platform. Your response is highly valued and will be treated with absolute confidentiality.

l Update your personal particulars today

Got a new address, passport, mobile number or email? Simply use digibank to update your details. Visit
https://go.dbs.com/sg-ppu to learn more.

For Your Information

DEPOSIT INSURANCE SCHEME
Singapore dollar deposits of non-bank depositors and monies and deposits denominated in Singapore dollars under the
Supplementary Retirement Scheme are insured by the Singapore Deposit Insurance Corporation, for up to S$100,000 in aggregate
per depositor per Scheme member by law. Monies and deposits denominated in Singapore dollars under the CPF Investment
Scheme and CPF Retirement Sum Scheme are aggregated and separately insured up to S$100,000 for each depositor per
Scheme member. Foreign currency deposits, dual currency investments, structured deposits and other investment products are not
insured.
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

GENERAL
Please examine this statement. Subject to any other applicable terms, please notify us of any error or discrepancy within fourteen
(14) days from the date of receipt of this statement.

Clients Residing in Australia - Limitations to Banking Services and Investment Offering

With effect from 6 February 2023, there will be limitations in banking services and investment offerings to our clients whose
residential address is in Australia. For more information, please visit our website at http://go.dbs.com/sg-auresident.

°rŽŽŽr°1šcJ ®Kl5˜;4‡œ1°rŽŽŽr°
p3Un3j[n{:x‰šH vJœªB57bIIW;Zf For Terms and Codes, Product Disclaimers, and
5RL=€Ž†«}W^`oF—@”8ˆ“~¨Tjdv€©q more information, scan this QR code or visit
pQ___Qp1§]bg—>6¦_Ue°=Z>­–ª
qqqqqqq1qq111q1q111qqqq1q11q1 http://go.dbs.com/sg-products-information. Page 5 of 5

PDS_MMCON_X_ONSH_0d8d01190000004f_03076
Arpi
tSai
ni
139CECILSTREET#16-
01
YSYBUI LDI
NG
SINGAPORE069539

Ki
ingzEnt
ert
ainme
ntPt
eLt
d(304Or
cha
rdRoa
d,01-
48Si
nga
por
e)
Ar
pitSai
ni
KI
INGZ2024B1 Jul
y
BAR Dat
eJoi
n: 01June2024

TRAINEE 04-
08-
2024
Wor
kPas
s 039676338

SGD$1000.
00

Wor
kingHour
s0600t
o1400 SGD$1000.
00

SGD$1000.
00

$1000.
00

71-
834851-
8(DBS) SGD$1000.
00
Arpi
tSai
ni
139CECILSTREET#16-
01
YSYBUI LDI
NG
SINGAPORE069539

Ki
ingzEnt
ert
ainme
ntPt
eLt
d(304Or
cha
rdRoa
d,01-
48Si
nga
por
e)
Ar
pitSai
ni
KI
INGZ2024B1 Augus
t
BAR Dat
eJoi
n: 01June2024

TRAINEE 04-
09-
2024
Wor
kPas
s 039676338

SGD$1000.
00

Wor
kingHour
s0600t
o1400 SGD$1000.
00

SGD$1000.
00

$1000.
00

71-
834851-
8(DBS) SGD$1000.
00
Arpi
tSai
ni
139CECILSTREET#16-
01
YSYBUI LDI
NG
SINGAPORE069539

Ki
ingzEnt
ert
ainme
ntPt
eLt
d(304Or
cha
rdRoa
d,01-
48Si
nga
por
e)
Ar
pitSai
ni
KI
INGZ2024B1 June
BAR Dat
eJoi
n: 01June2024

TRAINEE 04-
07-
2024
Wor
kPas
s 039676338

SGD$1000.
00

Wor
kingHour
s0600t
o1400 SGD$1000.
00

SGD$1000.
00

$1000.
00

71-
834851-
8(DBS) SGD$1000.
00
Date: 27Sep 2024
Policy Number: 10000000078649
ARPIT SAINI
PATHANPURA, CHAUSANA VISHAT ANT, SHAMLI, UTTAR PRADESH, INDIA, 247778

Subject : Niva Bupa Travel Insurance Policy No.10000000078649

Dear Pawan

Thank you for choosing Niva Bupa as your preferred travel insurance partner. At Niva Bupa, we
put your health first and are committed to provide you access to the very best of healthcare,
backed by the highest standards of service.
Please find enclosed your Niva Bupa Policy kit which will help you understand your policy in detail
and give you more information on how to access our services easily. Your Policy kit includes the
following:
· Policy Schedule: Confirming your specific policy details like date of commencement, persons
covered and specific conditions related to your plan.
· Premium Receipt: Receipt issued for the premium paid by you.
· Policy Terms and Conditions:For a clear understanding of policy coverage’s and exclusions.
· Proposal Form:This is a copy of the proposal form as per the information provided by you. Do
inform us immediately in case there is any change in the details mentioned therein.
· Annexure of Policyholder Servicing Turnaround Times as prescribed by Insurance
Regulatory and Development Authority (IRDA)

Do visit us online at www.nivabupa.com to view and download claim forms and for other useful
information. You can register with us online using your policy number, date of birth & email id
and access your policy details. In case of any further assistance, call us at 1860-500-8888
(customer helpline number) or email us at customercare@nivabupa.com

We request you to read your policy terms and conditions carefully so that you are fully aware of
your policy benefits. For benefits related to section 80D, please consult your tax advisor.

Assuring you of our best services and wishing you and your loved ones good health always.

Yours Sincerely,

Director - Operations & Customer Service

For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)

Important - Please read this document and keep in a safe place.

Policyholder Servicing Turnaround Times as prescribed by Insurance Regulatory and Development
Authority of India (IRDAI)
Turnaround Time*
(Calendar Days)
Processing Of Proposal And Communication Of Decisions –
15 Days
From The Date Of Receipt Of Proposal Form
Providing Copy Of The Proposal – From The Date Of
30 Days
Acceptance Of Risk
POLICY Post Policy Issue Service Requests – From The Date Of
10 Days
SERVICING Receipt Of Service Request
Proposal Refund In Case Of Cancellation – From The Date
15 Days
Of Decision Of The Proposal
Request For Policy Cancellation With Free-Look Period–
15 Days
From The Date Of Receipt Of Service Request
From The Date Of Receipt Of Last Necessary Document (No
30 Days
CLAIM Investigation)
SERVICING From The Date Of Receipt Of Last Necessary Document
45 Days
(With Investigation)
Acknowledge A Grievance – From The Date Of Receipt Of
3 Days
GRIEVANCE Grievance
HANDLING Resolve A Grievance– From The Date Of Receipt Of
14 Days
Grievance

*Turnaround time will start from the date of receipt of complete documents at Niva Bupa Health
Insurance Company Ltd.
 TravelAssure- Policy Schedule

Policyholder Details:
Name ARPIT SAINI

PATHANPURA, CHAUSANA VISHAT ANT,

Address SHAMLI,UTTAR PRADESH
247778

Policy Details:
Policy Number 10000000078649

Policy Start Date 27 Sep 2024

Policy End Date 17 Dec 2024

Plan SingleTrip
Policy Tenure 365 Days

Geographical Coverage WorldWide Excl USA-Canada

Renewal Due Date NA

Electronic Insurance Account (eIA) Details:

EIA Number None
Insurance Repository Name None

InsuredDetails:
Date of Birth/ Relationship Base Sum
Name Gender Passport No
Age to Proposer* Insured ($)
ARPIT SAINI 02 Jul 2005 Male Self 250,000 W9234260
*Relationship of all insured members is with respect to the first insured member.

Nominee Details:
Name SANJEEV SAINI
Relationship Father

Claim Administrator Servicing Branch Details

Niva Bupa Health Insurance Company
Limited.
Contact Details For Registering Claim:
Europ Assistance
24*7 Emergency Contact For +91 22 6787
Logix Infotech Park , Plot No D-5, Sector 59,
2092
Noida, Gautam Budh Nagar, Uttar Pradesh
Email Address : nivabupa@europ-
201301
assistance.in
Niva Bupa Health Insurance
Contact No: 1860-500-8888; Fax No.: 011-
30902010
Email ID: customercare@nivabupa.com
Pursuant to Notification no 13/2020- Central Tax and Notification no 14/2020- Central Tax
both dated 21st March 2020 read with rule 54 (2) of CGST Rules 2017, the provisions of E
Invoicing& QR code are not applicable to an Insurance company, hence E Invoice number and
QR code has not been printed on this document. GST under RCM: NIL

Policy issuing office: D-5, Second Floor, Sector-59, Noida, Gautam Budh Nagar, Uttar Pradesh-
201307.

Consolidated Stamp Duty deposited as per the order of Government of National Capital
Territory of Delhi

Niva Bupa GST No.: SAC Code / Type Of Service : 997136 / Travel Insurance
09AAFCM7916H1Z6 Services
Niva Bupa State Code: 09 Customer State Code / Customer GSTI No.: 6/NIL

Location: Noida Director - Operations & Customer Service

Date: 18 Sep 2024 For and on behalf of Niva Bupa Health Insurance Company
Limited
(Formerly known as Max Bupa Health Insurance Co. Ltd.)

Intermediary Details
Intermediary Contact
Intermediary Name Intermediary Code
No.
Policybazaar Insurance
WEB0030001 18002088787
Brokers Private Limited

Product Benefit Table

Benefit Deductible Sum Insured

Trip Cancellation - $1,000

Dental Treatment $100 $400

Financial Emergency Cash - $500

Hospital Daily Cash 2 Day(s) $20 Per Day

Loss of Checked-in Baggage $50 $750

Medical Evacuation - $50,000

Personal Accident - $20,000

Trip Delay 4 Hour(s) $50 Per 4 Hour

Upgradation to Business Class - $1,000

Emergency Ambulance $50 $25,000

Emergency In-patient medical

$100 $250,000
treatment

Emergency Trip Extension - $20,000

Hijack Daily Allowance - $100 Per Day

Loss of International Driving

- $100
license

Loss of Laptop, Tablet, Mobile

$50 $150
Phone, Camera

Loss of Passport - $300

Note: In case of life threatening medical condition we will cover pre-existing conditions up to
5% of "emergency in-patient medical treatment" sum insured and maximum up to $2500.
"COVID related hospitalization is covered in the policy"
 TravelAssure- Premium Receipt
ARPIT SAINI

PATHANPURA, CHAUSANA VISHAT ANT, SHAMLI, UTTAR PRADESH, INDIA, 247778

We acknowledge the receipt of payment towards the premium of the following Travel
insurance policy:

Policyholder Name ARPIT SAINI Policy No 10000000078649

Policy Start Date 27 Sep 2024 Policy End Date 17 Dec 2024

Product Name TravelAssure SingleTrip Base Sum Insured $ 250,000

Premium Calculation:

(A) Premium (Rs.) - Base Product 14410

(B) Premium (Rs.) – Optional Benefits 0
(C) Risk Loading (Rs.) 0
(D) Total Discount (Rs.) 0
(E) Net Premium / Taxable Value (Rs.) 410
(F) Integrated Goods And Service Tax (18.00 %) 74
(G) Central Goods And Service Tax (9.00 %) 0
(H) State/UT Goods And Service Tax (9.00 %) 0
Gross Premium (Rs.) 14,894
Fourteen Thousand Eight
Gross Premium (In Words)
Hundred Ninety-four Only

Issuance of policy is subject to clearance of premium paid

Details Of Person Insured

Name Age (In Years) Gender Relationship To Proposer*
ARPIT SAINI 19 Male Self

Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this
policy are considered null and void.

For the purpose of deduction under section 80D, the benefit shall be as per the provisions of
the Income Tax Act,1961 and any amendments made thereafter.

For more details kindly consult your tax advisor. In the event of non-realization of premium,
tax benefits cannot be obtained against this premium receipt.

Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of
Government of National Capital Territory of Delhi.

SAC Code / Type Of Service : 997136 / Travel

Niva Bupa GST No.: 09AAFCM7916H1Z6
Insurance Services
Niva Bupa State Code: 09 Customer State Code / Customer GSTI No.: 6/NIL
In the absence of Customer GST number receipt, Niva Bupa Health Insurance Co. Ltd. will
treat all customers as unregistered with GSTN. The customer will not get GST input credit on
GST paid on this policy. Customer GST number cannot be updated after policy issuance.

Location: Noida Director - Operations & Customer Service

For and on behalf of Niva Bupa Health Insurance Company
Date:27 Sep 2024 Limited
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
CUSTOMER INFORMATION SHEET

POLICY CLAUSE
S. No. TITLE DESCRIPTION
NUMBER

1. Product Name TravelAssure

2. What am I covered Base Coverage:

for: Ÿ Emergency Inpatient medical treatment- Coverage for inpatient hospitalization due to an accident or illness. 3.1
Ÿ Maternity- We will pay the expenses incurred by you on treatment if you were admitted in a hospital in the course of your 3.2
pregnancy. This cover is available only for people who are traveling overseas on student visa for full time college or
school education with policy term equal to or more than 12 months.
Ÿ New born baby cover- Emergency inpatient medical treatment and vaccination expenses of new born baby will be 3.3
covered as per "Emergency inpatient medical treatment" benefit of this policy. This cover is available only for people
who are traveling overseas on student visa for full time college or school education with policy term equal to or more
than 12 months.

Optional Coverage:
Ÿ Emergency Outpatient treatment- Coverage for outpatient treatment due to an accident or illness. 3.4.1
Ÿ Emergency ambulance- Coverage of ambulance cost for transportation of insured. 3.4.2
Ÿ Hospital daily cash- Daily benefit in case of hospitalization of insured. 3.4.3
Ÿ Dental treatment- Coverage of medical expenses for pain relieving dental treatment received by the Insured Person 3.4.4
Ÿ Medical evacuation- Reimbursement of the cost of the transportation of the Insured Person from a Hospital to the 3.4.5
nearest facility which is prepared to admit the Insured Person.
Ÿ Extension to in-patient care- Coverage if insured person is hospitalized during trip due to an accident or illness and 3.4.6
wants to get back to country or residence for continued treatment
Ÿ Personal accident- Coverage for accidental death, permanent total disability or permanent partial disability due to an 3.4.7
accident
Ÿ Accidental Death and Disability (Common Carrier)- Coverage for accidental death, permanent total disability or 3.4.8
permanent partial disability due to an accident while travelling in a common carrier
Ÿ Repatriation of mortal remains- Coverage of cost of either transporting insured person's mortal remains from the 3.4.9
foreign country to permanent place of residence or a cremation or burial ceremony in the foreign country.
Ÿ Total Loss of checked-in baggage- Coverage for loss of accompanying checked in baggage of Insured Person 3.4.10
Ÿ Delay of checked-in baggage- Payment for purchasing essential personal items in case checked-in baggage's delivery 3.4.11
is delayed by a Carrier
Ÿ Trip Delay- We will pay a fixed amount for each block of 4 hour delay up to the limits as specified in the policy schedule, if 3.4.12
your common carrier's actual departure time is delayed for more than 4 hours from the scheduled departure time
Ÿ Trip cancellation- Coverage for financial loss incurred due to cancellation of trip before its onset 3.4.13
Ÿ Trip interruption- Coverage for financial loss incurred due to in between abandonment of trip 3.4.14
Ÿ Loss of passport- Reimbursement of expenses for obtaining duplicate or fresh passport 3.4.15
Ÿ Loss of International Driving license- Reimbursement of expenses for obtaining duplicate or fresh international driving 3.4.16
license
Ÿ Missed connection- reimbursement for travel cost if you missed a pre-booked onward connection as a direct result of 3.4.17
the scheduled common carrier not running on its published timetable
Ÿ Financial emergency Cash- lump sum amount as stated in policy schedule in case travel funds are lost due to theft, 3.4.18
robbery or dacoity
Ÿ Personal liability- payment towards third party death, bodily injury or property damage 3.4.19
Ÿ Hijack daily allowance- fixed daily amount payable if the aircraft is hijacked 3.4.20
Ÿ Loss of Laptop, Tablet, Mobile Phone, Camera- Coverage in the case of robbery, theft or if the items were stolen 3.4.21
Ÿ Bounced Booking- Hotel/ Common Carrier- Reimbursement in case accommodation provider/ common carrier is 3.4.22
unable to honor your confirmed bookings
Ÿ Compassionate Visit- Reimbursement of accommodation (boarding and lodging)/ economy class transportation cost 3.4.23
for an immediate family member in case of hospitalization of insured person for more than 5 consecutive days
Ÿ Escort of minor child- Reimbursement of return economy class airfare and accommodation only for one immediate 3.4.24
family member to travel to insured person location of hospitalization and escort minor child back home in case of
hospitalization of insured person for more than 48 consecutive hours
Ÿ Adventure sports- Coverage for permanent total disablement or death of the Insured Person in an event of an accident 3.4.25
during risk period while engaged in adventure sports in a non-professional capacity
Ÿ Sports equipment hire- We will pay for sports equipment in case your equipment is lost in travel or your equipment is 3.4.26
delayed by 12 hours
Ÿ Rented sports equipment damage or loss- We will cover for the penalty/ fine charged to insured member on account of 3.4.27
damaging or losing the sports equipment rented out on the name of insured member
Ÿ Sports activity coverage- We will pay for the unused portion of the already paid sports activity if insured member fell 3.4.28
sick or hospitalized or had to cut short their trip

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Ÿ Loan protector- We will pay balance principal loan amount in case of death on insured person due to an accident during 3.4.29
policy period
Ÿ Emergency trip extension- We will pay for extended period of stay and economy class return fare in case trip is 3.4.30
extended beyond scheduled dates due to reason mentioned in policy wording
Ÿ Upgradation to business class- We will pay for the cost to upgrade the return ticket of insured member to business class 3.4.31
after insured member's hospitalization of 5 or more continuous days
Ÿ Study interruption- We will reimburse actual expenses on Tuition fee already paid to the educational institution in case 3.4.32
student is not able to continue his/her studies due to hospitalisation for more than 30 consecutive days
Ÿ Sponsor protection- We will pay for unpaid part of Tuition fee in case of death or disablement of the insured's sponsor 3.4.33
Ÿ Cancer screening and mammography examinations- We will reimburse the expenses for cancer screening and 3.4.34
mammography examinations of the Insured Person during the Risk Period
Ÿ Bail bond- we will pay for bail bond costs if insured person is falsely arrested or wrongfully detained by any government 3.4.35
or foreign authority during the Risk Period
Ÿ Waiver of deductible- We will waive off deductibles applicable under each cover of this policy. 3.4.36
Ÿ Optional co-payment- we will apply co-payment to applicable claims if this benefit is chosen by customer 3.4.37
Ÿ Refund of visa- We will pay for re-imbursement of Visa fee if your Visa got rejected for no fault or negligence 3.4.38
Ÿ Home to home cover- We will extend the Coverage for 6 hours before /beyond the Period of Insurance for In-Patient 3.4.39
treatment, Out-Patient and Personal Accident
Ÿ Colleague replacement- If an Insured Person suffers an Illness or Accident during the Risk Period as result of which he is 3.4.40
Hospitalised then We will reimburse the cost of an economy class return air fare to send a substitute person to complete
the business purpose for which the Insured Person was travelling
Ÿ Complete pre-existing disease cover - Pre-existing diseases will be covered up to sum insured of "emergency inpatient 3.4.41
medical treatment" after opting this cover

3. What are the 1. Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like 4
major exclusions situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader),
in the policy acts of terrorism
2. Your participation in any naval, military or air force operations whether in the form of military exercises or war games or
actual engagement with the enemy, whether foreign or domestic.
3. Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent (Code-Excl10)
4. Obesity or any weight control program.
5. Maternity Expenses (Code-Ecxl18)
a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections
incurred during Hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the
Policy Period.
6. Unproven Treatments (Code-Excl16)- Expenses related to any unproven treatment, services and supplies for or in
connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant
medical documentation to support their effectiveness.
7. The provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and
associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test
strips, and similar products.
8. Non-prescription drugs or treatments
9. If the Insured Person is travelling against the advice of a Doctor or is receiving or on a waiting list for specified medical
treatment.
10. Any claim for your death, injury, medical condition or disability resulting from;
a. your suicide or attempted suicide or wilfully self-inflicted injury or illness; or
b. your consumption of alcohol or drugs or substance abuse
c. depression
11. Any claim for an incident that results from your involvement in any unlawful activities or violation of operating/safety
guidelines published by the service provider contracted by you.
12. Any claim originating in a country against whom Indian government has imposed travel restrictions, or any country
which has imposed such restrictions against citizens of India
13. Any claim where trip was specifically planned for the purpose of availing treatment of an existing medical condition
(Medical tourism)
14. Any claim for an incident which happens during the trip that results from taking part in any adventure sports unless
specifically covered
15. Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an
Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to
the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner
(Code- Ecxl08);
16. Investigation & Evaluation- Code- Excl04
a. Expenses related to any admission primarily for diagnostics and evaluation purposes only
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

4. Waiting period 24 month waiting period for Maternity and new born baby cover 3.2 and 3.3

5. Payment basis Ÿ Cashless treatment or Reimbursement of covered expenses up to specified limits

Ÿ Fixed amount on the occurrence of a covered event 3
Ÿ All payments under this Policy will be in Indian Rupees only

6. Loss Sharing 20% co-payment applicable only if benefit "optional co-payment" is selected by customer. 3.4.37

7. Renewal Ÿ Single trip insurance policy is non-renewable 5.16

Conditions Ÿ Multi-Trip Policy can be renewed subject to below conditions:
i. This Policy will automatically terminate at the end of the Policy Period unless renewed.
ii. We are under no obligation to give notice that it is due for renewal, or to renew it or to renew it on the same terms
whether as to premium or otherwise.
iii. In respect of all applications for renewal received by Us before the end of the Policy Period, we will ordinarily offer
renewal terms unless We believe that You or any Insured Person or anyone acting on Your behalf or on behalf of an
Insured Person has acted in a dishonest or fraudulent manner under or in relation to this Policy or the renewal of the
Policy poses a moral hazard. We shall be entitled to call for and receive any information or documentation before
agreeing to renew the Policy, and in renewing We are not bound to renew for all Insured Persons.
iv. All applications for renewal of the Policy must be received by Us at least 30 days before the end of the Policy Period.

8. Renewal Benefits Not Applicable

9. Cancellation Ÿ Cancellation of Policy, at a date earlier than the Policy Period End Date can be done only upon :- 5.8
i. Denial of visa OR
ii. Cancellation of trip OR
iii. Early return of the individual to India
For cancellations due to above reasons, adequate documentary proof including but not limited to written request
from customer & copy of passport/Visa denial letter would need to be provided.
Ÿ The company may also initiate cancellation of the policy in case any untrue or incorrect statements are made or there has
been a misrepresentation, mis-description or non-disclosure of any material particulars or any material information
having been withheld, or if a Claim is fraudulently made or any fraudulent means or devices are used by the Policyholder
or the Insured Person or any one acting on his / their behalf.
Ÿ No refund of premium shall be eligible in case of cancellation of this Policy where a Claim has been incurred under the
Policy.

10. Claims When outside India- In the case of an emergency or the need for medical treatment, please ensure that you or your family 5.21
member contact Europ Assistance
Europ Assistance
24*7 Emergency Contact for +91 22 6787 2092
Email address : nivabupa@europ-assistance.in

Assist America
Toll Free Number-18004252955
Email Id- medservicesindia@assistamerica.in

When in India-
Contact No: 1860-500-8888
Fax No.: 011-30902010
Email ID: customercare@nivabupa.com

11. Policy Servicing/ Ÿ In case of any grievance the Insured Person may contact the company through: 5.17
Grievances/ Customer Services Department
Complaints 2nd Floor, Plot No D-5,
Sec-59, Noida , Gautam Buddh Nagar,
Uttar Pradesh - 201301
Contact No: 1860-500-8888
Fax No.: 011-30902010
Email ID: customercare@nivabupa.com
Senior citizens may write to us at: seniorcitizensupport@nivabupa.com
Ÿ If Insured person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may
contact the grievance officer at:
Grievance Redressal Officer
Niva Bupa Health Insurance Company Limited
2nd Floor, Plot No D-5,

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Sec-59, Noida , Gautam Buddh Nagar,
Uttar Pradesh - 201301
Email: priority.services@nivabupa.com or GRO@nivabupa.com
For details of grievance officer, kindly refer the link https://www.nivabupa.com/customer-care/health-
services/grievance-redressal.aspx
Ÿ IRDAI/(IGMS/Call Centre): Email ID: www.igms.irdai.gov.in
Ÿ Ombudsman (Refer Annexure III of policy document for List of Insurance Ombudsmen)

12. Insured's Rights Ÿ Free Look - If you do not agree to the terms and conditions of the Policy, you may cancel the Policy, stating your reasons 5.5
within 15 days of receipt of the Policy document provided no claims have been made under any benefits. The free look
provision is not applicable at the time of Renewal of the Policy. This Clause shall be applicable only for the policies which
are issued for a period of at least 365 days

13. Insured's Ÿ Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure may result in claim not
Obligations 5.8
being paid.

Legal Disclaimer Note: The information must be read in conjunction with the product brochure and 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.

Disclaimer: Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company
Limited) (IRDAI Registration Number 145). 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa
Health Insurance Company Limited under license. Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024, Customer Helpline: 1860-500-8888.
Website: www.nivabupa.com. CIN: U66000DL2008PLC182918.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

TravelAssure
Policy Document

1. Preamble
This 'TravelAssure' policy is a contract of insurance between You and Us which is subject to payment of full premium in
advance and the terms, conditions and exclusions of this Policy. Expense incurred outside the policy period will NOT be
covered. Unutilized Sum Insured will expire at the end of policy year. All applicable benefits, details and limits are
mentioned in your Policy Schedule. We will cover only allopathic treatments in this policy.

2. Defined Terms
The terms listed below in this Section and used elsewhere in the Policy in Initial Capitals shall have the meaning set out
against them in this Section.

Standard Definitions
2.1 Accident or Accidental means sudden, unforeseen and involuntary event caused by external, visible and violent
means.
2.2 Co-payment means a cost sharing requirement under a health insurance policy that provides that the
policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not
reduce the Sum Insured.
2.3 Day care center means any institution established for day care treatment of illness and/or injuries or a medical setup
with a hospital and which has been registered with the local authorities, wherever applicable, and is under
supervision of a registered and qualified medical practitioner AND must comply with all minimum criterion as under
a. has qualified nursing staff under its employment;
b. has qualified medical practitioner/s in charge
c. has fully equipped operation theatre of its own where surgical procedures are carried out
d. maintains daily records of patients and will make these accessible to the insurance company's authorized
personnel.
2.4 Day care treatment means medical treatment and/or surgical procedure which is
a. undertaken under General or Local Anesthesia in a hospital/day care center in less than 24 hrs because of
technological advancement, and
b. which would have otherwise required hospitalization of more than 24 hours. Treatment normally taken on an out-
patient basis is not included in the scope of this definition.
2.5 Deductible means a cost sharing requirement under a health insurance policy that provides that the insurer will not
be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case
of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce
the Sum Insured
2.6 Dental treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings
(where appropriate), crowns, extractions and surgery.
2.7 Emergency Care- Emergency care means management for an illness or injury which results in symptoms which occur
suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long
term impairment of the insured person's health.
2.8 Grace Period means the specified period of time immediately following the premium due date during which a
payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting
periods and coverage of preexisting diseases. Coverage is not available for the period for which no premium is
received
2.9 Hospital
For the purpose of domestic insurance
A hospital means any institution established for in-patient care and day care treatment of illness and/or injuries and
which has been registered as a hospital with the local authorities under Clinical Establishments (Registration and
Regulation) Act 2010 or under enactments specified under the Schedule of Section 36(1) and the said act Or complies

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 with all minimum criteria as under:
a. has qualified nursing staff under its employment round the clock;
b. has at least 10 in-patient beds in towns having a population of less than 10,00,000 and at least 15 in-patient beds
in all other places;
c. has qualified medical practitioner(s) in charge round the clock;
d. has a fully equipped operation theatre of its own where surgical procedures are carried out;
e. maintains daily records of patients and makes these accessible to the insurance company's authorized personnel;
2.10 Hospitalisation- Hospitalization means admission in a Hospital for a minimum period of 24 consecutive 'In-patient
Care' hours except for specified procedures/ treatments, where such admission could be for a period of less than 24
consecutive hours.
2.11 Illness- Illness means a sickness or a disease or pathological condition leading to the impairment of normal
physiological function and requires medical treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which
aims to return the person to his or her state of health immediately before suffering the disease/ illness/ injury
which leads to full recovery
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the
following characteristics:
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
ii. it needs ongoing or long-term control or relief of symptoms
iii. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
iv. it continues indefinitely
v. it recurs or is likely to recur
2.12 Injury means accidental physical bodily harm excluding illness or disease solely and directly caused by external,
violent, visible and evident means which is verified and certified by a Medical Practitioner
2.13 Inpatient Care- Treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered
event.
2.14 Maternity Expenses means
a) medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections
incurred during hospitalization);
b) expenses towards lawful medical termination of pregnancy during the policy period.
2.15 Medical Advice- Medical Advice means any consultation or advice from a Medical Practitioner including the issuance
of any prescription or follow-up prescription.
2.16 Medical Expenses- Medical Expenses means those expenses that an Insured Person has necessarily and actually
incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as
these are no more than would have been payable if the Insured Person had not been insured and no more than other
hospitals or doctors in the same locality would have charged for the same medical treatment.
2.17 Medical Practitioner/Doctor- A person who is qualified to practice medicine or is a physician, surgeon or an
anaesthetist and has a valid medical license issued by the appropriate authority. This person should not be the
insured person him/herself or an Immediate Family Member of the Insured or the insured person's employer/business
partner".
2.18 Medically Necessary Treatment- Any treatment, tests, medications, or stays in hospital (or part of a stay in hospital)
which:
a. Is required for the medical management of the illness or injury suffered by the insured.
b. Must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope,
duration, or intensity.
c. Must have been prescribed by a medical practitioner.
d. Must conform to the professional standards widely accepted in international medical practice or by the medical
community in India.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

2.19 New Born Baby- Newborn baby means baby born during the Policy Period and is aged upto 90 days.
2.20 Notification of claim means the process of intimating a claim to the insurer or TPA through any of the recognized
modes of communication.
2.21 Outpatient Treatment (OPD)- OPD treatment means the one in which the Insured visits a clinic / hospital or
associated facility like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner.
The Insured is not admitted as a day care or in-patient.
2.22 Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or
symptoms, and / or were diagnosed, and / or for which medical advice / treatment was received within 48 months
prior to the first policy issued by the insurer and renewed continuously thereafter.
2.23 Qualified Nurse : Qualified nurse means a person who holds a valid registration from the Nursing Council of India or
the Nursing Council of any state in India.
2.24 Reasonable and Customary Charges: Reasonable and Customary charges means the charges for services or supplies,
which are the standard charges for the specific provider and consistent with the prevailing charges in the
geographical area for identical or similar services, taking into account the nature of the illness / injury involved.
2.25 Renewal: Renewal means the terms on which the contract of insurance can be renewed on mutual consent with a
provision of grace period for treating the renewal continuous for the purpose of gaining credit for pre-existing
diseases, time-bound exclusions and for all waiting periods.
2.26 Subrogation means the right of the insurer to assume the rights of the insured person to recover expenses paid out
under the policy that may be recovered from any other source.
2.27 Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an illness or
injury, correction of deformities and defects, diagnosis and cure of diseases, relief from suffering and prolongation of
life, performed in a hospital or day care centre by a medical practitioner
2.28 Unproven/Experimental treatment means the treatment including drug experimental therapy which is not based on
established medical practice in India, is treatment experimental or unproven.

Specific Definitions
2.29 Adventure sports- Any sport or activity, which is potentially dangerous to the Insured Person whether he/ she is
trained, or not. This includes:
a. Sky Sports: Sky Diving, Hang Gliding, Ballooning, Parasailing, Paragliding, Bungee Jumping, Bridge Swinging, Zip
Lining, Zip Trekking
b. Mountain Sports: Skiing, Snowboarding, Rock Climbing, Rock Scrambling, Rappelling, Via Ferrata, Fell Running,
Fell Walking, Gorge Walking, Indoor Rock Climbing, Mountain Biking, Cannoning, Mountaineering
c. Water Sports: Fishing, Deep Sea Fishing, Kite Surfing, Body Boarding, Paddle Boarding, Kayaking, Canoeing,
Scuba Diving, Shark Diving, Swimming with Dolphins, Diving with Whales, Wakeboarding, Surfing, white water
rafting, Snorkeling, Waterskiing, Whale Watching
d. Racing Sports: Auto (car) racing, Motor rallying, Motorcycle racing, Air racing, Kart racing, Boat racing, Hovercraft
racing, Lawn, mower racing, Snowmobile racing, Truck racing, Off Road 4x4
e. Earth Sport: Land Windsurfing, Zorbing, Sand Boarding,
2.30 Age or Aged means completed years as at the commencement date.
2.31 Assistance Service Provider means service provider specified in Policy Schedule appointed by the Company from
time to time.
2.32 Bodily Injury / Injury- Accidental physical bodily harm (excluding illness or disease) solely and directly caused by
external, violent, and visible and evident means which is verified and certified by a medical practitioner.
2.33 Checked-In Baggage shall mean the baggage entrusted by the Insured and accepted by a Common Carrier for
transportation for which a baggage receipt/tag is issued to the Insured by the Common Carrier. This shall exclude
items that are carried/ transported under a contract of affreightment.
2.34 Child or Children means Your children Aged between 6 months and 21 years at the commencement of the Policy

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Period if they are unmarried, still financially dependent on You and have not established their own independent
households.
2.35 Claim Deductible- means a cost sharing requirement under a health insurance policy that provides that the insurer
will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours
in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not
reduce the Sum Insured.
2.36 Common Carrier- Any commercial public airline, railway, motor transport, or water borne vessel (including ocean
going and/or coastal vessels and/or vessels engaged for official or personal purposes), operating under license issued
by the appropriate authority for transportation of passengers and/or cargo.
2.37 Contract of Affreightment is an agreement between a charterer and a common carrier, where the common carrier
agrees to transport specific number of goods for the charterer at a specified period.
2.38 Damages- The sum of money claimed or awarded in compensation for loss/injury. But this does not include fines,
penalties, punitive damages, exemplary damages, any non-pecuniary relief, or any other amount for which an
Insured is not financially liable, or which is without legal recourse.
2.39 Depreciation means the monetary value of an asset decreases over time due to use, wear and tear or obsolescence.
This decrease is measured as depreciation.
2.40 Educational Institution shall mean any school, vocational institute, polytechnic, college, university or institute or
higher learning which is duly licensed to provide educational services by trained or qualified teacher/professor and
where the Insured is registered as a full-time student
2.41 Excursions- Day trips and outings arranged either by you or your travel or accommodation provider.
2.42 Family means legally married Spouse and/or a maximum of 4 Children as named in the Schedule.
2.43 Geographical scope means the countries or geographical boundaries In which the coverage under this policy is valid
as specified in the policy schedule.
2.44 Hijacked means the unlawful seizure or exercise of control of any Carrier by force or violence or threat of force or
violence or an act, including but not limited to the use of force or violence or the threat thereof, committed for any
reason (including political, religious or ideological) by any person or group of persons, whether acting alone or on
behalf of or in connection with any organisation or government.
2.45 Home/Residential Address- Your address in India as mentioned in Policy Schedule
2.46 Hospital
For the purpose of overseas insurance-
Any institution established for in-patient care and day care treatment of illness and/or injuries and which has been
registered as a hospital with the local authorities and complies with all minimum criteria as under:
a. has qualified nursing staff under its employment round the clock;
b. has qualified medical practitioner(s) in charge round the clock;
c. has a fully equipped operation theatre of its own where surgical procedures are carried out;
d. Maintains daily records of patients and makes these accessible to the insurance company's authorized personnel.
2.47 Immediate Family- Spouse, children, mother, father, brother, sister, parent in law, daughter-in-law, son-in-law,
grandparent, grandchild.
2.48 Insured Person means You and the persons named in the Schedule.
2.49 Money- Includes coins, cash (including foreign currency), traveller's cheques and credit cards/ debit cards.
2.50 Policy Period/ Period of Insurance
Single-trip Policies: The below dates are shown on your policy schedule:
a. "Trip Cancellation" cover begin from the date your policy is issued, or the date of booking of your ticket
(whichever is later). It ends when you start utilization of the ticket for its intended purpose.
b. For all other coverage, cover starts when you start the insured trip. It continues until the expiry date and time of
the policy or on the date and time you return whichever is earlier
Multi-trip Policies:

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 The period as shown on your policy schedule.
Each trip you make during the period of insurance will be treated as a separate insurance, each subject to the policy
terms, conditions and exclusions.
Cover for individual trips apply as follows
a. "Trip Cancellation" cover begin from the date of policy issuance or the date of booking of ticket (whichever is
later) and ends when you start utilization of the ticket for its intended purpose.
b. All other Covers start when you start the insured trip and continues for the duration of each trip.
We will cover trips booked during one period of insurance but not taking place until the next period of insurance if
your multi-trip policy with us is still in force at the time of the incident resulting in a claim.
You may travel as many times as you wish during the period of coverage provided that no one trip exceeds the
maximum number of days as specified and contracted for at the time of application and shown on your policy
schedule.
2.51 Permanent Partial Disability- Continuous loss or impairment of a body part or sensory organ which is certified by a
Medical practitioner
2.52 Permanent Total Disability- The disability resulting in either of:
a. Loss of the sight of both eyes.
b. Physical separation of or the loss of ability to use both hands or both feet.
c. Physical separation of or the loss of ability to use one hand and one foot.
d. Loss of sight of one eye and the physical separation of or the loss of ability to use either one hand or one foot.
2.53 Planned Event- Events/tickets for places like museums/historical sites /attractions, visit passes, guided tours, music
and other entertainment shows, theme park entry tickets, skiing tickets, Scheduled Adventure sport booking ticket.
2.54 Policy- Insurance related documents issued in Your name including without limitations certificate of insurance,
proposal, policy schedule, applicable endorsements, Policy wording containing the terms and conditions of the
insurance contract.
2.55 Schedule means the schedule attached to and forming part of this policy, and if more than one then latest in time.
2.56 Sponsor means any individual responsible for paying the tuition fees of the student of his/her fulltime study in a
registered educational institution outside his/her home country
2.57 Spouse means the Insured Person's legally married spouse as long as she continues to be married to him.
2.58 Sum Insured/ Policy Limits- The amount stated in the Schedule against each relevant Cover, which shall be the
Company's maximum liability under this Policy for any and all Claims under such Cover. Some covers also include
other specific limits, for example, for any one item or limits for valuables in total.
2.59 Terrorism/ Terrorist Incident- Any actual or threatened use of force or violence directed at or causing damage, injury,
harm or disruption. Commission of an act dangerous to human life or property, against any individual, property or
government, with the stated or unstated objective of pursuing economic, ethnic, nationalistic, political, racial or
religious interests, whether such interests are declared or not. Robberies or other criminal acts, primarily committed
for personal gain and acts arising primarily from prior personal relationships between perpetrator(s) and victim(s)
shall not be considered Terrorist activity. Terrorism shall also include any act, which is verified or recognized by the
relevant Government as an act of terrorism.
2.60 Time Excess- Time before/after (as the case may be) when our claim liability doesn't trigger. This refers to specified
time period which needs to elapse/pass before or after (as the case may be) to make us liable for benefit payment
under the policy. Example, a time excess of 60 minutes for Common Carrier Delay cover means that insurer will pay
claim only when the delay is more than 60 minutes. A time excess of 6 hours for "common carrier delay" cover means
that insurer will pay claim only when the insured affects the cancellation before 6 hours of scheduled timing of the
services.
2.61 Theft- As defined in Section 378 of Indian Penal Code, 1860 whoever, intending to take dishonestly any movable
property out of the possession of any person without that person's consent, moves that property in order to carry out
such taking is said to commit theft.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 2.62 Travel Agent- An agent, tour operator, or other entity from which the Insured purchases his travel arrangements, and
includes all officers, employees, and affiliates of such agent or tour operator.
2.63 Travelling Companion- An individual or individuals traveling with the Insured during the Period of Insurance,
provided that, the Insured and such individual(s) are traveling to the same destination on the same dates and
provided that such individual(s) is/ are also Insured under the Policy. For the purpose of this definition, any
individual(s) forming part of a group traveling on a tour arranged by a travel agent or a tour leader is not considered
as Traveling Companion, unless the individual(s) is part of the Insured's Immediate Family.
2.64 Trip(s)/ Insured Journey-
For Domestic travel: Refers to the journey performed by you within India commencing during the period of insurance
and limited to sector(s) for which the risk is covered as per the policy.
For International travel: Refers to the journey performed by you commencing from India and returning to India during
the period of insurance and limited to sector(s) for which the risk is covered as per the policy.
2.65 Unattended- Property that is not in your full view or positioned where you are unable to prevent unauthorized taking
of your property, unless it is left in a locked room or safe. Property left in a motor vehicle is considered unattended
unless the vehicle is locked and the items are placed out of view in an enclosed storage compartment, boot or
luggage space.
2.66 We, us, our, ours, Company, insurer- Niva Bupa Health Insurance Limited
2.67 You, your, yours, yourself, policyholder, insured person(s)- The person or people named on your policy schedule we
insure.

3. Base Benefit- It is compulsory to opt for base benefit. Refer to policy schedule for sum insured available under each benefit.

3.1 Emergency In-patient medical treatment (Expenses during emergency hospitalization)

We will pay the expenses incurred by you on treatment (Naturally this excludes expenses not linked to treatment like
food, beverage, toiletries and cosmetics) if you were admitted in a hospital for emergency care for more than 24
hours. Claims will be treated as Day Care treatment for hospitalization of less than 24 hours.
Special conditions
1. The treatment of illness/ accident shall commence during the period of insurance.
2. Refer Annexure 1 for expenses that are not covered or subsumed into room charges / procedure charges / costs of
treatment.
3. People traveling overseas on student visa for full time education will be covered in India as well till the end of
policy period.
Claim deductible- As shown on your policy schedule
What is not covered (in addition to General exclusions- section 5)
1. Out-patient treatment
2. Any claim for:
i. the cost of any non-emergency treatment or surgery including exploratory tests which are not directly related
to the illness/accident that you originally went to hospital for;
ii. any form of treatment that your treating doctor and we/our Medical Emergency Assistance provider think can
reasonably wait until you return home;
iii. routine medication which you were consuming or started, at the time your trip start, and you knew that you
would need while you were away;
iv. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds
registered as a nursing home attached to such establishments or where admission is arranged wholly or partly
for domestic reasons. (Code-Excl13);
3. Costs incurred following your decision not to move hospital or return to India after the date when it was deemed
safe for you to do so by us/our Medical Emergency Assistance provider and your treating doctor.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 4. Vitamins and tonics, vaccination (unless related to animal bite), Weight management services and treatments
related to weight reduction programs including treatment of obesity, external Congenital disease, defect or
anomalies.
5. Physiotherapy, rehabilitation of organs.
3.2 Maternity
We will pay the expenses incurred by you on treatment (Naturally this excludes expenses not linked to treatment like
food, beverage, toiletries and cosmetics) if you were admitted in a hospital in the course of your pregnancy. Coverage
includes delivery, lawful medical termination of pregnancy and the cost of a midwife or obstetric nurse.
Special conditions
1. The Insured Person was not pregnant at the commencement of the Policy Period
2. A waiting period of 24 months will apply to all claims under this Benefit
3. Clause 5 of General exclusions stand waived for this benefit
4. This benefit can be used only twice during the insured person's lifetime
5. This cover is available only for people who are traveling overseas on student visa for full time college or school
education with policy term equal to or more than 12 months
Claim deductible- As shown on your policy schedule
3.3 New born baby cover
Emergency inpatient medical treatment and vaccination expenses of new born baby will be covered as per
"Emergency inpatient medical treatment" benefit of this policy.
Special conditions (in addition to special conditions of "maternity")
1. Any claim under this benefit will use sum insured of "maternity" benefit only
2. Coverage for vaccination of the new born is restricted to up to USD 500

3.4 Optional Benefits- Insured can choose from any of the below benefits on payment of additional premium. Refer to
policy schedule for sum insured available under each benefit.

3.4.1 Emergency Outpatient treatment (OPD)

We will reimburse the Medical Expenses incurred on emergency out-patient treatment.
Claim deductible- As shown on your policy schedule
What is not covered (in addition to General exclusions- section 5)?
1. Anything mentioned in "What is not covered" section of "emergency inpatient medical treatment" cover
3.4.2 Emergency Road Ambulance
We will cover the road ambulance cost for transportation of the Insured Person to a Hospital.
Special conditions
1. The ambulance service provider must be registered.
2. This claim will be payable only if claim under "emergency inpatient medical treatment" cover of this Policy is also
payable
Claim deductible- As shown on your policy schedule
3.4.3 Hospital Daily Cash
We will pay a daily cash amount for each day the insured person is hospitalized.
Special conditions
1. Insured person is hospitalized for Minimum 48 consecutive hours to claim under this benefit
2. This cover is available for maximum of 15 days of hospitalization during the policy period
3. This claim will be payable only if claim under "emergency inpatient medical treatment" cover of this Policy is also
payable
3.4.4 Dental treatment
We will pay the expenses incurred by you on pain relieving dental treatment received under anaesthesia at hospital

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 following:
1. An Accident or
2. Sudden acute pain to one or more of the Insured Person's natural teeth
Claim deductible- As shown on your policy schedule
3.4.5 Medical evacuation
We will pay the expenses incurred on your transportation from one Hospital to another in case the hospital where you
are admitted cannot provide satisfactorily medical services.
Special conditions
1. Transportation has been prescribed by a Doctor and is medically necessary
2. If transportation is required, then we/Our Medical Emergency Assistance provider will discuss with the Doctor
whether to transport the Insured Person to a more suitable country for medical treatment or to India.
3. This claim will be payable only if claim under "emergency inpatient medical treatment" cover of this Policy is also
payable.
3.4.6 Extension to in-patient care
If you were hospitalized during trip and are in need of treatment even after coming back to India, then we will cover
expenses for
1. Hospitalization in an Indian hospital if hospitalized within a period of 30 days from the end of the policy period
2. Your return economy class ticket to India
Special conditions
1. This claim will be payable only if claim under "emergency inpatient medical treatment" cover of this Policy is also
payable
2. Hospitalization in home country is for same illness or injury for which you were hospitalized during trip
Claim deductible- As shown on your policy schedule
3.4.7 Personal Accident
If your Accident during the policy period causes any or combination of the conditions as mentioned in Table 1, then
we will pay in accordance with Table 1.

S. % age of Sum S. % age of Sum

No. Description Description
Insured payable No. Insured payable
1 Death 100% 12 Loss of each other Finger 5%
Complete & Irrecoverable loss of 2 Limbs
(both hands or both feet or one hand Loss of each leg above centre
2 100% 13 70%
and one foot) of the femur

Complete & Irrecoverable loss of a Loss of each leg up to a point

3 Limb and an eye 100% 14 65%
below the femur
Complete and irrecoverable loss of Loss of each leg to a point
4 sight of both eyes 100% 15 50%
below the knee
Complete and irrecoverable loss of
5 speech & hearing of both ears 100% 16 Loss of each foot at the ankle 40%
6 Loss of each arm at the shoulder joint 70% 17 Loss of each big toe 5%
Loss of each arm to a point above
7 elbow joint 65% 18 Loss of each other toe 2%
8 Loss of each arm below elbow joint 50% 19 Loss of each eye 50%
9 Loss of each hand at the wrist 50% 20 Loss of hearing in each ear 30%
10 Loss of each Thumb 20% 21 Loss of sense of smell 10%
11 Loss of each Index Finger 10% 22 Loss of sense of taste 5%

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Complete & Irrecoverable loss of limb means physical separation or complete loss of functionality of the limb, within
365 days from the date of the Accident. This will include Paralysis including Paraplegia, Quadriplegia with loss of
functional use of limb.
Special conditions
1. Claim is admissible only if the accident causes death or disability within 365 days from the date of the accident
2. Our payment will not exceed 100% of the Sum Insured if the accident causes a combination of more than one
condition mentioned in Table 1.
3. If a loss is not mentioned in the table 1, then we will assess the degree of disability and determine the amount of
payment to be made. In all such cases our liability will be limited to 50% of the Sum Insured.
4. Any disability claim amount already paid to you will be deducted from future death claim, if any.
What is not covered (in addition to General exclusions- section 5)- Any Claim arising while you are travelling in a
common carrier (including boarding and alighting from that Common Carrier) as a fare paying passenger.
3.4.8 Accidental Death and Disability (Common Carrier)
If your Accident in a common carrier (including boarding and alighting from that Common Carrier) during the policy
period causes any or combination of the conditions as mentioned in Table 2, then we will pay in accordance with
Table 2.

S. % age of Sum S. % age of Sum

No. Description Description
Insured payable No. Insured payable
1 Death 100% 12 Loss of each other Finger 5%
Complete & Irrecoverable loss of 2 Limbs
(both hands or both feet or one hand Loss of each leg above centre
2 100% 13 70%
and one foot) of the femur

Complete & Irrecoverable loss of a Loss of each leg up to a point

3 Limb and an eye 100% 14 65%
below the femur
Complete and irrecoverable loss of Loss of each leg to a point
4 sight of both eyes 100% 15 50%
below the knee
Complete and irrecoverable loss of
5 speech & hearing of both ears 100% 16 Loss of each foot at the ankle 40%
6 Loss of each arm at the shoulder joint 70% 17 Loss of each big toe 5%
Loss of each arm to a point above
7 elbow joint 65% 18 Loss of each other toe 2%
8 Loss of each arm below elbow joint 50% 19 Loss of each eye 50%
9 Loss of each hand at the wrist 50% 20 Loss of hearing in each ear 30%
10 Loss of each Thumb 20% 21 Loss of sense of smell 10%
11 Loss of each Index Finger 10% 22 Loss of sense of taste 5%

Complete & Irrecoverable loss of limb means physical separation or complete loss of functionality of the limb. This will
include Paralysis including Paraplegia, Quadriplegia with loss of functional use of limb.
Special conditions
1. Claim is admissible only if the accident causes death or disability within 365 days from the date of the accident
2. Our payment will not exceed 100% of the Sum Insured if the accident causes a combination of more than one
condition mentioned in Table 2.
3. If a loss is not mentioned in the table 1, then we will assess the degree of disability and determine the amount of
payment to be made. In all such cases our liability will be limited to 50% of the Sum Insured.
4. Any disability claim amount already paid to you will be deducted from future death claim, if any.
5. You will be presumed to be dead if you are not found within 365 days of the disappearance/accident of the
common carrier.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 6. Claim is payable only if you are travelling in the common carrier as fare paying passenger
3.4.9 Repatriation of mortal remains
If you die in the Risk Period, then We will reimburse the cost of either transporting your mortal remains to permanent
place of residence or a cremation ceremony in the city/country of death.
Special condition- Claim under this cover is admissible only if hospitalization claim is also payable under "emergency
inpatient medical treatment" OR death claim is payable under "personal accident" or "accidental death or disability
(common carrier)" cover of this policy
3.4.10 Total Loss of checked-in baggage
We will pay the pro-rated amount if common carrier permanently loses your checked-in baggage.
How pro-rata will work?
If you have checked-in 3 baggage's and one was lost by common carrier, then we will pay one-third of the Sum
Insured.
Special conditions
1. Any Claim amount paid already under the "Delay of Checked-in Baggage" cover, will be deducted from the claim
amount payable under this cover.
2. If common carrier has paid any compensation amount for Total Loss of Checked-in Baggage, that amount will be
deducted from the claim amount payable under this cover.
What is not covered (in addition to General exclusions- section 5)?
1. Losses arising from any delay, detention, confiscation by customs officials or other public authorities
2. Partial loss- Loss of one or more items from the baggage.
3.4.11 Delay of checked-in baggage
We will pay the sum insured if delivery of your checked-in baggage is by common carrier is delayed by more than 12
hours from the expected time of delivery.
Special conditions- If common carrier has paid any compensation amount for Delay of Checked-in Baggage, that
amount will be deducted from the claim amount payable under this cover.
What is not covered (in addition to General exclusions- section 5)?
1. Delay arising from any detention, confiscation by customs officials or other public authorities
2. Any delay of checked-in baggage on the return to origin city/ country of trip
3.4.12 Trip Delay
If departure of your scheduled common carrier is delayed due to any of the following reasons, then we will pay an
amount for every 4 hours of delay:
1. Delay due to bad Weather.
2. Delay due to a sudden Strike or any other action by employees of the Common Carrier.
3. Delay due to equipment failure of the Common Carrier.
4. Delay due to operational problem at the Common Carrier end like crew/staff scheduling issues.
5. Cancellation or rescheduling done by the Common carrier.
What is not covered (in addition to General exclusions- section 5)?
1. Any delay due to reasons, which were made public or known to You at least 6 hours prior to the scheduled
departure of the Common Carrier.
3.4.13 Trip cancellation
If you cancel your trip before starting the journey due to any of the reasons listed below, then we will cover for costs
that you have already paid towards the trip and cannot get back or which legally must be paid.
1. Death or minimum 24 hour hospitalization of your immediate family member or traveling companion or You.
2. Your presence is required by judicial authority during the period of insurance.
3. You are unable to start your trip due to any natural disaster declared by the appropriate government authority.
4. Due to unexpected strike, riot or Civil commotion at Your destination or hometown or departure city.
5. Loss of passport.
6. Compulsory quarantine or prevention of travel by Government of India.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Special conditions
1. We will cover only travel ticket and accommodation costs.
2. We will cover only one instance of Trip Cancellation for single trip policies and maximum of three instances for
multi trip policies.
What is not covered (in addition to General exclusions- Section 5)?
1. Any cancellation due to Hospitalization resulting from pre-existing disease, Childbirth, Pregnancy or related
medical complications to You, Your immediate family or traveling companion.
2. Failure to start the journey due to rejection of VISA.
3.4.14 Trip interruption
If you return home without completing the trip due to below mentioned reasons, then we will reimburse
1. additional travel costs (in the same class as original booking) if you cannot use your return ticket;
2. unused accommodation costs that insured person has paid and cannot get back
Reasons for returning home:
1. Death or minimum 24 hour hospitalization of your immediate family member or traveling companion or You
2. You are unable to start your trip due to any natural disaster declared by the appropriate government authority.
3. The common carrier which you boarded as a passenger is hijacked.
4. Compulsory quarantine or prevention of travel by government.
5. Due to unexpected strike, riot or Civil commotion at place of visit other than your hometown.
Special conditions
1. If you need to return home and intend to make a claim under this cover, you must call and inform the Medical
Emergency Assistance provider as soon as reasonably possible.
2. Any refund which you have received against cancellation of travel ticket will be deducted from claim amount
3. We will cover only one instance of Trip Cancellation for single trip policies and maximum of three instances for
multi trip policies.
What is not covered (in addition to General exclusions- Section 5)?
1. Any claim which was not authorized by our Medical Emergency Assistance provider before you returned home.
2. Any abandonment due to Hospitalization due to a pre-existing disease, Childbirth, Pregnancy or related medical
complications to You, Your immediate family or traveling companion.
3. Any claim for Trip interruption where there is no valid claim for Emergency Treatment.
3.4.15 Loss of Passport
If you lose your passport while on trip, then We will reimburse the actual expenses incurred in obtaining a duplicate
or fresh passport either overseas or within 30 days of his return to India.
What is not covered (in addition to General exclusions- Section 5)?
1. Loss, delay or confiscation or detention by customs, police or public authorities.
2. Any loss or theft, if you do not report it to the police/embassy within 24 hours of discovery or as soon as
reasonably possible and request a written police report
3.4.16 Loss of International Driving license
If you lose your international driving license while on trip, then We will reimburse the actual expenses incurred in
obtaining a duplicate or fresh international driving license either overseas or within 30 days of his return to India.
What is not covered (in addition to General exclusions- Section 5)?
1. Loss, delay or confiscation or detention by customs, police or public authorities.
2. Any loss or theft of your International Driving license, if you do not report it to the police within 24 hours of
discovery or as soon as reasonably possible and request a written police report
3.4.17 Missed Connection
If common carrier you are travelling in is not running on its published timetable and you missed a pre-booked onward
connection as a direct result of this delay then we will reimburse for extra accommodation and travel costs you incur
to reach the next destination shown on your ticket/itinerary.
Special conditions

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 1. We will cover only one such instance for single trip policies and maximum of three instances for multi trip policies
2. We will cover extra accommodation and travel costs for the same class as originally planned.
3. There should be minimum of 3 hours gap between scheduled arrival of incoming common carrier and scheduled
departure of connection common carrier
Claim deductible- The claim deductible is as shown on your policy schedule
What is not covered (in addition to General exclusions- Section 5)?
1. Any claim caused by a strike or industrial action or any other reason for which the dates had been publicly
announced or reported by the media at the time you took out your policy.
2. Any occasion when the carrier has offered a reasonable alternative transport or connection or the Insured Person's
ticket for the connecting flight could have been used for an alternative connection.
3.4.18 Financial emergency Cash
If you are left without any travel funds (including cash, travelers cheque, debit or credit card) due to theft, pilferage or
robbery of your Money whilst on a trip, then we will pay for the financial emergency cash.
Special condition- Any such loss should immediately be reported to the police of the foreign country within 24 hours
and to Us within 48 hours.
What is not covered (in addition to General exclusions- Section 5)?
1. Any loss of Money that was not in the personal custody of the Insured Person
2. Any loss of Money in respect of which a claim is made only after the Insured Person has already returned to India.
3.4.19 Personal Liability
We will cover costs incurred for:
1. Your actual legal liability for unintentional injury, property damage or death that you cause during your travel.
2. All costs, fees and expenses in the investigation, defence or settlement of any claim.
Special conditions
1. You shall:
a. give Us written notice within 10 days of any claim or demand made against you
b. not admit liability/ settle/ compromise/ make any payment without Our prior written consent.
c. allow Us, in Our sole and absolute discretion, to take over and conduct investigation, defence and/or
settlement of any claim. You shall provide all the cooperation and assistance We may require. Having taken
over the defence of any claim, We may in Our sole and absolute discretion relinquish the same.
2. We will not settle any claim without your consent. But if you refuses settlement recommend by Us and chooses to
contest or continue any legal proceedings, then Our liability will not exceed the amount for which the claim could
have been settled plus the defence costs incurred with Our consent up to the date of such refusal.
3. For us to cover the costs, claim shall be made on you by the third parties during the Period of Insurance or within
60 days from the date of expiry of the insurance.
Claim deductible- The claim deductible is as shown on your policy schedule
What is not covered (in addition to General exclusions- Section 5)?
1. Any fines or exemplary damages aimed at punishing you rather than awarding compensation to third party
2. Liability arising from:
a. Violation of operating/safety guidelines published by the service provider contracted by you.
b. Action of any type by any other person accompanying you.
c. Loss of or damage to property which belongs to you or is under your control or the control of a member of
your household or the control of people who work for you.
d. Your job/profession/professional activities/trade/business/employment or occupation.
e. Any willful, malicious, criminal or unlawful act, error, or omission.
f. Liability assumed by you by an agreement / contract which would not have attached in the absence of such
agreement / contract.
g. Personal injuries including but not limited to libel, slander, false arrest, sexual molestation, corporal
punishment, wrongful eviction, wrongful detention, defamation, any mental injury, anguish, or shock resulting

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 therefrom.
h. Ownership and / or Occupation of any land and / or building, unless you are occupying any temporary holiday
accommodation, which is not owned by you.
i. Ownership and / or Usage of any of the following:
i. livestock (except domestic animals);
ii. firearms (except sporting guns used for clay-pigeon shooting);
iii. motorized vehicles, aircraft of any description, including unpowered flight
iv. vessels (except manually-propelled watercraft); or
j. Your participation in any leisure activity or activity based holiday or adventure sports where Personal Liability
is specifically excluded.
k. Transmission of illness or disease by the insured
l. Any family member, relative, friend, travel companion or close business associate
3. Any Claim paid or compromised or commitment made without our prior written consent
3.4.20Hijack Daily Allowance
If the aircraft in which an Insured Person is travelling as a fare paying passenger during the Risk Period is Hijacked
and the journey is interrupted for a continuous and completed period of more than 12 hours, then We will pay the
daily allowance specified in the Schedule.
Special conditions
1. Claim will be provided for a maximum duration of 7 days
2. Clause 1 of General exclusions (Section 5) stand waived for this benefit
What is not covered (in addition to General exclusions- Section 5)?
1. Any claim where the Insured person is considered as accessory or is in anyway involved with the Hijacking.
2. Any claim as a consequence of change in the direction of the route of the aircraft due to security reasons
3.4.21 Loss of Laptop, Tablet, Mobile Phone, Camera
We will indemnify the depreciated value up to sum insured mentioned in policy schedule, only in the case of robbery,
theft or if the belonging was stolen. Depreciation value to be calculated basis below table

Equipment age Up to 1 year Up to 2 years Up to 3 years Up to 4 years Up to 5 years More than 5 years
Applicable
50% 70% 75% 80% 90% 95%
depreciation

Special condition- Coverage under this benefit is limited to laptop, tablet, mobile phone and camera
Claim deductible- The claim deductible is as shown on your policy schedule
What is not covered (in addition to General exclusions- Section 5)?
1. Any loss of item sent in advance or mailed or shipped separately
2. Any item that was in a baggage lost by common carrier
3. Loss, delay or confiscation or detention by customs, police or public authorities.
4. Any loss of software or data in laptop/ tablet/camera/mobile and any consequential loss
3.4.22 Bounced Booking- Hotel/ Common Carrier
If Accommodation provider/ Common Carrier is unable to honor your confirmed bookings (pre-paid or contracted to
pay) due to overbooking then we will reimburse difference of cost in original booking and alternate booking.
Special conditions
1. Original booking and alternate booking should be of same class and for the same number of nights or same travel
destination. Upgradation to higher class will be considered in case similar alternate arrangement is not available
2. You must always check-in on time stipulated as 'must check-in by' time on your reservation or fulfil any other
obligation on your part.
3. In case of international flights, you are expected to have web-checked-in prior to your arrival at the airport.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 4. The overbooking at the common carrier must happen at check-in.
What is not covered (in addition to General exclusions- Section 5)?
1. Any booking for which You are unable to furnish proof of booking/payment and bounced booking.
2. Any contractual breach by You including but not limited to non-adherence to the terms and conditions of the
booking service provider.
3. If you had any waitlisted booking irrespective of whether such bookings have been promised to be confirmed
later.
4. Claims where the alternative travel/accommodation arrangements is provided by the service provider.
5. If you volunteer to take a late flight (Voluntary denied booking).
3.4.23 Compassionate Visit
If You are hospitalized and someone from your family/friend is visiting you, then we will reimburse economy class
travel cost for one such person
Special conditions
1. Provided there is no other adult traveling companion with you.
2. Provided that no Adult member of your Immediate Family is present at the location of your hospitalization.
3. Claim under this benefit will be applicable only if we have accepted claim under "emergency inpatient medical
treatment" cover of this policy
4. You should have been hospitalization for a period of minimum 5 consecutive days
3.4.24 Escort of minor child
If You, accompanied only by minor children, are hospitalized and someone from your family is travelling to your
location to escort minor children back to city of residence, then we will reimburse
1. Economy class return travel ticket for one family member along with reasonable costs of accommodation
2. Economy class travel ticket for minor children
Special conditions
1. The cover is available for a maximum of two minor children and We shall indemnify maximum of one such event
during the policy period.
2. Provided there is no other adult traveling companion to take care of children.
3. Provided that no Adult member of your Immediate Family is present at the location of your hospitalization.
4. Claim under this cover will be payable only if claim is also payable under "Personal Accident" or "accidental death
and disability (common carrier" or "emergency inpatient medical treatment" cover of this policy.
5. Hospitalization should have been for a continuous period of more than 48 hours and occurs not within 3 days of
the completion of the trip.
3.4.25 Adventure Sports
By selecting this Cover, participation in adventure sports will be included in your policy.
Special conditions
1. Such extension will not result into any increase in Sum Insured of the respective Coverage.
2. Clause 15 of General exclusion stands waived for this cover
What is not covered (in addition to General exclusions- Section 5)?
1. Non-adherence to the guidelines / instructions of the organizers of adventure sports
2. Participation in a professional capacity and without supervision of trained professional
3.4.26 Sports Equipment hire
If the sports equipment being carried by You is lost because of the reasons mentioned below, then we will reimburse
cost of renting the same type of equipment
1. Robbery/ theft of the sports equipment
2. Baggage containing the sports equipment is lost or delayed for 12 hours or more by common carrier
Special conditions- If there is a compensation amount paid by the common carrier for Delay/loss, that amount will be
deducted from the claim amount payable under this cover.
What is not covered (in addition to General exclusions- Section 5)?

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 1. Loss, delay or confiscation or detention by customs, police or public authorities.
2. Any loss or theft, if you do not report it to the police within 24 hours of discovery or as soon as reasonably
possible and request a written police report
3.4.27 Rented sports equipment damage or loss
If You damages or loses sports equipment which was rented out to You for Your personal use, then We shall
reimburse the penalty/ fine charged by the sports equipment owner.
Special conditions
1. You shall ensure the safety of sports equipment at all times during the rental period.
2. You shall not pass on hired equipment to third parties.
3. The complete payment of Rental equipment has been made by the You before the equipment is rented out You.
4. The hired equipment is NOT insured and insurance is not included in the normal rental tariffs.
5. You shall make sure that the sports equipment rented out to You are in good condition and without any damage.
Claim deductible- As shown on your policy schedule
What is not covered (in addition to General exclusions- Section 5)- In the case of theft, if you do not report it to the
police within 24 hours of discovery or as soon as reasonably possible and request a written police report
3.4.28 Sports Activity Coverage
We will reimburse for the unused portion of the sports activity which you had already paid for or had contracted to
pay (minus refunds) in case
1. You fall ill and medical practitioner has advised you to refrain from taking part in the sports activities
2. You are hospitalized
3. You have to cut short your trip and return to origin city
Special conditions
1. Reason for Hospitalization is admissible under "emergency inpatient medical treatment" cover of this Policy
2. Reason for cutting short your trip is admissible under "trip interruption" cover of this policy
Claim deductible- The claim deductible is as shown on your policy schedule
3.4.29 Loan Protector
If your Accident during the policy period causes your death, then We will pay the balance outstanding principal loan
amount as on the date of death.
Special conditions
1. We will not pay for any arrears or penalties levied by the bank or financial institution.
2. Claim under this cover will be payable only if claim under "personal accident" or "accidental death or disability
(common carrier)" cover of this policy is also payable
3.4.30 Emergency Trip Extension
If duration of your international trip is extended beyond the scheduled dates because of reasons mentioned below
then we will extend period of insurance once for a period of up to 7 days
1. Death of the Travelling Companion.
2. You or your travelling companion is hospitalized
3. Any natural disaster (declared by appropriate government authority) at your current location or at destination
that forces you to extend the trip.
4. Cancellation or Re-scheduling of the common carrier due to unexpected strike, riot or Civil commotion at the port
where the Trip got extended.
Special conditions
1. Reason for Hospitalization is admissible under "emergency inpatient medical treatment" cover of this Policy
2. Any refundable amount pertaining to the original scheduled return ticket will be deducted from the admissible
claim amount
What is not covered (in addition to General exclusions- Section 5)?
1. Any extension due to Childbirth, Pregnancy or related medical complications occurring to you or your immediate
family member or traveling companion.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

3.4.31 Upgradation to Business Class
If insured person is hospitalized for a period of 5 or more continuous days, then we will cover the extra cost incurred
in upgrading the insured person's return ticket to business class by the most direct route from the place of
hospitalization.
Special conditions
1. Claim under this benefit is payable only if claim under " emergency inpatient medical treatment" cover of this
Policy is also payable
2. Your return air travel to city of residence shall commence not later than 20 consecutive days from the date of
discharge
3. If your economy class air ticket cannot be up-graded, then the Company's maximum liability under this Benefit
shall be limited to the difference between the cost of the new business class ticket and the refund amount received
on the economy class ticket cancelled
4. The Company shall not be liable to make any payment under this Benefit if you were originally booked to return to
the Country of Residence on a business class air ticket.
3.4.32 Study interruption
In case you have to discontinue your planned studies for remainder part of ongoing semester, then we will reimburse
you for
1. The actual semester fees paid which cannot be refunded by the Educational Institution.
2. Booked Air tickets from the city of residence of the student to the country where Educational Institution is,
provided interruption happens when the insured is at his own city of residence.
3. Return Air-ticket back to insured's city of residence, in case, interruption happens at the city of educational
institution
This benefits can be availed subject to the following:
1. You are Hospitalized for more than 30 consecutive days
2. In case of death or Permanent Total Disability of any one of Your Immediate Family Member or the Sponsor during
the policy period.
Special conditions
1. Any actual/possible refund amount from the Educational Institution will be deducted from the admissible claim
amount.
2. Any actual/possible refundable amount pertaining to the original scheduled ongoing/return ticket will be
deducted from the admissible claim amount.
3. In the event of a claim, only the figures shown on official invoice(s) from the educational institution and
voucher(s) of payment of the said Tuition fees, shall be used for calculating any reimbursement paid by us.
4. Simultaneous claims under "Study Interruption" cover and "Sponsor Protection" is not permitted.
5. This cover is available only for people who are traveling overseas on student visa for full time college or school
education
What is not covered (in addition to General exclusions- Section 5)- Any exclusion mentioned in the "What is not
covered?" Section of the "Personal Accident" or "emergency inpatient medical treatment" cover applicable to You,
Your Immediate Family, your Sponsor.
3.4.33 Sponsor protection
In case of death or permanent total disability of your sponsor, as named in policy schedule, due to an accident during
planned studies, we will pay a lump sum amount up to the limits shown in your policy schedule for the below
expenses
1. The unpaid tuition fees of remaining part of your enrolled full-time study in a registered educational institution
2. One time return economy class air-ticket between the city of residence of the student and the city of Educational
Institution.
Special conditions
1. Death/Permanent Total Disablement of Sponsor should occur during the covered period and the journey is also

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 undertaken during the period of insurance.
2. Any actual/possible refundable amount pertaining to the original scheduled return ticket will be deducted from
the admissible claim amount, if any.
3. In the event of a claim, only the figures shown on official invoice(s) from the educational institution and
voucher(s) of payment of the said Tuition fees, shall be used for calculating any reimbursement paid by Us.
4. Simultaneous claims under "Study Interruption" cover and "Sponsor protection" is not permitted.
5. This cover is available only for people who are traveling overseas on student visa for full time college or school
education
6. if the Insured Person is eligible to receive or receives any scholarship for the tuition fees, then We will pay the
difference between the amount due or paid under the scholarship and the amount payable in respect of the claim
under this benefit
What is not covered (in addition to General exclusions- Section 5)- Any exclusion mentioned in the "What is not
covered?" Section of the "Personal Accident" cover applicable to Your Sponsor
3.4.34 Cancer Screening and Mammography Examinations
We will reimburse the expenses incurred on your cancer screening and mammography examinations during the Risk
Period.
Special conditions
1. Screening or examination has been prescribed by a medical practitioner
2. This cover is available only for people who are traveling overseas on student visa for full time college or school
education
3.4.35 Bail bond
If the you are falsely arrested or wrongfully detained by any government or foreign authority during the Risk Period,
then We will pay the bail bond amount in case you are acquitted by competent court and furnishing of relevant court
documents.
What is not covered (in addition to General exclusions- Section 5)?
1. Insured Person has been charged with breaking the law with any criminal intent.
2. Insured Person has been charged with driving a vehicle at over the speed limit.
3.4.36 Waiver of deductible
By selecting this cover, deductibles applicable under each cover of this policy will be waived off.
3.4.37 Optional co-payment
By selecting this cover, co-payment of 20% will be applicable to all the payable/admissible claims under this policy.
3.4.38 Refund of Visa (if rejected)
We will pay for re-imbursement of Visa fee if your Visa got rejected for no fault or negligence on your part provided
that you had submitted all the valid documents in order as directed by the Embassy of the respective Country for
which the Visa is being applied and Visa application should be filed with the respective Embassy well in advance and
as per the prescribed processing time, if any.
Special conditions- This cover is not available for multi-trip policies
3.4.39 Home to home cover
We will extend the Coverage before /beyond the Period of Insurance for In-Patient treatment, Out-Patient and
Personal Accident up to the sum Insured for the following:
1. Starting of the Journey from Home (or any intermediate place) at the Country of Residence to the Airport for
duration of 6 hours before the Scheduled departure time of the Common Carrier
2. Return journey from the Airport to Home (or any intermediate place) after de-boarding the Common Carrier at
the Country of Residence for duration of 6 hours after the Actual arrival time
You should inform the Company immediately if you suffer an illness or injury and which occurs within the duration
specified in this Benefit
What is not covered (in addition to General exclusions- Section 5)- Any exclusion mentioned in "what is not covered?"
section of "emergency inpatient medical treatment", "emergency outpatient treatment" and "personal accident"

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 cover of this policy
3.4.40Colleague Replacement
If an Insured Person is Hospitalized then We will reimburse the cost of an economy class return air fare to send a
substitute person to complete the business purpose for which the Insured Person was travelling provided that
1. Insured Person's Hospitalization lasts for a period of at least 7 consecutive days
2. Insured Person's travel was for a pre-arranged specific and specified business purpose
3. The substitute employee commences his journey within 30 days from the date of Hospitalization of the Insured
Person
4. Substitute employee is in fact an employee and a proper substitute for the Hospitalized Insured Person
Special conditions- This cover is not available for people who are traveling overseas on student visa for full time
college or school education
3.4.41 Complete pre-existing disease cover
Pre-existing diseases will be covered up to sum insured of "emergency inpatient medical treatment" after opting this
cover.
Special conditions- This cover is available only for people who are traveling overseas on student visa for full time
college or school education

4. General Exclusions
Specific Exclusions
We will not make any payment for any claim directly or indirectly for, caused by, or in any way attributable to any of the
following unless expressly stated to the contrary in this Policy:
1. Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war like
situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader),
acts of terrorism
2. Your participation in any naval, military or air force operations whether in the form of military exercises or war games or
actual engagement with the enemy, whether foreign or domestic.
3. Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent (Code-Excl10)
4. Obesity or any weight control program.
5. Maternity Expenses (Code-Ecxl18)
a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred
during Hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the
Policy Period.
6. Unproven Treatments (Code-Excl16)- Expenses related to any unproven treatment, services and supplies for or in
connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical
documentation to support their effectiveness.
7. The provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and
associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test
strips, and similar products.
8. Non-prescription drugs or treatments
9. If the Insured Person is travelling against the advice of a Doctor or is receiving or on a waiting list for specified medical
treatment.
10. Any claim for your death, injury, medical condition or disability resulting from;
a. your suicide or attempted suicide or wilfully self-inflicted injury or illness; or
b. your consumption of alcohol or drugs or substance abuse
c. depression
11. Any claim for an incident that results from your involvement in any unlawful activities or violation of operating/safety

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 guidelines published by the service provider contracted by you.
12. Any claim originating in a country against whom Indian government has imposed travel restrictions, or any country
which has imposed such restrictions against citizens of India
13. Any claim where trip was specifically planned for the purpose of availing treatment of an existing medical condition
(Medical tourism)
14. Any claim for an incident which happens during the trip that results from taking part in any adventure sports unless
specifically covered
15. Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an
Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to
the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner
(Code- Ecxl08);
16. Investigation & Evaluation- Code- Excl04
a. Expenses related to any admission primarily for diagnostics and evaluation purposes only
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment

5. General Terms and Clauses

5.1 Condition Precedent to Admission of Liability
The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any payment
for claim(s) arising under the policy.
5.2 Insured person
Only those persons named as Insured Persons in the Schedule/Certificate of Insurance shall be covered under this
Policy.
If an Insured Person dies, he/she will cease to be an Insured Person upon Us/Administrator receiving all relevant
particulars in this regard. We will return a rateable part of the premium received for such person IF AND ONLY IF
there are no claims in respect of that Insured Person under the Policy.
5.3 Reasonable Care
Insured persons shall take all reasonable steps to safeguard the interests against any illness or injury that may give
rise to a claim.
5.4 Material change
It is a condition precedent to the Company's liability under the Policy that the Policyholder shall immediately notify
the Company in writing of any material change in the risk on account of change in nature of occupation or business at
his own expense. The Company may, in its discretion, adjust the scope of cover and/or the premium paid or payable,
accordingly.
5.5 Free look period
This Clause shall be applicable only for the policies which are issued for a period of at least 365 days. This clause is
not applicable on policy renewal.
a. The Policyholder may, within 15 days from the receipt of the Policy document, return the Policy stating reasons, if
the terms and conditions are not acceptable to the Policyholder.
b. If no Claim has been made under the Policy, the Company will refund the premium received after deducting
proportionate risk premium for the period on cover and stamp duty charges. If only part of the risk has
commenced, such proportionate risk premium shall be calculated as commensurate with the risk covered during
such period.
5.6 Discount
Below mentioned discounts are available in the policy.
S.no Discounting Parameters % discount
1 Existing NBHI Customers 10%
2 Loyalty Discount to Repeat Customers 10%
3 Discount basis number of members travelling 10% for each member
4 NBHI Employee Discount 15%

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

5.7 Extension of the policy period
a. Extension of the Policy Period for a Single Trip Policy-
On the Policyholder's written request, the Company may at its sole discretion extend the Policy Period provided
that the total Policy Period shall not exceed 365 days. If any Claim has been made under the Policy in respect of
the original Policy Period then the Insured shall be entitled to all benefits payable on fixed basis for which any
claim has not been made with the company earlier under the same policy. For other benefits where the payment
is on indemnity basis, balance sum insured shall be available during the extended policy period.
b. Extension of the Geographical Scope of the Policy
i. On the Policyholder's written request, the Company may at its sole discretion extend Geographical Scope of
the Policy specified in the Policy Certificate provided that the additional premium specified by the Company is
received in advance of commencement of coverage and provided that the Insured Person has not already
entered any part of the proposed extended Geographical Scope of the Policy or made any medical related
Claim under the Policy.
c. All requests for extensions must be made at least 1 day before the expiry of the original Policy Period and
accompanied by all the following information and documents:
i. Duly completed application for extension;
ii. Details of complete particulars of all Claims;
iii. A good health declaration.
d. However, if the request to extend the Policy is received within 3 days of the Policy Period End Date then coverage
shall be reinstated, at Company's sole discretion subject to underwriting, with effect from Policy Period End Date
on the date of receipt of premium by the Company. In such case Company shall not be liable for any Claim arising
during the Policy Period End Date and date of receipt of premium.
e. This product may be withdrawn by the Company after due approval from the IRDA. In case this product is
withdrawn by the Company. This Policy can be extended under the then prevailing product or its nearest
substitute approved by IRDA. The Company shall duly intimate the Policyholder regarding withdrawal of this
product and the options available to the Policyholder at the time of extension of this policy.
5.8 Termination/ cancellation
a. Cancellation of Policy, at a date earlier than the Policy Period End Date can be done only upon :-
i. Denial of visa OR
ii. Cancellation of trip OR
iii. Early return of the individual to India
For cancellations due to above reasons, adequate documentary proof including but not limited to written request
from customer & copy of passport/Visa denial letter would need to be provided.
b. The policyholder may request for cancellation of the policy. The company shall cancel the policy and premium will
be refunded if difference between the date of request of cancellation and end date of policy is at least 15 days or
more.
Refund amount = Amount of premium paid for the original policy period less the premium applicable by taking
the request date as the new policy period end date.
Example - Mr. X has purchased a single trip policy with trip duration as 90 days for a premium of Rs. 9,000. He
curtails the trip after 30 days. The premium for 30 day single trip is Rs. 4,200, hence refund 9,000 less (4,200) =
Rs. 4,800.
c. Policies with term equal to or more than 1 year, premium will be refunded on short scale basis as under:

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Refund Premium (%)
Policy in-force up to
Less than 1 year 1 year 2 years 3 years
Up to 30 days 75% 87.5% 90%
31 to 90 days 50% 75% 87.5%
91 to 180 days 25% 62.5% 75%
181 to 365 days 0% 0% 50% 60%
366 to 455 days 25% 50%
456 to 545 days 12% 25%
545 to 720 days 0% 12%
Exceeding 720 days 0%

The above grid shall be applicable for 'Yearly / Annual' premium payment frequency. For Half Yearly or Quarterly
premium payment frequencies, the Company shall refund premium as per below grid:

No. of completed months at the Refund %

time of cancellation Half-Yearly Quarterly
0 62.5% 50%
1 33.3% 16.7%
2 25% 0%
3 8.3% 50%
4 4.2% 16.7%
5 0% 0%
6 62.5% 50%
7 33.3% 16.7%
8 25% 0%
9 8.3% 50%
10 4.2% 16.7%
11 0% 0%

For monthly premium payment frequency, no refund shall be applicable for cancellation of the Policy.
d. The company may also initiate cancellation of the policy in case any untrue or incorrect statements are made or
there has been a misrepresentation, mis-description or non-disclosure of any material particulars or any material
information having been withheld, or if a Claim is fraudulently made or any fraudulent means or devices are used
by the Policyholder or the Insured Person or any one acting on his / their behalf.
e. No refund of premium shall be eligible in case of cancellation of this Policy where a Claim has been incurred under
the Policy.
5.9 Limitation of liability
Any Claim under this Policy for which the notification or intimation of Claim is received 12 calendar months after the
event or occurrence giving rise to the Claim shall not be admissible, unless the Policyholder proves to the Company's
satisfaction that the delay in reporting of the Claim was for reasons beyond his control.
5.10 Other insurance
If at the time when any claim is made under this Policy, Insured Person has two or more policies from one or more
Insurers to indemnify treatment cost, which also covers any claim (in part or in whole) being made under this Policy,
then the Insured Person shall have the right to require a settlement of his/her claim in terms of any of his/her
policies. The insurer so chosen by the Insured Person shall settle the claim, as long as the claim is within the limits of
and according to terms of the chosen Policy.
Also where the Insured Person has two or more policies from one or more Insurers, then the Insured Person shall have
the right to claim from other policy/ policies for the amounts which is disallowed under earlier chosen policy/ policies

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 even if sum insured is not exhausted. The insurer so chosen by the Insured Person shall settle the claim, as long as the
claim is within the limits of and according to terms of the chosen Policy.
Provided further that, If the amount to be claimed under the Policy chosen by the Insured Person, exceeds the Sum
Insured under a single Policy after considering the deductibles or co-pay (if applicable), the Insured Person shall have
the right to choose the insurers by whom claim is to be settled. In such cases, the respective insurers may then settle
the balance of the claimed amount as per the limits and according to terms of the respective Policy. This clause shall
only apply to indemnity sections of the Policy
5.11 Subrogation
You and/or any Insured Persons shall at Your own expense do or concur in doing or permit to be done all such acts
and things that may be necessary or reasonably required by Us for the purpose of enforcing and/or securing any civil
or criminal rights and remedies or obtaining relief or indemnity from any other party to which We are or would
become entitled upon Us making reimbursement under this Policy, whether such acts or things shall be or become
necessary or required before or after Our payment. Neither You nor any Insured Person shall prejudice these
subrogation rights in any manner and shall at Your own expense provide Us with whatever assistance or cooperation
is required to enforce such rights. Any recovery We make pursuant to this clause shall first be applied to the amounts
paid or payable by Us under this Policy and Our costs and expenses of effecting a recovery, whereafter We shall pay
any balance remaining to You. However, this clause shall not be applicable for benefit 18 which indemnifies the
insured person for treatment cost incurred due to diseases contracted during the period of travel.
5.12 Alterations to the Policy
This Policy constitutes the complete contract of insurance. This Policy cannot be changed or varied by anyone
(including an insurance agent or broker) except Us, and any change We make will be evidenced by a written
endorsement signed and stamped by Us.
5.13 Notices
Any notice, direction or instruction under this Policy shall be in writing and if it is to:
a. Any Insured Person, it would be sent to You at the address specified in Schedule/endorsement/Certificate of
Insurance.
b. Us, shall be delivered to Our address specified in the Schedule/Certificate of Insurance.
c. No insurance agents, brokers, other person/ entity unless authorised by Us is authorised to receive any notice on
Our behalf.
5.14 Dispute Resolution Clause
Any and all disputes or differences under or in relation to this Policy shall be determined by the Indian Courts and
subject to Indian law.
5.15 Cause of action
No claim shall be payable under this policy unless the event or occurrence giving rise to the claim occurs in the
geographical scope specified in the policy schedule.
5.16 Renewal
a. Single trip insurance policy is non-renewable
b. Multi-Trip Policy can be renewed subject to below conditions:
i. This Policy will automatically terminate at the end of the Policy Period unless renewed.
ii. We are under no obligation to give notice that it is due for renewal, or to renew it or to renew it on the same
terms whether as to premium or otherwise.
iii. In respect of all applications for renewal received by Us before the end of the Policy Period, we will ordinarily
offer renewal terms unless We believe that You or any Insured Person or anyone acting on Your behalf or on
behalf of an Insured Person has acted in a dishonest or fraudulent manner under or in relation to this Policy or
the renewal of the Policy poses a moral hazard. We shall be entitled to call for and receive any information or
documentation before agreeing to renew the Policy, and in renewing We are not bound to renew for all Insured

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Persons.
iv. All applications for renewal of the Policy must be received by Us at least 30 days before the end of the Policy
Period.
v. Grace period- delay in payment up to 30 days from the premium due date is allowed where you can still pay
your premium and continue your policy. Coverage would not be available for the period for which no premium
has been received. Post 30 days from premium due date,
5.17 Redressal of Grievance:
In case of any grievance the Insured Person may contact the company through:
Website: www. nivabupa.com
Toll free: 1860-500-8888
E-mail: customercare@nivabupa.com (Senior citizens may write to us at: seniorcitizensupport@nivabupa.com)
Fax : 011-3090-2010
Courier: Customer Services Department
2nd Floor, Plot No D-5, Sec-59, Noida , Gautam Buddh Nagar, Uttar Pradesh - 201301
Insured person may also approach the grievance cell at any of the company's branches with the details of grievance.
If Insured person is not satisfied with the redressal of grievance through one of the above methods, Insured Person
may contact the grievance officer at:
Head - Customer Services
Niva Bupa Health Insurance Company Limited
2nd Floor, Plot No D-5, Sec-59, Noida , Gautam Buddh Nagar, Uttar Pradesh - 201301
Contact No: 1860-500-8888
Email: customercare@nivabupa.com
For details of grievance officer, kindly refer the link https://www. nivabupa.com/customer-care/health-
services/grievance-redressal.aspx
If the Insured person is not satisfied with the above, they can escalate to GRO@nivabupa.com.
If Insured person is not satisfied with the redressal of grievance through above methods, the Insured Person may also
approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance as per lnsurance
Ombudsman Rules 2017 (at the addresses given in Annexure I).
Grievance may also be lodged at IRDAI Integrated Grievance Management System - https://igms.irda.gov.in/
5.18 Premium Payment in Installments
Premium payment in installments is applicable only for policies with term equal to or more than 1 year.
lf the insured person has opted for Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly,
as mentioned in the policy Schedule/Certificate of insurance, the following Conditions shall apply (notwithstanding
any terms contrary elsewhere in the policy)
i. Grace Period of 30 days in case of single premium policies, and a period of 15 days in case of other than single
premium policies, would be given to pay the instalment premium due for the policy.
ii. During such grace period, coverage will not be available from the due date of instalment premium till the date of
receipt of premium by Company.
iii. The insured person will get the accrued continuity benefit in respect of the "Waiting Periods", "Specific Waiting
Periods" in the event of payment of premium within the stipulated grace Period.
iv. No interest will be charged lf the instalment premium is not paid on due date
v. ln case of instalment premium due not received within the grace period, the policy will get cancelled.
vi. ln the event of a claim, all subsequent premium instalments shall immediately become due and payable.
vii. The company has the right to recover and deduct all the pending installments from the claim amount due under
the policy.
5.19 Assignment
The Policy can be assigned subject to applicable laws.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

5.20 Pre-existing conditions
International single and multi-trip- We will not cover any type of Pre-existing Condition whether declared or not
declared. However, in case of life threatening medical condition we will cover pre-existing conditions up to 5% of
"emergency in-patient medical treatment" sum insured and maximum up to $2500.
Domestic single and multi-trip- We will not cover any type of Pre-existing Condition whether declared or not
declared.
International Student Travel- We will not cover any type of Pre-existing Condition whether declared or not declared.
However, in case of life threatening medical condition we will cover pre-existing conditions up to 5% of "emergency
in-patient medical treatment" sum insured and maximum up to $2500. However, if customer opts for optional benefit
"Complete pre-existing disease cover" then pre-existing conditions will be covered up to the sum insured of
"emergency inpatient medical treatment" cover.
5.21 Claims Process & Requirements
When outside India- In the case of an emergency or the need for medical treatment, please ensure that you or your
family member contact
Europ Assistance
24*7 Emergency Contact for +91 22 6787 2092
Email address : nivabupa@europ-assistance.in
Assist America
Toll Free Number-18004252955
Email Id- medservicesindia@assistamerica.in
When in India-
Contact No: 1860-500-8888
Fax No.: 011-30902010
Email ID: customercare@nivabupa.com
5.21.1 Notification of Claim
We or Our Assistance Company must be informed of any event or occurrence that may give rise to a claim
under this Policy within 7 days of the occurrence of the event giving rise to the claim.
5.21.2 Supporting Documentation required
a. Dully filled and signed claims form and KYC Documents.
b. Death Certificate
c. Copy of Post-mortem report (wherever applicable)
d. Disability Certificate, issued by a Medical Board duly constituted by the Central and/or the State
Government.
e. Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy bills).
f. Medical Records, Case histories, investigation reports
g. A precise diagnosis of the treatment for which a claim is made.
h. Original Discharge summary with first and subsequent consultation/treatment papers.
i. Laboratory investigation reports with supporting prescriptions.
j. Copy of settlement letter from other insurance company or TPA
k. MLC/First Information Report (FIR) (in accident cases)
l. Legal heir certificate (not required if valid nomination exists)
IMPORTANT:
a. All documents MUST be submitted within 30 days from discharge.
b. For any delay in submission, You MUST provide the reasons in writing. We will condone such delay on
merits (i.e. reasons beyond your control).
c. We reserve the right to ask for additional documents/reports from case to case basis.
d. We reserve the right to check and investigate the hospital / medical records from any doctor, Hospital,

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 clinic, individual or institution.
5.21.3 Claims payment
a. We shall be under no obligation to make any payment under this Policy unless We have received all
premium payments in full in time and all payments have been realised and We have been provided with
the documentation and information We or Our TPA has requested to establish the circumstances of the
claim, its quantum or Our liability for it, and unless the Insured Person has complied with his obligations
under this Policy.
b. We will only make payment to Insured Person under this Policy. Receipt of payment by Insured Person shall
be considered as a complete discharge of Our liability against the respective claim under this Policy. In the
event of Insured Person's death, We will make payment to the Nominee (as named in the
Schedule/Certificate of Insurance), payments under this Policy shall only be made in Indian Rupees within
India.
c. We are not obliged to make payment for any claim or that part of any claim that could have been avoided
or reduced if the Insured Person had taken reasonable care, or that is brought about or contributed to by
the Insured Person failing to follow the directions, advice or guidance provided by a Medical Practitioner.
d. We shall reject the claim by sending claim rejection letter to Insured Person or settle a claim by making the
payment of claim that has been admitted as payable by Us under the Policy terms and conditions within 30
days of receipt of last necessary document(s) / information and any other additional information required
for the settlement of the claim. All claims will be settled in accordance with the applicable regulatory
guidelines, including IRDAI (Protection of Policyholders Regulation), 2017. In case of delay in payment of
any claim that has been admitted as payable by Us under the Policy terms and condition, beyond the time
period as prescribed under IRDAI (Protection of Policyholders Regulation), 2017, we shall pay interest at a
rate which is 2% above the bank rate from the date of receipt of last necessary document(s) to the date of
payment of claim. For the purpose of this clause, 'bank rate' shall mean the bank rate fixed by the Reserve
Bank of India (RBI) at the beginning of the financial year in which claim has fallen due.
e. Where the circumstances of a claim warrant an investigation in our Opinion, We shall initiate and complete
such investigation at the earliest, in any case not later than 30 days from the date of receipt of last
necessary document. In such cases, We shall settle the claim within 45 days from the date of receipt of last
necessary document. In case of delay beyond stipulated 45 days , We shall be liable to pay interest at a rate
2% above the bank rate from the date of receipt of last necessary document to the date of payment of
claim.
f. All payments made shall be subject to an applicable Deductible (if any) for such payment for each and
every claim made, and to the Accumulation Limit.
g. All payments under this Policy will be in Indian Rupees only.
5.21.4 Fraud/ Dishonest or Fraudulent Claims
If any claim is in any manner dishonest or fraudulent, or is supported by any dishonest or fraudulent means or
devices, whether by You or the Insured Person or anyone acting on behalf of You or an Insured Person, then
this Policy shall be:
a. cancelled ab-initio from the inception date or the renewal date (as the case may be), upon a 30 day notice
by sending an endorsement to Your address shown in the Schedule/Certificate of Insurance or the Policy
may be modified by Us with the consent of the Proposer and
b. all benefits payable, if any, under such Policy shall be forfeited with respect to such claim
5.22 Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the premium rates.
The Insured Person shall be notified three months before the changes are effected.
5.23 Withdrawal of Product

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 a. In the likelihood of this product being withdrawn in future with due approval of IRDAI, the Company will intimate
the Insured Person about the same 90 days prior to expiry of the Policy.
b. Insured Person will have the option to migrate to similar health insurance product available with the Company at
the time of renewal with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period
etc. provided the Policy has been maintained without a break as per extant regulatory framework.
5.24 Disclosure of Information
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.
(Explanation: "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)

Disclaimer: Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company
Limited) (IRDAI Registration Number 145). 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa
Health Insurance Company Limited under license. Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024, Customer Helpline: 1860-500-8888.
Website: www.nivabupa.com. CIN: U66000DL2008PLC182918.

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 Annexure - I
The expenses that are not covered or subsumed into room charges / procedure charges / costs of treatment
List I - Expenses not covered
Sl. No. Item Sl. No. Item Sl. No. Item
1. BABY FOOD 24. ATTENDANT CHARGES 47. LUMBO SACRAL BELT

2. BABY UTILITIES CHARGES 25. EXTRA DIET OF PATIENT (OTHER THAN THAT 48. NIMBUS BED OR WATER OR AIR BED CHARGES
WHICH FORMS PART OF BED CHARGE)
3. BEAUTY SERVICES 26. BIRTH CERTIFICATE 49. AMBULANCE COLLAR
4. BELTS/ BRACES 27. CERTIFICATE CHARGES 50. AMBULANCE EQUIPMENT
5. BUDS 28. COURIER CHARGES 51. ABDOMINAL BINDER

6. COLD PACK/HOT PACK 29. CONVEYANCE CHARGES 52. PRIVATE NURSES CHARGES- SPECIAL
NURSING CHARGES
7. CARRY BAGS 30. MEDICAL CERTIFICATE 53. SUGAR FREE Tablets
CREAMS POWDERS LOTIONS
8. EMAIL / INTERNET CHARGES 31. MEDICAL RECORDS 54. (Toiletries are not payable, only prescribed
medical pharmaceuticals payable)
FOOD CHARGES (OTHER THAN PATIENT's
9. 32. PHOTOCOPIES CHARGES 55. ECG ELECTRODES
DIET PROVIDED BY HOSPITAL)
10. LEGGINGS 33. MORTUARY CHARGES 56. GLOVES
11. LAUNDRY CHARGES 34. WALKING AIDS CHARGES 57. NEBULISATION KIT
OXYGEN CYLINDER ANY KIT WITH NO DETAILS MENTIONED
12. MINERAL WATER 35. 58.
(FOR USAGE OUTSIDE THE HOSPITAL) [DELIVERY KIT, ORTHOKIT, RECOVERY KIT, ETC]
13. SANITARY PAD 36. SPACER 59. KIDNEY TRAY
14. TELEPHONE CHARGES 37. SPIROMETRE 60. MASK
15. GUEST SERVICES 38. NEBULIZER KIT 61. OUNCE GLASS
16. CREPE BANDAGE 39. STEAM INHALER 62. OXYGEN MASK
17. DIAPER OF ANY TYPE 40. ARMSLING 63. PELVIC TRACTION BELT
18. EYELET COLLAR 41. THERMOMETER 64. PAN CAN
19. SLINGS 42. CERVICAL COLLAR 65. TROLLY COVER

20. BLOOD GROUPING AND 43. SPLINT 66. UROMETER, URINE JUG
CROSS MATCHING OF DONORS SAMPLES

21. SERVICE CHARGES WHERE NURSING 44. DIABETIC FOOT WEAR 67. AMBULANCE
CHARGE ALSO CHARGED
22. TELEVISION CHARGES 45. KNEE BRACES (LONG/ SHORT/ HINGED) 68. VASOFIX SAFETY
23. SURCHARGES 46. KNEE IMMOBILIZER/SHOULDER IMMOBILIZER

List II - Items that are to be subsumed into Room Charges

Sl. No. Item Sl. No. Item Sl. No. Item

1. BABY CHARGES (UNLESS SPECIFIED/INDICATED) 14. BED PAN 27. ADMISSION KIT
2. HAND WASH 15. FACE MASK 28. DIABETIC CHART CHARGES
DOCUMENTATION
3. SHOE COVER 16. FLEXI MASK 29.
CHARGES /ADMINISTRATIVE EXPENSES
4. CAPS 17. HAND HOLDER 30. DISCHARGE PROCEDURE CHARGES
5. CRADLE CHARGES 18. SPUTUM CUP 31. DAILY CHART CHARGES
6. COMB 19. DISINFECTANT LOTIONS 32. ENTRANCE PASS / VISITORS PASS CHARGES

7. EAU-DE-COLOGNE / ROOM FRESHNERS 20. LUXURY TAX 33. EXPENSES RELATED TO PRESCRIPTION
ON DISCHARGE
8. FOOT COVER 21. HVAC 34. FILE OPENING CHARGES
INCIDENTAL EXPENSES / MISC. CHARGES
9. GOWN 22. HOUSE KEEPING CHARGES 35.
(NOT EXPLAINED)
10. SLIPPERS 23. AIR CONDITIONER CHARGES 36. PATIENT IDENTIFICATION BAND / NAME TAG
11. TISSUE PAPER 24. IM IV INJECTION CHARGES 37. PULSEOXYMETER CHARGES
12. TOOTH PASTE 25. CLEAN SHEET
13. TOOTH BRUSH 26. BLANKET/WARMER BLANKET

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 List III - Items that are to be subsumed into Procedure Charges
Sl. No. Item Sl. No. Item Sl. No. Item
1. HAIR REMOVAL CREAM 9. WARD AND THEATRE BOOKING CHARGES 17. BOYLES APPARATUS CHARGES
DISPOSABLES RAZORS CHARGES
2. 10. ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS 18. COTTON
(for site preparations)
3. EYE PAD 11. MICROSCOPE COVER 19. COTTON BANDAGE
4. EYE SHEILD 12. SURGICAL BLADES, HARMONICSCALPEL,SHAVER 20. SURGICAL TAPE
5. CAMERA COVER 13. SURGICAL DRILL 21. APRON
6. DVD, CD CHARGES 14. EYE KIT 22. TORNIQUET
7. GAUSE SOFT 15. EYE DRAPE 23. ORTHOBUNDLE, GYNAEC BUNDLE
8. GAUZE 16. X-RAY FILM

List IV - Items that are to be subsumed into costs of treatment

Sl. No. Item Sl. No. Item Sl. No. Item
1. ADMISSION/REGISTRATION CHARGES 7. INFUSION PUMP- COST 13. MOUTH PAINT

2. HOSPITALISATION FOR EVALUATION/ 8. HYDROGEN PEROXIDE\SPIRIT\ 14. VACCINATION CHARGES

DIAGNOSTIC PURPOSE DISINFECTANTS ETC

3. URINE CONTAINER 9. NUTRITION PLANNING CHARGES - 15. ALCOHOL SWABES

DIETICIAN CHARGES- DIET CHARGES

4. BLOOD RESERVATION CHARGES AND 10. HIV KIT 16. SCRUB SOLUTION/STERILLIUM
ANTE NATAL BOOKING CHARGES
5. BIPAP MACHINE 11. ANTISEPTIC MOUTHWASH 17. GLUCOMETER & STRIPS
6. CPAP/ CAPD EQUIPMENTS 12. LOZENGES 18. URINE BAG

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 ANNEXURE - II
List of Insurance Ombudsmen
Office Details Jurisdiction of Office Union Territory, District
AHMEDABAD - Shri Kuldip Singh
Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road, Ahmedabad - 380 001. Gujarat, UT of Dadra & Nagar Haveli, Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in

BENGALURU - Smt. Neerja Shah

Office of the Insurance Ombudsman,
Jeevan Soudha Building, PID No. 57-27-N-19, Ground Floor, Karnataka.
19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru - 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in

BHOPAL - Shri Guru Saran Shrivastava

Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Madhya Pradesh, Chhattisgarh.
Opp. Airtel Office, Near New Market, Bhopal - 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in

BHUBANESHWAR - Shri Suresh Chandra Panda

Office of the Insurance Ombudsman,
62, Forest park, Bhubneshwar - 751 009.
Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in

CHANDIGARH - Dr. Dinesh Kumar Verma

Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Punjab, Haryana (excluding Gurugram, Faridabad,
Sector 17 - D, Chandigarh - 160 017. Sonepat and Bahadurgarh), Himachal Pradesh,
Tel.: 0172 - 2706196 / 2706468 UT of Jammu & Kashmir, Ladakh and Chandigarh.
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@cioins.co.in

CHENNAI - Shri M. Vasantha Krishna

Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453, Anna Salai,
Tamil Nadu, UT-Pondicherry Town and Karaikal
Teynampet, CHENNAI - 600 018.
(which are part of UT of Pondicherry).
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in

DELHI - Shri Sudhir Krishna

Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building, Delhi & Following Districts of
Asaf Ali Road, New Delhi - 110 002. Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in

GUWAHATI - Shri Kiriti .B. Saha

Office of the Insurance Ombudsman,
Jeevan Nivesh, 5th Floor, Nr. Panbazar over bridge, Assam, Meghalaya, Manipur, Mizoram,
S.S. Road, Guwahati - 781001(ASSAM). Arunachal Pradesh, Nagaland and Tripura.
Tel.: 0361 - 2632204 / 2602205
Email: bimalokpal.guwahati@cioins.co.in

HYDERABAD - Shri I. Suresh Babu

Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court", Lane Opp. Saleem Function Palace,
Andhra Pradesh, Telangana, UT of Yanam
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004.
and part of UT of Pondicherry.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 JAIPUR - Smt. Sandhya Baliga
Office of the Insurance Ombudsman,
Jeevan Nidhi - II Bldg., Gr. Floor, Rajasthan.
Bhawani Singh Marg, Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in

ERNAKULAM - Ms. Poonam Bodra

Office of the Insurance Ombudsman,
2nd Floor, Pulinat Bldg., Opp. Cochin Shipyard,
M. G. Road, Ernakulam - 682 015. Kerala, UT of Lakshadweep, Mahe-a part of UT of Pondicherry.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in

KOLKATA - Shri P. K. Rath

Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue, KOLKATA - 700 072. West Bengal, Sikkim, UT of Andaman
Tel.: 033 - 22124339 / 22124340 & Nicobar Islands.
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in

LUCKNOW -Shri Justice Anil Kumar Srivastava Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda,
Office of the Insurance Ombudsman, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
6th Floor, Jeevan Bhawan, Phase-II, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad,
Tel.: 0522 - 2231330 / 2231331 Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur,
Fax: 0522 - 2231310 Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
Email: bimalokpal.lucknow@cioins.co.in Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.

MUMBAI - Shri Milind A. Kharat

Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe, Goa,
S. V. Road, Santacruz (W), Mumbai - 400054. Mumbai Metropolitan Region
Tel.: 022 - 26106552 / 26106960 excluding Navi Mumbai & Thane.
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in

NOIDA - Shri Chandra Shekhar Prasad

State of Uttaranchal and the following Districts of Uttar Pradesh:
Office of the Insurance Ombudsman,
Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah,
Bhagwan Sahai Palace
Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar,
4th Floor, Main Road, Naya Bans, Sector 15,
Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar,
Distt: Gautam Buddh Nagar, U.P-201301.
Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj,
Tel.: 0120-2514252 / 2514253
Email: bimalokpal.noida@cioins.co.in Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.

PATNA - Shri N. K. Singh

Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building,
Bihar, Jharkhand.
Bazar Samiti Road, Bahadurpur, Patna - 800006.
Tel.: 0612-2680952
Email: bimalokpal.patna@cioins.co.in
PUNE - Shri Vinay Sah
Office of the Insurance Ombudsman, Maharashtra,
Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, Area of Navi Mumbai and Thane
N.C. Kelkar Road, Narayan Peth, Pune - 411030.
excluding Mumbai Metropolitan Region.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in

EXECUTIVE COUNCIL OF INSURERS, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054.
Tel.: 022 - 69038801/03/04/05/06/07/08/09 | Email: inscoun@cioins.co.in
Shri B. C. Patnaik, Secretary General | Smt. Poornima Gaitonde, Secretary

Product Name: TravelAssure | Product UIN: NBHTIOP22148V012122

 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

/data1/pdf/20080711/tmp/Kotak-bank-Logo-03_03Jun2022.png
N

Harsh Periwal
CRN 677148447

Home branch
A 64 ZEN PG SUBHAS NAGAR
SHOPING CENTER SHASTRI NAGAR RAWATSAR
JAIPUR KMBL,16-SARDAR SAHAR ROAD,STATE HIGHWAY
JAIPUR 302016 NO.7,RAWATSAR,RAJASTHAN-335524
RAJASTHAN 01537 250018
INDIA

Ref.No. 5939047-32346060

Portfolio Summary
Summary of all your assets and liabilities as on 31 May, 2024

ASSETS

Deposit Accounts INDIAN RUPEES TOTAL BALANCE 0.93

Savings Account(s) + Prepaid Liquid 0.93

Total INDIAN RUPEES 0.93

RBI has advised Banks to make the facility of Positive Pay available to customers issuing high value cheques. Effective January 1, 2021, customers will
be required to provide details for all cheques issued by them via Net Banking/Mobile Banking/at the branch on the same day of the issuance or before it
is handed over to the beneficiary. For more details, visit www.kotak.com
The complimentary insurance cover on Kotak Debit Cards has changed w.e.f. July 2023. Please view the revised covers under Debit Card Services in the
Cards&Fastag section on our web portal. For any queries related to Debit Card insurance, please write to us at dc.insurance@kotak.com or visit
https://www.kotak.com/en/personal-banking/cards/debit-cards/debit-card-services/insurnace-on-debit-card.html.

Need help? Page 1 of 9

Visit your nearest Kotak Mahindra Bank branch/ATM

Call Kotak’s customer centre 1860-266-2666

Any discrepancy in the statement should be brought to the notice of Kotak Mahindra Bank Ltd. within one month from date of statement.
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

/ac Co
Account # 7747351617
Saving Account(s) + Variant KOTAK 811 FULL KYC

Prepaid Currency Indian Rupees

01 May, 2024 - 31 May, 2024

Harsh Periwal Home branch

CRN 677148447 Rawatsar

IFSC KKBK0003709
MICR 335485051

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

01 May, 2024 OPENING BALANCE ... +0.43 0.43

01 May, 2024 UPI/RITA DEVI/412278135591/UPI UPI-412248706004 +1,500.00 1,500.43
01 May, 2024 UPI/SUNITA SHARMA/448872331763/Payment from UPI-412249286913 +3,900.00 5,400.43
Ph
01 May, 2024 UPI/PAWAN KUMAR DEV/448899567241/Payment from UPI-412249334896 -5,000.00 400.43
Ph
01 May, 2024 UPI/PAWAN KUMAR DEV/412215102021/NA UPI-412249486180 +5,000.00 5,400.43
01 May, 2024 UPI/PAWAN KUMAR DEV/448867491199/Payment from UPI-412249546143 -5,000.00 400.43
Ph
01 May, 2024 UPI/PAWAN KUMAR DEV/412215182469/NA UPI-412249572398 +5,000.00 5,400.43
01 May, 2024 UPI/PAWAN KUMAR DEV/448891370417/Payment from UPI-412249579940 -5,000.00 400.43
Ph
01 May, 2024 UPI/PAWAN KUMAR DEV/412215205830/NA UPI-412249597256 +5,000.00 5,400.43
01 May, 2024 UPI/PAWAN KUMAR DEV/448821990236/Payment from UPI-412249604829 -5,000.00 400.43
Ph
01 May, 2024 UPI/PAWAN KUMAR DEV/412215218727/NA UPI-412249611497 +5,000.00 5,400.43
01 May, 2024 UPI/GAYATRI DEVI W /412215355077/NA UPI-412249761565 -5,000.00 400.43
01 May, 2024 UPI/NAGAPPAN NAGAPP/412232336721/Payment UPI-412258173962 -300.00 100.43
from Ph
01 May, 2024 UPI/NEERAJ KUMAR/448819055162/Payment from Ph UPI-412259139302 +200.00 300.43
01 May, 2024 UPI/COOL CARE SERVI/412279074888/Payment from UPI-412259173347 -300.00 0.43
Ph
01 May, 2024 UPI/HARSH PERIWAL/412268442955/Payment from Ph UPI-412260989489 +9.00 9.43
01 May, 2024 UPI/HARSH PERIWAL/412225831424/NA UPI-412261007692 +38.00 47.43
01 May, 2024 UPI/NEERAJ KUMAR/448831762140/Payment from Ph UPI-412261062420 +60.00 107.43
01 May, 2024 UPI/SRI BALAJI TRAD/412211057906/V5J3OY UPI-412261079378 -100.00 7.43
01 May, 2024 UPI/RITA DEVI/412291615664/UPI UPI-412262673241 +500.00 507.43
01 May, 2024 UPI/SAI WELDING WOR/412256376338/AGY8MX UPI-412262728772 -500.00 7.43
01 May, 2024 UPI/RITA DEVI/412293277608/UPI UPI-412264442755 +500.00 507.43
01 May, 2024 UPI/ASTYLES/412215457195/AFLVBO UPI-412264466225 -500.00 7.43

Page 2 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

01 May, 2024 UPI/RITA DEVI/412210381150/UPI UPI-412282742513 +400.00 407.43

01 May, 2024 UPI/SRI BALAJI TRAD/412295442844/YTXUX3 UPI-412282807941 -400.00 7.43
01 May, 2024 UPI/PAWAN KUMAR DEV/448865106393/Payment from UPI-412284042565 +5,000.00 5,007.43
Ph
01 May, 2024 UPI/BHUMIKA KUMAWA/448827430831/Payment from UPI-412284087627 -3,000.00 2,007.43
Ph
01 May, 2024 UPI/EZYFOREX ENTERP/412228619439/Payment from UPI-412284267213 -1,000.00 1,007.43
Ph
01 May, 2024 UPI/ASTYLES/412280929313/GQIAAE UPI-412284498857 -500.00 507.43
01 May, 2024 UPI/YOGESH ENTERPRI/412250447612/GBYQBG UPI-412284638756 -500.00 7.43
02 May, 2024 UPI/Vijay Vijay/448977636863/Payment from Ph UPI-412395668098 +200.00 207.43
02 May, 2024 UPI/TIRUMALA TRADER/412357823904/VUNIAJ UPI-412395712255 -100.00 107.43
02 May, 2024 UPI/ASTYLES/412326039943/9JS9XM UPI-412395753272 -100.00 7.43
02 May, 2024 Recd:IMPS/412312045674/IMUTERATIO/KKBK/X0018/ IMPS-412312611955 +200.00 207.43
Bk1SE
02 May, 2024 UPI/ASTYLES/412321880754/6AN5AK UPI-412399820644 -100.00 107.43
02 May, 2024 UPI/TIRUMALA TRADER/412322942320/6499XS UPI-412300007560 -100.00 7.43
03 May, 2024 UPI/BANTI/412466463698/Payment from Ph UPI-412441913221 +190.00 197.43
03 May, 2024 UPI/SAI WELDING WOR/412411073732/RAZK4K UPI-412442015613 -195.00 2.43
04 May, 2024 UPI/DEENDYAL SAHAR/449148588345/Payment from UPI-412577706006 +500.00 502.43
Ph
04 May, 2024 UPI/DEENDYAL SAHAR/449190556384/Payment from UPI-412577708011 +500.00 1,002.43
Ph
04 May, 2024 UPI/DEENDYAL SAHAR/449149960932/Payment from UPI-412577708383 +500.00 1,502.43
Ph
04 May, 2024 UPI/DEENDYAL SAHAR/449135284162/Payment from UPI-412577708657 +500.00 2,002.43
Ph
04 May, 2024 UPI/A R COLLECTION/412557188838/OLUH UPI-412577712831 -2,000.00 2.43
04 May, 2024 UPI/DEENDYAL SAHAR/449136238534/Payment from UPI-412577782351 +2,000.00 2,002.43
Ph
04 May, 2024 UPI/KARTIK ENTERPRI/412513512837/OGYN UPI-412577789420 -2,000.00 2.43
04 May, 2024 Recd:IMPS/412528030946/WIN LIFE IMPS-412505437895 +3,000.00 3,002.43
M/KKBK/X5952/WINLI
04 May, 2024 UPI/KRISHI VIKAS KE/412583691040/DLCPQ4 UPI-412579143876 -2,000.00 1,002.43
04 May, 2024 Recd:IMPS/412507251496/EKO INDIA IMPS-412507508997 +1,000.00 2,002.43
/KKBK/X4661/P2AMO
04 May, 2024 UPI/NIRMALA K/412503069290/WhLN UPI-412579505795 -1,000.00 1,002.43
04 May, 2024 UPI/PERFECT TRADING/412528867164/EKNP UPI-412579715710 -1,000.00 2.43
04 May, 2024 Recd:IMPS/412525188114/FINZEN IMPS-412516229533 +1,460.00 1,462.43
PAY/KKBK/X3292/Payou
04 May, 2024 UPI/AVIO LIFESTYLE /412535828008/GIVK UPI-412598816190 -1,000.00 462.43
04 May, 2024 UPI/Bharti Airtel L/449155801450/Payment from Ph UPI-412599330050 -19.00 443.43
04 May, 2024 UPI/RAJIM MUDI BHAN/412537911681/5OJ2BG UPI-412500878015 -400.00 43.43
04 May, 2024 UPI/SUBHASH KUMAWAT/449120840572/Payment UPI-412508089331 -20.00 23.43
from Ph
04 May, 2024 UPI/Amit Sharma/449138283008/Payment from Ph UPI-412520061581 +20.00 43.43
04 May, 2024 UPI/BAJRANG SOMANPH/412526794403/UPI UPI-412520149272 -40.00 3.43
05 May, 2024 Recd:IMPS/412619192649/SPICE IMPS-412619977896 +1,480.00 1,483.43
MONE/KKBK/X3588/Trans
05 May, 2024 UPI/Bharti Airtel L/449279460035/Payment from Ph UPI-412654251627 -212.00 1,271.43

Page 3 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

05 May, 2024 UPI/RBS ENTERPRISES/412617741653/V5TT UPI-412654702529 -500.00 771.43

05 May, 2024 UPI/AVIO LIFESTYLE /412615319520/USW1 UPI-412655170694 -500.00 271.43
05 May, 2024 UPI/Vijay Vijay/449233856303/Payment from Ph UPI-412661579907 -150.00 121.43
06 May, 2024 UPI/Bharti Airtel L/449380806419/Payment from Ph UPI-412702871699 -19.00 102.43
07 May, 2024 UPI/Manisha Kumari/412871068218/Payment from Ph UPI-412811868437 +5,000.00 5,102.43
07 May, 2024 UPI/RITA DEVI/449409444035/Sent from Paytm UPI-412811872471 -2,000.00 3,102.43
07 May, 2024 UPI/RITA DEVI/449409446403/Sent from Paytm UPI-412811875489 -2,000.00 1,102.43
07 May, 2024 UPI/RITA DEVI/449409448699/Sent from Paytm UPI-412811877093 -1,000.00 102.43
07 May, 2024 UPI/Kamlesh saini/412809700866/Payment from Ph UPI-412812584125 -40.00 62.43
07 May, 2024 UPI/Mr BABULAL SAIN/412831049359/Payment from UPI-412812852599 -30.00 32.43
Ph
07 May, 2024 UPI/JioCinema/412835506757/Collect request UPI-412821491348 -29.00 3.43
07 May, 2024 Chrg: ATM DECL FEE/xx1105/407918641500/190324 TBMS-1430407394 -3.43 0.00
08 May, 2024 UPI/LOKESH KUMAWAT/412946203561/NA UPI-412987549284 +50.00 50.00
08 May, 2024 UPI/Amit Sharma/449597649979/Payment from Ph UPI-412987873346 +7.00 57.00
08 May, 2024 UPI/KAPTAN KUSHWAH/449505446386/Payment from UPI-412987895289 -30.00 27.00
Ph
08 May, 2024 UPI/Nitesh/449535085753/Payment from Ph UPI-412991385628 +30.00 57.00
08 May, 2024 UPI/LEELAVATI KUSH/412951010126/Payment from UPI-412992922411 -10.00 47.00
Ph
08 May, 2024 UPI/Raj Kumar Saini/449573354314/Payment from Ph UPI-412993030658 -20.00 27.00
08 May, 2024 UPI/JUNED BHATI/412947876017/Payment from Ph UPI-412996425954 +3,000.00 3,027.00
08 May, 2024 UPI/JUNED BHATI/412906575256/Payment from Ph UPI-412996435448 +50.00 3,077.00
08 May, 2024 UPI/SAMTA FASHION/412932854104/Payment from Ph UPI-412996563075 -500.00 2,577.00
08 May, 2024 UPI/P K TRADERS/412992093326/EPV9 UPI-412996617432 -500.00 2,077.00
08 May, 2024 UPI/SAMTA FASHION/412975895516/Payment from Ph UPI-412998051082 -500.00 1,577.00
08 May, 2024 Recd:IMPS/412923917195/KGC IMPS-412923961390 +500.00 2,077.00
INFOTE/KKBK/X0195/payou
08 May, 2024 Recd:IMPS/413028002852/CUB IMPS-413000978473 +500.00 2,577.00
PAYOUT/KKBK/X1347/PAYME (Value Date :09-MAY-24)
08 May, 2024 UPI/SUBHANSU SEKHAR/449649982540/Payment from UPI-413098712404 -500.00 2,077.00
Ph (Value Date :09-MAY-24)
08 May, 2024 Recd:IMPS/413025007792/RESOK IMPS-413000990616 +500.00 2,577.00
IMPE/KKBK/X7963/OEGFW (Value Date :09-MAY-24)
08 May, 2024 Recd:IMPS/413026009535/RESOK IMPS-413000995542 +500.00 3,077.00
IMPE/KKBK/X7963/5TK6Y (Value Date :09-MAY-24)
09 May, 2024 Recd:IMPS/413004987705/NEOKRED IMPS-413004054047 +700.00 3,777.00
TE/KKBK/X9001/DASTR
09 May, 2024 UPI/RAVINDRA SINGH /449666678330/Payment from UPI-413001548444 -500.00 3,277.00
Ph
09 May, 2024 Recd:IMPS/413008327308/CMSIMPSPay/KKBK/X1642/ IMPS-413008136857 +500.00 3,777.00
Remit
09 May, 2024 UPI/Abdul Sabir Kho/413051895898/Payment from Ph UPI-413003349846 -2,800.00 977.00
09 May, 2024 UPI/Abdul Sabir Kho/413037847662/Payment from Ph UPI-413003370300 -200.00 777.00
09 May, 2024 UPI/Mr BABULAL SAIN/413040686416/Payment from UPI-413003504044 -30.00 747.00
Ph
09 May, 2024 UPI/K S R TEA COMPA/413018659691/Merchant 20QR UPI-413003624085 -240.00 507.00
09 May, 2024 UPI/SAMTA FASHION/413079123040/Payment from Ph UPI-413004962444 -300.00 207.00
09 May, 2024 Recd:IMPS/413010153905/CMSIMPSPay/KKBK/X1642/ IMPS-413010266576 +778.00 985.00
Remit

Page 4 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

09 May, 2024 UPI/ILAMARAN ./413054400235/Payment from Ph UPI-413009120406 -300.00 685.00

09 May, 2024 UPI/Mr BABULAL SAIN/413056212289/Payment from UPI-413009785650 -30.00 655.00
Ph
09 May, 2024 UPI/Raj Kumar Saini/449671773076/Payment from Ph UPI-413011788510 -10.00 645.00
09 May, 2024 UPI/LEELAVATI KUSH/413021323478/Payment from UPI-413011896699 -10.00 635.00
Ph
09 May, 2024 UPI/AVISEKH ENTERPR/413095292983/Payment from UPI-413019193746 -300.00 335.00
Ph
09 May, 2024 UPI/AVISEKH ENTERPR/413041248902/Payment from UPI-413019515608 -300.00 35.00
Ph
09 May, 2024 UPI/BIJENDER/449603722213/Payment from Ph UPI-413031677825 +10,000.00 10,035.00
09 May, 2024 UPI/manishsaini2024/413098069981/Payment from Ph UPI-413033109632 -500.00 9,535.00
09 May, 2024 UPI/Amit Sharma/449606425930/Payment from Ph UPI-413039267417 +3,000.00 12,535.00
09 May, 2024 UPI/HARI SINGH/413031742559/Payment from Ph UPI-413040085908 -10.00 12,525.00
09 May, 2024 UPI/KRISHNAAWATAR K/413083612314/Payment from UPI-413040123722 -40.00 12,485.00
Ph
09 May, 2024 UPI/KRISHNAAWATAR K/449634673963/Payment from UPI-413040263467 +40.00 12,525.00
Ph
09 May, 2024 UPI/Swiggy/413002522235/Swiggy Order Id UPI-413040662385 -306.00 12,219.00
09 May, 2024 UPI/LOKESH KUMAWAT/413044716454/NA UPI-413041336560 +500.00 12,719.00
09 May, 2024 UPI/HARSH PERIWAL/449677955233/Payment from Ph UPI-413041589110 -83.00 12,636.00
09 May, 2024 UPI/SWIGGY/413087229645/TXN FAILED AT M UPI-413041597676 +83.00 12,719.00
09 May, 2024 UPI/HARSH PERIWAL/449608664669/Payment from Ph UPI-413041615905 -83.00 12,636.00
09 May, 2024 PCI/1105/UKVI/LONDON100524/00:09 413018756291 -12,542.00 94.00
10 May, 2024 UPI/Mr DAL CHAND/449719035635/Payment from Ph UPI-413150355776 -30.00 64.00
10 May, 2024 UPI/Mr BABULAL SAIN/413124290626/Payment from UPI-413150520730 -30.00 34.00
Ph
11 May, 2024 Rem Chrgs:ATM DECL TBMS-1432840183 -26.07 7.93
FEE/xx1105/407918641500/190324
11 May, 2024 UPI/Sonu Kumar/449863436823/UPI UPI-413211165298 +2,000.00 2,007.93
11 May, 2024 UPI/Sonu Kumar/449870634723/UPI UPI-413211178618 +2,000.00 4,007.93
11 May, 2024 UPI/Sonu Kumar/449833845627/UPI UPI-413211215216 +1,994.00 6,001.93
11 May, 2024 UPI/KAPTAN KUSHWAH/449891968960/Payment from UPI-413212102184 -50.00 5,951.93
Ph
11 May, 2024 UPI/Mr BABULAL SAIN/413257712708/Payment from UPI-413218150519 -30.00 5,921.93
Ph
11 May, 2024 UPI/SHREE NATH MEDI/449870586975/Payment from UPI-413218452382 -40.00 5,881.93
Ph
11 May, 2024 UPI/KALPANA AGARWAL/413227246553/UPI UPI-413220970536 +2,500.00 8,381.93
11 May, 2024 UPI/VFS Global Serv/413217113162/Payment from Ph UPI-413221166377 -8,343.00 38.93
11 May, 2024 UPI/Mr JITENDRA SO/449854362318/Payment from Ph UPI-413222752678 -10.00 28.93
11 May, 2024 UPI/Saniv Khan/449858455816/Payment from Ph UPI-413222822182 -20.00 8.93
12 May, 2024 UPI/GAYATRI KAMAL D/413344071790/UPI UPI-413343100451 +3,000.00 3,008.93
12 May, 2024 UPI/LOKESH KUMAWAT/449919537422/NA UPI-413343155724 +1,000.00 4,008.93
12 May, 2024 UPI/ABDUL SABIR KHO/449919826723/NA UPI-413343469040 -3,600.00 408.93
12 May, 2024 UPI/LOVEPREET SING/449911114631/Sent from Paytm UPI-413344857241 -265.00 143.93
12 May, 2024 UPI/SUNIL KUMAWAT/413301898122/NA UPI-413345885987 -20.00 123.93
12 May, 2024 UPI/Shri Ganesh Cha/413364539867/Payment from Ph UPI-413348472707 -30.00 93.93

Page 5 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

12 May, 2024 UPI/MADAN LAL SO BE/449903632145/Payment from UPI-413348719142 -20.00 73.93

Ph
12 May, 2024 UPI/DAULATRAM SANWA/449955822060/Payment UPI-413351822693 -20.00 53.93
from Ph
12 May, 2024 UPI/Akabar/413345451322/Payment from Ph UPI-413356307646 -20.00 33.93
12 May, 2024 UPI/Omkunvar/449988154176/Payment from Ph UPI-413356789394 -10.00 23.93
12 May, 2024 UPI/PRAMOD SINGH SO/449987521318/Payment from UPI-413360180279 -20.00 3.93
Ph
14 May, 2024 UPI/RITA DEVI/413531001795/UPI UPI-413545151046 +200.00 203.93
14 May, 2024 UPI/Amarsingh Amar/450167822744/Payment from Ph UPI-413546551277 -10.00 193.93
14 May, 2024 UPI/Deva Ram/413543997204/Payment from Ph UPI-413547179218 -80.00 113.93
16 May, 2024 UPI/JUNED BHATI/450387345565/Payment from Ph UPI-413704225078 +20,000.00 20,113.93
16 May, 2024 UPI/BHUMIKA KUMAWA/450389157325/Payment from UPI-413704258541 -8,000.00 12,113.93
Ph
16 May, 2024 UPI/PhonePe/450373144785/Payment from Ph UPI-413704318670 -442.00 11,671.93
16 May, 2024 UPI/ABDUL FAYAZ/413728058547/Payment from Ph UPI-413704610346 +4,400.00 16,071.93
16 May, 2024 UPI/Lokesh Kumawat/450331000152/Payment from Ph UPI-413705218350 -1,500.00 14,571.93
16 May, 2024 UPI/NARESH KUMAR SO/450385854537/Payment from UPI-413705483332 -5,000.00 9,571.93
Ph
16 May, 2024 UPI/RAJU REGAR/413774750822/Payment from Ph UPI-413706915242 -140.00 9,431.93
16 May, 2024 UPI/Vijay Vijay/450311002708/Payment from Ph UPI-413707303885 -200.00 9,231.93
16 May, 2024 UPI/JATIN SWAMI/450301254045/Payment from Ph UPI-413709103168 -4,300.00 4,931.93
16 May, 2024 UPI/J A TRADERS/413772884756/9K92 UPI-413710318017 -100.00 4,831.93
16 May, 2024 UPI/LOKESH KUMAWAT/413784480086/Payment from UPI-413710701893 -1,500.00 3,331.93
Ph
16 May, 2024 UPI/BATRA MOBILES/450374656838/Payment from Ph UPI-413713622260 -2,100.00 1,231.93
16 May, 2024 UPI/RAJU REGAR/413729467954/Payment from Ph UPI-413714359372 -130.00 1,101.93
16 May, 2024 UPI/KALSUM WO YUNUS/413709785285/Payment from UPI-413717829311 -20.00 1,081.93
Ph
16 May, 2024 UPI/Onkar Singh/450335245580/Payment from Ph UPI-413717980159 -20.00 1,061.93
16 May, 2024 UPI/GULAB/413789317068/Payment from Ph UPI-413736244195 -200.00 861.93
16 May, 2024 UPI/LOKESH KUMAWAT/413747161654/NA UPI-413737972648 +1,000.00 1,861.93
16 May, 2024 UPI/BHUMIKA KUMAWA/450385750045/Payment from UPI-413738174855 -1,800.00 61.93
Ph
17 May, 2024 UPI/LOKESH KUMAWAT/413857095892/Payment from UPI-413877788048 -61.00 0.93
Ph
17 May, 2024 UPI/GULAB SON OF RI/413853614397/UPI UPI-413877997747 +50.00 50.93
17 May, 2024 UPI/LOKESH KUMAWAT/413883556540/Payment from UPI-413878009326 -50.00 0.93
Ph
18 May, 2024 UPI/Lokesh Kumawat/450574421632/Payment from Ph UPI-413986192700 +300.00 300.93
18 May, 2024 UPI/Emitra Shop/413994256654/Payment from Ph UPI-413986319940 -205.00 95.93
18 May, 2024 UPI/BHARAT ASRANI/450557610838/Payment from Ph UPI-413998127319 -80.00 15.93
18 May, 2024 UPI/Lokesh Kumawat/450552550391/Payment from Ph UPI-413901755761 +200.00 215.93
18 May, 2024 UPI/SUBHASH KUMAWAT/450512122887/Payment UPI-413901834230 -200.00 15.93
from Ph
18 May, 2024 UPI/Vijay Vijay/450558285970/Payment from Ph UPI-413909282092 +120.00 135.93
18 May, 2024 UPI/Ahil Department/450586698301/UPI UPI-413909869547 -120.00 15.93
18 May, 2024 UPI/Ram Niwas/413977702248/UPI UPI-413911167120 +200.00 215.93
18 May, 2024 UPI/SHREE BALAJI DA/413978202429/UPI UPI-413911545336 -100.00 115.93

Page 6 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

19 May, 2024 UPI/Ahil Department/414089948601/UPI UPI-414026787271 -51.00 64.93

19 May, 2024 UPI/Mithaas Sweets/414090278665/UPI UPI-414027028748 -60.00 4.93
19 May, 2024 UPI/RITA DEVI/450619197455/Payment from Ph UPI-414043043260 +1,000.00 1,004.93
19 May, 2024 UPI/Mithaas Sweets/414009038601/UPI UPI-414043108764 -40.00 964.93
19 May, 2024 UPI/ARVIND KUMAR/450662618818/UPI UPI-414043155896 -50.00 914.93
19 May, 2024 UPI/PARHLAD KUSHWAH/414084243278/UPI UPI-414043230480 -30.00 884.93
19 May, 2024 UPI/SHREE BALAJI DA/414009436802/UPI UPI-414043440238 -76.00 808.93
19 May, 2024 UPI/HARSH PERIWAL/450672051933/Payment from Ph UPI-414043469712 -808.00 0.93
19 May, 2024 Recd:IMPS/414019765865/SPICE IMPS-414019196881 +490.00 490.93
MONE/KKBK/X3588/Trans
19 May, 2024 UPI/HARSH PERIWAL/450689482490/Payment from Ph UPI-414051346999 -490.00 0.93
21 May, 2024 UPI/RITA DEVI/414291990154/UPI UPI-414224451552 +40.00 40.93
21 May, 2024 UPI/Bharti Airtel L/450829616331/Payment from Ph UPI-414224457960 -39.00 1.93
21 May, 2024 UPI/Komal/414200233964/UPI UPI-414227447528 +500.00 501.93
21 May, 2024 UPI/SAHARAN PETROLE/414231120506/Sent from UPI-414228731720 -320.00 181.93
Paytm
21 May, 2024 UPI/RAM RATAN/450897224161/Payment from Ph UPI-414229174923 -150.00 31.93
22 May, 2024 UPI/Bharti Airtel L/450906542515/Payment from Ph UPI-414356650192 -29.00 2.93
23 May, 2024 UPI/RITA DEVI/414468649271/UPI UPI-414406621650 +19.00 21.93
23 May, 2024 UPI/Bharti Airtel L/451074775749/Payment from Ph UPI-414406784541 -19.00 2.93
24 May, 2024 UPI/JUNED BHATI/451159775805/Payment from Ph UPI-414533557529 +6,100.00 6,102.93
24 May, 2024 UPI/ABHISHEK SONI/451145342275/Payment from Ph UPI-414534503840 -4,300.00 1,802.93
24 May, 2024 UPI/Vishnu Hair Dre/414585135229/Payment from Ph UPI-414534974157 -30.00 1,772.93
24 May, 2024 UPI/Ram Niwas/451122573902/Payment from Ph UPI-414535018577 -200.00 1,572.93
24 May, 2024 UPI/HARSH PERIWAL/451169662582/Payment from Ph UPI-414535043825 -1,500.00 72.93
24 May, 2024 UPI/HARSH PERIWAL/451147929425/Payment from Ph UPI-414542116127 -20.00 52.93
24 May, 2024 Recd:IMPS/414526135506/J K IMPS-414514734423 +600.00 652.93
ENTERP/KKBK/X6374/Mobil
24 May, 2024 UPI/HARSH PERIWAL/451174323613/Payment from Ph UPI-414543292197 -600.00 52.93
24 May, 2024 Recd:IMPS/414515920271/SNOWYFLY/KKBK/X6150/ IMPS-414515822682 +110.00 162.93
BT24
24 May, 2024 UPI/SITA RAM SAINI /451191908601/Payment from Ph UPI-414546524752 -80.00 82.93
24 May, 2024 UPI/HARSH PERIWAL/451115253392/Payment from Ph UPI-414551135588 -82.00 0.93
24 May, 2024 UPI/JUNED BHATI/451163754152/Payment from Ph UPI-414555367463 +2,350.00 2,350.93
24 May, 2024 UPI/BHUMIKA KUMAWA/451143957914/Payment from UPI-414555373929 -1,500.00 850.93
Ph
24 May, 2024 UPI/BP Petrol Pump /451179351346/Payment from Ph UPI-414555929566 -160.00 690.93
24 May, 2024 UPI/Bharti Airtel L/451144744072/Payment from Ph UPI-414557356628 -39.00 651.93
24 May, 2024 UPI/Bharti Airtel L/451126347573/Payment from Ph UPI-414561898430 -39.00 612.93
25 May, 2024 NEFT AXNPN14695519312 PHONEPE PRIVATE LIMITED NEFTINW-0863353455 +50.00 662.93
PAY
25 May, 2024 UPI/ANEE BEAUTY PAR/414672832385/M2IE UPI-414669418829 -100.00 562.93
25 May, 2024 UPI/BHUMIKA KUMAWA/451224939906/Payment from UPI-414669714322 -500.00 62.93
Ph
25 May, 2024 UPI/ROHIT GOYAL/414669181609/Payment from Ph UPI-414671011624 -23.00 39.93
25 May, 2024 UPI/Ahil Department/414662834460/Payment from Ph UPI-414671028909 -39.00 0.93
25 May, 2024 UPI/JUNED BHATI/451251065170/Payment from Ph UPI-414602399356 +1,200.00 1,200.93

Page 7 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

DATE TRANSACTION DETAILS CHEQUE/REFERENCE# DEBIT CREDIT BALANCE

25 May, 2024 UPI/BHUMIKA KUMAWA/451234602260/Payment from UPI-414602441108 -1,000.00 200.93

Ph
25 May, 2024 UPI/HARSH PERIWAL/451262871683/Payment from Ph UPI-414602571685 -200.00 0.93
26 May, 2024 UPI/Sonu Kumar/451388586757/Payment from Ph UPI-414717174891 +60.00 60.93
26 May, 2024 UPI/SUBHASH KUMAWAT/451320095602/Payment UPI-414717287905 -40.00 20.93
from Ph
26 May, 2024 UPI/SUBHASH KUMAWAT/451389310614/Payment UPI-414717315878 -20.00 0.93
from Ph
26 May, 2024 UPI/RITA DEVI/451367621186/Payment from Ph UPI-414732622297 +50.00 50.93
26 May, 2024 UPI/SUBEE DEVI W O /451383171251/Payment from Ph UPI-414733023179 -30.00 20.93
26 May, 2024 UPI/KAPTAN KUSHWAH/451388798922/Payment from UPI-414740867966 -20.00 0.93
Ph
27 May, 2024 UPI/JUNED BHATI/451481779170/Payment from Ph UPI-414857198510 +2,400.00 2,400.93
27 May, 2024 UPI/8824343061610pa/414800249294/Payment from UPI-414857215208 -1,700.00 700.93
Ph
27 May, 2024 UPI/HARSH PERIWAL/451480133273/Payment from Ph UPI-414857537934 -700.00 0.93
27 May, 2024 UPI/OM PARKASH SOJA/451427512184/Payment from UPI-414870054831 +500.00 500.93
Ph
27 May, 2024 UPI/SUBHASH KUMAWAT/451419564103/Payment UPI-414870172556 -120.00 380.93
from Ph
27 May, 2024 UPI/SUBHASH KUMAWAT/451439409336/Payment UPI-414870289927 -50.00 330.93
from Ph
27 May, 2024 UPI/BABA RAM FILLIN/414840604343/Payment from UPI-414874426920 -320.00 10.93
Ph
27 May, 2024 UPI/Himani/451424674472/Payment from Ph UPI-414883914352 +229.00 239.93
27 May, 2024 UPI/MS HOTEL ROYAL /414884893853/Payment from UPI-414883920311 -229.00 10.93
Ph
29 May, 2024 UPI/JUNED BHATI/451659303183/Payment from Ph UPI-415046171205 +7,200.00 7,210.93
29 May, 2024 UPI/BHUMIKA KUMAWA/451613072092/Payment from UPI-415046250465 -1,100.00 6,110.93
Ph
29 May, 2024 UPI/MOHD SUHAIL/415051780035/Payment from Ph UPI-415046614063 -472.00 5,638.93
29 May, 2024 UPI/GAYATRI DEVI W /451647052147/Payment from Ph UPI-415046891173 -1,000.00 4,638.93
29 May, 2024 UPI/BP Petrol Pump /451663544080/Payment from Ph UPI-415047286995 -160.00 4,478.93
29 May, 2024 UPI/BP Petrol Pump /451673802747/Payment from Ph UPI-415047357073 -320.00 4,158.93
29 May, 2024 UPI/MAA BHAWANI JOD/415064009942/Payment from UPI-415047639702 -420.00 3,738.93
Ph
29 May, 2024 UPI/PARHLAD KUSHWAH/415002655095/Payment UPI-415047969371 -10.00 3,728.93
from Ph
29 May, 2024 UPI/SITA RAM SAINI /451661500883/Payment from Ph UPI-415048050014 -20.00 3,708.93
29 May, 2024 UPI/OM HARDWARE STO/415064888747/Payment from UPI-415048134933 -50.00 3,658.93
Ph
29 May, 2024 UPI/MAHAVEER MEDICA/415042929681/Payment from UPI-415048297280 -120.00 3,538.93
Ph
29 May, 2024 UPI/Tulsi ram/415038988616/L UPI-415048374665 -180.00 3,358.93
29 May, 2024 UPI/Ahil Department/415032210599/Payment from Ph UPI-415048480993 -162.00 3,196.93
29 May, 2024 UPI/HARSH PERIWAL/451631522814/Payment from Ph UPI-415053221615 -700.00 2,496.93
29 May, 2024 UPI/BHUMIKA KUMAWAT/451635116191/Sent from UPI-415057070780 -2,496.00 0.93
Paytm

SUMMARY AP-Auto

Page 8 of 9
 AP-Aut Bank deposit of up to Rs.Strip
5,00,000 wi
opay for /actuate/activeportal/msgimg/Global - Safe
0 677148447

Analysis of your account’s activity between 01 May, 2024 - 31 May, 2024

Saving Account(s) + Prepaid Opening balance 0.43

Total debited 165 Transactions -1,31,256.50
Total credited 77 Transactions +1,31,257.00
Closing balance 0.93
Overdraft drawing power 0.00
Average monthly/quarterly balance 114.58
Recoverable 0.00
Hold balance
Others 0.00

Opening balance
Sweep TD 0.00
Sweep TD broken -0.00
Sweep TD created +0.00
Closing balance 0.00

**The amount displayed includes new sweep TD created/interest credited to the linked cumulative TD.

Bank deposit of up to Rs. 5,00,000 with respect to each depositor is fully protected by the Deposit Insurance and Credit Guarantee Corporation under the Deposit Insurance
Scheme.
Effective July 1, 2017, GST has been levied on the charges at the prescribed rate of 18%. Please note that this statement / advice should not be construed as a Tax Invoice
under the Goods and Services Tax Act.

End of Statement
This is system generated report and does not require signature & stamp

Page 9 of 9

Commonly Used Narrations: AP-Autopay for Billpay , ATL-Other Bank ATM Withdrawal , ATW-Kotak ATM Withdrawal , BP-Bill Pay transaction , CDM-Kotak Cash Deposit Machine , CMS-Cash
Management Service , IB-Internet Banking transaction , IMPS-Immediate Payment Service , IMT-Instant Money Transfer , KB-Billpay transaction via Keya Chatbot , MB-Mobile Banking Transaction ,
NACH-National Automated Clearing House , NEFT-National Electronic Funds Transfer , Netcard-Netc@rd transaction , OS-Online Shopping transaction , OT -Online Trading transaction via Payment
Gateway , PB-Phone Banking , PCI/PCD-POS transaction , RTGS-Real Time Gross Settlement , UPI-Unified Payment Interface , VISACCPAY-Visa Credit Card Payment , VMT-VISA Money Transfer ,
WB-Billpay transaction via WhatsApp Banking
Digitally signed by DS KOTAK MAHINDRA BANK LTD
Date: Sun Jun 16 16:01:30 IST 2024
 S/N: EN05011003515081
Consolidated Statement
, "%

%
)
)
,
ARPIT SAINI
BLK 17 JOO SENG ROAD
#08-123
SINGAPORE 360017
./-.0-./0--00--00-/.0-0-0/./.0

Account Summary as at 30 Sep 2024

Deposits

Current and Savings Account Total: SGD Equivalent 1.43

Summary of Currency Breakdown:

SGD 1.43

Account Account No. Balance Balance

(Base Currency) (SGD Equivalent)

DBS Multiplier Account 271-834851-8 SGD 1.43 1.43

SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

Account Summary as of 30 Sep 2024 Page 1 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 Transaction Details as at 30 Sep 2024
Deposits

DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

CURRENCY: SINGAPORE DOLLAR

Balance Brought Forward SGD 54.41

01/09/2024 Debit Card Transaction 3.80 50.61

BUS/MRT 493063448 SI NG 27AUG
4628-4500-6587-4209
03/09/2024 Debit Card Transaction 8.38 42.23
LAZADA SI NG 01SEP
4628-4500-6587-4209
03/09/2024 Debit Card Transaction 8.38 50.61
LAZADA SI NG 01SEP
4628-4500-6587-4209
03/09/2024 Advice Point-Of-Sale Transaction or Proceeds 10.00 40.61
NETS QR PAYMENT 424713245078858
TO: SILVER TRADE.COM
03/09/2024 Advice FAST Payment / Receipt 500.00 540.61
INCOMING PAYNOW REF 9496894
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
04/09/2024 Debit Card Transaction 1.88 538.73
BUS/MRT 494179669 SI NG 29AUG
4628-4500-6587-4209
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

04/09/2024 Debit Card Transaction 1.88 536.85

BUS/MRT 494781818 SI NG 30AUG
4628-4500-6587-4209
05/09/2024 Debit Card Transaction 1.88 534.97
BUS/MRT 495326405 SI NG 31AUG
4628-4500-6587-4209
05/09/2024 Debit Card Transaction 20.16 514.81
LAZADA SINGAPORE SI NG 03SEP
4628-4500-6587-4209
05/09/2024 Advice FAST Payment / Receipt 30.00 484.81
PAYNOW TRANSFER 8780603
TO: PY-01 PTE. LTD.
R
OTHER
06/09/2024 Advice FAST Payment / Receipt 96.00 580.81
INCOMING PAYNOW REF 7441424
FROM: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 580.81

Transaction Details as of 30 Sep 2024 Page 2 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 580.81

07/09/2024 Advice Outward Telegraphic Transfer 80.00 500.81

MB150342182411G81
0016OT4307409
VALUE DATE : 07/09/2024
08/09/2024 Advice FAST Payment / Receipt 2.00 498.81
PAYNOW TRANSFER 6524929
TO: MJ FRUITS
PAYNOW TRANSFER
OTHER
09/09/2024 Advice FAST Payment / Receipt 5.00 493.81
PAYNOW TRANSFER 9853435
TO: PRAVEEN
PAYNOW TRANSFER
OTHER
09/09/2024 Advice FAST Payment / Receipt 4,000.00 4,493.81
INCOMING PAYNOW REF 5517125
FROM: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
09/09/2024 Advice Outward Telegraphic Transfer 10.00 4,483.81
MB150527797357C46
0016OT4402847
VALUE DATE : 09/09/2024
09/09/2024 Advice Outward Telegraphic Transfer 10.00 4,473.81
MB150528637067C28
0016OT4403559
VALUE DATE : 09/09/2024
09/09/2024 Advice Outward Telegraphic Transfer 3,979.99 493.82
MB150536132359G54
0016OT4408920
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

VALUE DATE : 09/09/2024

09/09/2024 Advice FAST Payment / Receipt 400.00 93.82
PAYNOW TRANSFER 6418523
TO: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
10/09/2024 Advice FAST Payment / Receipt 30.00 123.82
INCOMING PAYNOW REF 8922299
FROM: BAGUIO FELEX QUILANTANG
PAYNOW TRANSFER
OTHER
11/09/2024 Advice Outward Telegraphic Transfer 15.00 108.82
MB150636643879G72
0016OT4506784
VALUE DATE : 11/09/2024
11/09/2024 Advice FAST Payment / Receipt 15.00 123.82
INCOMING PAYNOW REF 5288977
FROM: PRAVEEN
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 123.82

Transaction Details as of 30 Sep 2024 Page 3 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 123.82

12/09/2024 Debit Card Transaction 17.60 106.22

7-ELEVEN-BRAS BASAH SI NG 10SEP
4628-4500-6587-4209
12/09/2024 Advice FAST Payment / Receipt 220.00 326.22
INCOMING PAYNOW REF 8454773
FROM: KARWASRA DEEPAK
PAYNOW TRANSFER
OTHER
12/09/2024 Advice FAST Payment / Receipt 220.00 106.22
PAYNOW TRANSFER 9179295
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
12/09/2024 Advice FAST Payment / Receipt 30.00 76.22
PAYNOW TRANSFER 9217512
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
12/09/2024 Advice Outward Telegraphic Transfer 70.00 6.22
MB150725474167A49
0016OT4583532
VALUE DATE : 12/09/2024
19/09/2024 Debit Card Transaction 2.49 3.73
BUS/MRT 503028220 SI NG 14SEP
4628-4500-6587-4209
20/09/2024 Advice FAST Payment / Receipt 2.70 1.03
PAYNOW TRANSFER 9479227
TO: ARASI STORE
53328080WCAR HX3408753204
OTHER
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

23/09/2024 Advice FAST Payment / Receipt 1,269.25 1,270.28

INCOMING PAYNOW REF 1892067
FROM: TIMOTHY TAN TSE YUEN
TRANSFER - MOBILE
OTHER
23/09/2024 Advice FAST Payment / Receipt 701.80 1,972.08
INCOMING PAYNOW REF 1892133
FROM: TIMOTHY TAN TSE YUEN
ARMIT
OTHER
23/09/2024 Advice FAST Payment / Receipt 82.00 1,890.08
PAYNOW TRANSFER 5637888
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
23/09/2024 Advice FAST Payment / Receipt 30.00 1,860.08
PAYNOW TRANSFER 5640086
TO: KHUSH
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 1,860.08

Transaction Details as of 30 Sep 2024 Page 4 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 1,860.08

23/09/2024 Advice FAST Payment / Receipt 600.00 2,460.08

INCOMING PAYNOW REF 5680226
FROM: PRAVEEN
PAYNOW TRANSFER
OTHER
23/09/2024 ATM Cash Withdrawal 1,650.00 810.08
65874209,BUFFALO RD662B
23/09/2024 Advice FAST Payment / Receipt 15.00 795.08
PAYNOW TRANSFER 5997512
TO: BHAGAT ENTERPRISE PTE. LTD.
T
OTHER
24/09/2024 Advice FAST Payment / Receipt 948.15 1,743.23
INCOMING PAYNOW REF 9507135
FROM: BISHNOI ARMAN
PAYNOW TRANSFER
OTHER
25/09/2024 Advice FAST Payment / Receipt 218.00 1,525.23
PAYNOW TRANSFER 5178722
TO: BIRMINGHAM ACADEMY PTE. LTD.
M0254951K NOC
OTHER
25/09/2024 Advice FAST Payment / Receipt 10.00 1,535.23
INCOMING PAYNOW REF 5744785
FROM: PRAVEEN
PAYNOW TRANSFER
OTHER
25/09/2024 Advice Outward Telegraphic Transfer 10.01 1,525.22
MB151428054293H84
0016OT5156928
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

VALUE DATE : 25/09/2024

25/09/2024 Advice FAST Payment / Receipt 218.00 1,743.22
INCOMING PAYNOW REF 6358630
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
25/09/2024 ATM Cash Withdrawal 1,700.00 43.22
65874209,BUFFALO RD662B
25/09/2024 Advice Outward Telegraphic Transfer 20.00 23.22
MB151448777290E53
0016OT5177608
VALUE DATE : 25/09/2024
27/09/2024 Debit Card Transaction 6.78 16.44
LAZADA SI NG 25SEP
4628-4500-6587-4209
Balance Carried Forward SGD 16.44

Transaction Details as of 30 Sep 2024 Page 5 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 16.44

27/09/2024 Advice FAST Payment / Receipt 300.00 316.44

INCOMING PAYNOW REF 6019416
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
27/09/2024 Advice FAST Payment / Receipt 700.00 1,016.44
INCOMING PAYNOW REF 6549277
FROM: SUNIL KUMAR
PAYNOW TRANSFER
OTHER
27/09/2024 Advice FAST Payment / Receipt 700.00 316.44
PAYNOW TRANSFER 6601803
TO: SUNIL KUMAR
PAYNOW TRANSFER
OTHER
27/09/2024 Advice Outward Telegraphic Transfer 200.01 116.43
MB151559342331A33
0016OT5299498
VALUE DATE : 27/09/2024
28/09/2024 Advice Outward Telegraphic Transfer 50.01 66.42
MB151600123134I26
0016OT5335349
VALUE DATE : 28/09/2024
28/09/2024 Advice FAST Payment / Receipt 15.00 81.42
INCOMING PAYNOW REF 9202898
FROM: PRAVEEN
PAYNOW TRANSFER
OTHER
28/09/2024 Advice Outward Telegraphic Transfer 14.99 66.43
MB151621764620J13
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

0016OT5354262
VALUE DATE : 28/09/2024
29/09/2024 Debit Card Transaction 5.00 61.43
EAT. @ TIONG BAHRU SI NG 26SEP
4628-4500-6587-4209
30/09/2024 Advice Outward Telegraphic Transfer 60.00 1.43
MB151692067753A16
0016OT5392089
VALUE DATE : 30/09/2024

Total Balance Carried Forward in SGD: 9,684.56 9,631.58 1.43

Transaction Details as of 30 Sep 2024 Page 6 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 Messages For You

l Best execution policy for handling of customers’ orders

DBS has made available to you our Best Execution Policy that sets out our policies and procedures to place and/or execute
(i) customers’ orders on the best available terms (commonly referred to as “best execution”) and; (ii) comparable customers’
orders in accordance with the time of receipt of such orders.

When executing orders on our customers’ behalf, we will consider a range of execution factors. The factors may include
price, costs, speed, likelihood of execution and settlement, size and nature of the order, or any other considerations relevant
to the placement and/or execution of the order.

A copy of the DBS Wealth Management & Retail Best Execution Policy is available on our DBS website at
www.dbs.com.sg/bestexecution

l Revision of Terms and Conditions Governing Accounts (Applicable to Individuals)

With effect from 16 September 2024, selected clauses in the Terms and Conditions Governing Accounts will be updated.
Please refer to https://go.dbs.com/sg-16SEP24TNC for more details.

l SIBOR Transition to SORA

In line with the discontinuation of the Singapore Interbank Offer Rate (SIBOR), customers with SIBOR-based credit facilities,
including home loans, are encouraged to switch to an alternative home loan package by 30 April 2024. To find out how you
can apply for an alternative home loan package, please visit https://go.dbs.com/sg-hlsibor

l We regularly conduct customer satisfaction surveys to better understand your banking experience with us.
As a valued customer, you may receive a push notification or email invitation to share your feedback via Qualtrics, our
designated digital survey platform. Your response is highly valued and will be treated with absolute confidentiality.

l Update your personal particulars today

Got a new address, passport, mobile number or email? Simply use digibank to update your details. Visit
https://go.dbs.com/sg-ppu to learn more.

For Your Information

DEPOSIT INSURANCE SCHEME
Singapore dollar deposits of non-bank depositors and monies and deposits denominated in Singapore dollars under the
Supplementary Retirement Scheme are insured by the Singapore Deposit Insurance Corporation, for up to S$100,000 in aggregate
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

per depositor per Scheme member by law. Monies and deposits denominated in Singapore dollars under the CPF Investment
Scheme and CPF Retirement Sum Scheme are aggregated and separately insured up to S$100,000 for each depositor per
Scheme member. Foreign currency deposits, dual currency investments, structured deposits and other investment products are not
insured.

GENERAL
Please examine this statement. Subject to any other applicable terms, please notify us of any error or discrepancy within fourteen
(14) days from the date of receipt of this statement.

Clients Residing in Australia - Limitations to Banking Services and Investment Offering

With effect from 6 February 2023, there will be limitations in banking services and investment offerings to our clients whose
residential address is in Australia. For more information, please visit our website at http://go.dbs.com/sg-auresident.

°rŽŽŽr°1šcJ ®Kl5˜;4‡œ1°rŽŽŽr°
p3Un3j[n{:x‰šH vJœªB57bIIW;Zf For Terms and Codes, Product Disclaimers, and
5RL=€Ž†«}W^`oF—@”8ˆ“~¨Tjdv€©q more information, scan this QR code or visit
pQ___Qp1§]bg—>6¦_Ue°=Z>­–ª
qqqqqqq1qq111q1q111qqqq1q11q1 http://go.dbs.com/sg-products-information. Page 7 of 7

PDS_MMCON_X_ONSH_0dea016800000039_01915
 S/N: EN05010903516003
Consolidated Statement
, "%

%)
)
,
ARPIT SAINI
BLK 17 JOO SENG ROAD
#08-123
SINGAPORE 360017
./-.0-./0--00--00-/.0-0-0/./.0

Account Summary as at 31 Aug 2024

Deposits

Current and Savings Account Total: SGD Equivalent 54.41

Summary of Currency Breakdown:

SGD 54.41

Account Account No. Balance Balance

(Base Currency) (SGD Equivalent)

DBS Multiplier Account 271-834851-8 SGD 54.41 54.41

SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

Account Summary as of 31 Aug 2024 Page 1 of 6

PDS_MMCON_X_ONSH_0dcc011c0000000c_02518
 Transaction Details as at 31 Aug 2024
Deposits

DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

CURRENCY: SINGAPORE DOLLAR

Balance Brought Forward SGD 4.35

01/08/2024 Debit Card Transaction 2.38 1.97

BUS/MRT 475957779 SI NG 27JUL
4628-4500-6587-4209
01/08/2024 Advice FAST Payment / Receipt 17.00 18.97
INCOMING PAYNOW REF 5746095
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
01/08/2024 Advice Point-Of-Sale Transaction or Proceeds 16.40 2.57
NETS QR PAYMENT 421413254233700
TO: 7-ELEVEN
03/08/2024 Advice FAST Payment / Receipt 400.00 402.57
INCOMING PAYNOW REF 7126128
FROM: SUMIT
PAYNOW TRANSFER
OTHER
03/08/2024 Advice FAST Payment / Receipt 50.00 452.57
INCOMING PAYNOW REF 7150997
FROM: SUMIT
PAYNOW TRANSFER
OTHER
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

05/08/2024 Advice FAST Payment / Receipt 10.00 442.57

PAYNOW TRANSFER 6694078
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
05/08/2024 Advice FAST Payment / Receipt 15.00 427.57
PAYNOW TRANSFER 7066716
TO: SUN SHINE HAIR & SKIN CAREP
R
OTHER
10/08/2024 Advice Point-Of-Sale Transaction or Proceeds 29.90 397.67
NETS QR PAYMENT 422311514486833
TO: YOU ME FASHION
10/08/2024 Advice FAST Payment / Receipt 20.00 417.67
INCOMING PAYNOW REF 6664576
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 417.67

Transaction Details as of 31 Aug 2024 Page 2 of 6

PDS_MMCON_X_ONSH_0dcc011c0000000c_02518
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 417.67

10/08/2024 Advice FAST Payment / Receipt 395.00 22.67

PAYNOW TRANSFER 6659024
TO: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
11/08/2024 Advice FAST Payment / Receipt 80.00 102.67
INCOMING PAYNOW REF 8557804
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
11/08/2024 Advice FAST Payment / Receipt 49.00 53.67
PAYNOW TRANSFER 8967890
TO: BHAVIK
PAYNOW TRANSFER
OTHER
12/08/2024 Advice FAST Payment / Receipt 10.00 43.67
PAYNOW TRANSFER 5270620
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
14/08/2024 Debit Card Transaction 2.49 41.18
BUS/MRT 482618940 SI NG 08AUG
4628-4500-6587-4209
16/08/2024 Advice FAST Payment / Receipt 90.00 131.18
INCOMING PAYNOW REF 5442596
FROM: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
16/08/2024 Advice FAST Payment / Receipt 130.00 1.18
PAYNOW TRANSFER 5448364
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

TO: RAHUL KUMAR

PAYNOW TRANSFER
OTHER
17/08/2024 Advice FAST Payment / Receipt 200.00 201.18
INCOMING PAYNOW REF 7573464
FROM: SUMIT
PAYNOW TRANSFER
OTHER
17/08/2024 Advice FAST Payment / Receipt 50.00 151.18
PAYNOW TRANSFER 7678609
TO: VIKAS
PAYNOW TRANSFER
OTHER
17/08/2024 Advice FAST Payment / Receipt 400.00 551.18
INCOMING PAYNOW REF 9086252
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
Balance Carried Forward SGD 551.18

Transaction Details as of 31 Aug 2024 Page 3 of 6

PDS_MMCON_X_ONSH_0dcc011c0000000c_02518
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 551.18

17/08/2024 Advice FAST Payment / Receipt 400.00 151.18

PAYNOW TRANSFER 9089746
TO: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
19/08/2024 Advice FAST Payment / Receipt 4.00 147.18
PAYNOW TRANSFER 7247149
TO: KHUSH
PAYNOW TRANSFER
OTHER
19/08/2024 Advice FAST Payment / Receipt 1,173.90 1,321.08
INCOMING PAYNOW REF 7286076
FROM: NON RESIDENT PTE. LTD.
JULY SALARY
OTHER
19/08/2024 Advice FAST Payment / Receipt 183.00 1,138.08
PAYNOW TRANSFER 7449622
TO: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
19/08/2024 Advice FAST Payment / Receipt 76.00 1,062.08
PAYNOW TRANSFER 7454506
TO: KHUSH
PAYNOW TRANSFER
OTHER
19/08/2024 Advice FAST Payment / Receipt 16.00 1,046.08
PAYNOW TRANSFER 7460971
TO: VERMA HARIOM SUBHASHBHAI
PAYNOW TRANSFER
OTHER
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

20/08/2024 Advice FAST Payment / Receipt 96.57 949.51

PAYNOW TRANSFER 9059296
TO: ERIC
PAYNOW TRANSFER
OTHER
20/08/2024 Advice FAST Payment / Receipt 50.00 899.51
PAYNOW TRANSFER 5280188
TO: SUMIT
PAYNOW TRANSFER
OTHER
20/08/2024 Advice FAST Payment / Receipt 1.00 900.51
INCOMING PAYNOW REF 5284514
FROM: SUMIT
PAYNOW TRANSFER
OTHER
20/08/2024 ATM Cash Withdrawal 900.00 0.51
65874209,BUFFALO RD662B
Balance Carried Forward SGD 0.51

Transaction Details as of 31 Aug 2024 Page 4 of 6

PDS_MMCON_X_ONSH_0dcc011c0000000c_02518
 DBS Multiplier Account Account No. 271-834851-8

Date Description Withdrawal (-) Deposit (+) Balance

w

Balance Brought Forward SGD 0.51

25/08/2024 Advice FAST Payment / Receipt 30.00 30.51

INCOMING PAYNOW REF 8192281
FROM: SINGH KHUSHPREET
PAYNOW TRANSFER
OTHER
25/08/2024 Point-of-Sale Transaction 3.10 27.41
65874209,ARASI STORE
27/08/2024 Advice FAST Payment / Receipt 50.00 77.41
INCOMING PAYNOW REF 7693079
FROM: GEDIYA HARSH PARSOTTAMBHAI
PAYNOW TRANSFER
OTHER
27/08/2024 Advice FAST Payment / Receipt 60.00 17.41
PAYNOW TRANSFER 7719718
TO: HANMANT
PAYNOW TRANSFER
OTHER
28/08/2024 Advice FAST Payment / Receipt 1.00 16.41
PAYNOW TRANSFER 5821011
TO: MJ FRUITS
PAYNOW TRANSFER
OTHER
29/08/2024 Advice FAST Payment / Receipt 1,000.00 1,016.41
INCOMING PAYNOW REF 7226639
FROM: THAKUR DEEPAK CHETANSINGH
PAYNOW TRANSFER
OTHER
31/08/2024 ATM Cash Withdrawal 950.00 66.41
65874209,BUFFALO RD662B
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

31/08/2024 Advice Point-Of-Sale Transaction or Proceeds 12.00 54.41

NETS QR PAYMENT 424412151803404
TO: NANAK ELECTRONICS

Total Balance Carried Forward in SGD: 3,461.84 3,511.90 54.41

Transaction Details as of 31 Aug 2024 Page 5 of 6

PDS_MMCON_X_ONSH_0dcc011c0000000c_02518
 Messages For You

l Best execution policy for handling of customers’ orders

DBS has made available to you our Best Execution Policy that sets out our policies and procedures to place and/or execute
(i) customers’ orders on the best available terms (commonly referred to as “best execution”) and; (ii) comparable customers’
orders in accordance with the time of receipt of such orders.

When executing orders on our customers’ behalf, we will consider a range of execution factors. The factors may include
price, costs, speed, likelihood of execution and settlement, size and nature of the order, or any other considerations relevant
to the placement and/or execution of the order.

A copy of the DBS Wealth Management & Retail Best Execution Policy is available on our DBS website at
www.dbs.com.sg/bestexecution

l Revision of Terms and Conditions Governing Accounts (Applicable to Individuals)

With effect from 16 September 2024, selected clauses in the Terms and Conditions Governing Accounts will be updated.
Please refer to https://go.dbs.com/sg-16SEP24TNC for more details.

l SIBOR Transition to SORA

In line with the discontinuation of the Singapore Interbank Offer Rate (SIBOR), customers with SIBOR-based credit facilities,
including home loans, are encouraged to switch to an alternative home loan package by 30 April 2024. To find out how you
can apply for an alternative home loan package, please visit https://go.dbs.com/sg-hlsibor

l We regularly conduct customer satisfaction surveys to better understand your banking experience with us.
As a valued customer, you may receive a push notification or email invitation to share your feedback via Qualtrics, our
designated digital survey platform. Your response is highly valued and will be treated with absolute confidentiality.

l Update your personal particulars today

Got a new address, passport, mobile number or email? Simply use digibank to update your details. Visit
https://go.dbs.com/sg-ppu to learn more.

For Your Information

DEPOSIT INSURANCE SCHEME
Singapore dollar deposits of non-bank depositors and monies and deposits denominated in Singapore dollars under the
Supplementary Retirement Scheme are insured by the Singapore Deposit Insurance Corporation, for up to S$100,000 in aggregate
SG40020000876 (08/2014) DBS Co. Reg. No. 196800306E GST Reg No: MR-8500180-3 / POSB Biz Reg No. 52880148A

per depositor per Scheme member by law. Monies and deposits denominated in Singapore dollars under the CPF Investment
Scheme and CPF Retirement Sum Scheme are aggregated and separately insured up to S$100,000 for each depositor per
Scheme member. Foreign currency deposits, dual currency investments, structured deposits and other investment products are not
insured.

GENERAL
Please examine this statement. Subject to any other applicable terms, please notify us of any error or discrepancy within fourteen
(14) days from the date of receipt of this statement.

Clients Residing in Australia - Limitations to Banking Services and Investment Offering

With effect from 6 February 2023, there will be limitations in banking services and investment offerings to our clients whose
residential address is in Australia. For more information, please visit our website at http://go.dbs.com/sg-auresident.

°rŽŽŽr°1šcJ ®Kl5˜;4‡œ1°rŽŽŽr°
p3Un3j[n{:x‰šH vJœªB57bIIW;Zf For Terms and Codes, Product Disclaimers, and
5RL=€Ž†«}W^`oF—@”8ˆ“~¨Tjdv€©q more information, scan this QR code or visit
pQ___Qp1§]bg—>6¦_Ue°=Z>­–ª
qqqqqqq1qq111q1q111qqqq1q11q1 http://go.dbs.com/sg-products-information. Page 6 of 6

PDS_MMCON_X_ONSH_0dcc011c0000000c_02518
 Formulaire de demande harmonisé
N°14076*05
Demande de Visa Schengen
Ce formulaire de demande est gratuit PHOTO

Les membres de la famille de ressortissants de l’UE, de l’EEE ou de la Confédération suisse ou de ressortissants du Royaume-Uni
bénéficiaires de l'accord sur le retrait du Royaume-Uni ne doivent pas remplir les cases 21, 22, 30, 31 et 32 (assorties d'un *).
Les données des cases 1 à 3 doivent correspondre à celles figurant sur le document de voyage.

1. Nom [nom de famille] : SAINI Partie réservée à

l’administration
Date de la demande :
2. Nom à la naissance [nom(s) de famille antérieur(s)] : 16/10/2024
Numéro de la demande :
FRA1SI20247 015815
3. Prénom(s) [nom(s) usuel(s)] : Arpit Demande introduite :
 Auprès d’une
ambassade/d’un consulat
4. Date de naissance (jour-mois- 5. Lieu de naissance : 7. Nationalité actuelle :  Auprès d’un
année) : prestataire de services
02/07/2005 PATHANPURA Indienne
 Auprès d’un
Nationalité à la naissance, si différente : intermédiaire commercial
6. Pays de naissance :  à la frontière
Inde Autre(s) nationalité(s) : (nom) :
 autres :

Responsable du dossier :

8. Sexe : 9. État Civil : Documents justificatifs :

 Célibataire  Marié(e)  Partenariat enregistré ■ Séparé(e)  Document de voyage
 Homme
■
 Femme  Autre  Divorcé(e)  Veuf(Veuve)  Autre (à préciser) :  Moyens de
subsistance
10. Autorité parentale (pour les mineurs)/tuteur légal ( nom, prénom, adresse (si différente de celle du demandeur),  Invitation
numéro de téléphone, adresse électronique et nationalité :  Assurance maladie en
voyage
 Moyen de transport
 Autres :

Décision concernant le
visa :
11. Numéro national d’identité, le cas échéant : W9234260  Refusé
 Délivré
 A
 C
12. Type de document de voyage :
■ Passeport ordinaire  Passeport diplomatique  Passeport de service  Passeport officiel  Passeport spécial  VTL
 Autre document de voyage (à préciser) :
Valable :
13. Numéro du document de voyage : 14. Date de délivrance : 15. Date d’expiration : 16. Délivré par (pays) : A partir du .......….…….…
………
W9234260 10/10/2023 09/10/2033 Inde
Jusqu’au.....…….….……
….…....
17. Données à caractère personnel du membre de la famille qui est un ressortissant de l’UE, de l’EEE ou de la
Confédération suisse ou un ressortissant du Royaume-Uni bénéficiaire de l’accord sur le retrait du Royaume-Uni de l’UE, Nombre d’entrées :
selon le cas :  1  2  Multiples
Nom (nom de famille) : Prénom(s) [nom(s) usuel(s)] : Nombre de jours : ............

Date de naissance (jour-mois-année) : Nationalité : Numéro du document de voyage ou de la carte d’identité :

1/4
*FRA1SI20247015815*
18. Lien de parenté avec un ressortissant de l’UE, de l’EEE ou de la Confédération suisse ou un ressortissant du Royaume-Uni bénéficiaire de l’accord
de retrait du Royaume-Uni de l’UE, selon le cas :
 Conjoint  Enfant  Petit-fils ou petite-fille  Ascendant dépendant  Partenariat enregistré  Autre

19. Adresse du domicile et adresse électronique du demandeur : Numéro de téléphone :

PATHANPURA +6582140438
247778
PATHANPURA
Inde
krsolar499@gmail.com

20. Résidence dans un pays autre que celui de la nationalité actuelle :


■ Non  Oui : Titre de séjour ou équivalent N°…………….…..…..….……………….……Valide jusqu’au ………..…………..

* 21. Profession actuelle :

Employé

* 22. Nom, adresse et numéro de téléphone de l’employeur. Pour les étudiants, adresse de l’établissement d’enseignement :
KIINGS ENTERTAINMENT PTE.LTD
304 ORCHARD ROAD 1-48 LUCKY PLAZA SINGAPORE, 238863, SINGAPORE
Singapour, +6593471891

23. Objet(s) du voyage :


■ Tourisme  Affaires  Visite à la famille ou à des amis  Culture  Sports  Visite officielle
 Raisons médicales  Études  Transit aéroportuaire  Autre (à préciser) :

24. Informations complémentaires sur l'objet du voyage :

for see the culture of france

25. État membre de destination principale (et autres Etats membres de 26. État membre de première entrée :
destination, le cas échéant) :
France métropolitaine

27. Nombre d’entrées demandées :


■ Une entrée  Deux entrées  Entrées multiples

Date d’arrivée prévue pour le 1er séjour envisagé dans l’espace Schengen : 23/11/2024
Date de départ prévue de l’espace Schengen après le 1er séjour envisagé : 26/11/2024

28. Empreintes digitales relevées précédemment aux fins d’une demande de visa Schengen :
■ Non  Oui. Date, si elle est connue : ……….…………... Numéro du visa, s’il est connu :………………………………………………

29. Autorisation d’entrée dans le pays de destination finale, le cas échéant :

Délivrée par……………………………….……………………………………...………, valable du……………………..au……...…………………
* 30. Nom et prénom de la ou des personnes qui invitent dans le ou les États membres. A défaut, nom d’un ou des hôtels ou lieux d’hébergement
temporaire dans le ou les États membres :

YELO LUMIERE POWERED BY SONDER

2/4
Adresse et adresse électronique de la ou des personnes qui invitent /du ou des hôtels /du ou des lieux Numéro de téléphone :
d’hébergement temporaire :
5 PLACE DE LA GARE, CANNES CITY CENTRE, 06400, FRANCE +33187212290
France

* 31. Nom et adresse de l’entreprise /l’organisation hôte : Numéro de téléphone de l’entreprise /

l’organisation :

Nom, prénom, adresse, numéro de téléphone, et adresse électronique de la personne de contact dans l’entreprise/organisation :

* 32. Les frais de voyage et de subsistance durant le séjour du demandeur sont financés :


■ Par le demandeur  Par un garant (hôte, entreprise, organisation), veuillez préciser :
 Visé dans la case 30 ou 31
Moyens de subsistance :  Autre (à préciser) :

■ Argent liquide
 Chèques de voyage

■ Carte de crédit
 Hébergement prépayé Moyens de subsistance :

■ Transport prépayé  Argent liquide
 Autre (à préciser) :  Hébergement fourni
 Tous les frais sont financés pendant le séjour
 Transport prépayé
 Autre (à préciser) :

33. Nom et prénom de la personne qui remplit le formulaire de demande, si elle n’est pas le demandeur :

Adresse et adresse électronique de la personne qui remplit le formulaire de demande : Numéro de téléphone :

3/4
*FRA1SI20247015815*
Je suis informé(e) que les droits de visa ne sont pas remboursés si le visa est refusé.

Applicable en cas de délivrance d'un visa à entrées multiples

Je suis informé(e) de la nécessité de disposer d’une assurance maladie en voyage adéquate pour mon premier séjour et lors de voyages ultérieurs sur le territoire des
États membres.

En connaissance de cause, j'accepte ce qui suit : aux fins de l'examen de ma demande, il y a lieu de recueillir les données requises dans ce formulaire de demande,
de me photographier et, le cas échéant, de prendre mes empreintes digitales. Les données à caractère personnel me concernant qui figurent dans le présent
formulaire de demande, ainsi que mes empreintes digitales et ma photo, seront communiquées aux autorités compétentes des États membres et traitées par elles,
aux fins de la décision relative à ma demande de visa,
Ces données ainsi que celles concernant la décision relative à ma demande, ou toute décision d'annulation, d'abrogation ou de prolongation de visa, seront saisies
et conservées dans le système d'information sur les visas (VIS) pendant une période maximale de cinq ans durant laquelle elles seront accessibles aux
autorités chargées des visas, aux autorités compétentes chargées de contrôler les visas aux frontières extérieures et dans les États membres, aux
autorités compétentes en matière d'immigration et d'asile dans les États membres aux fins de la vérification du respect des conditions d'entrée et de séjour réguliers
sur le territoire des États membres, de l'identification des personnes qui ne remplissent pas ou plus ces conditions, de l'examen d'une demande d'asile
et de la détermination de l'autorité responsable de cet examen. Dans certaines conditions, ces données seront aussi accessibles aux autorités désignées des États
membres et à Europol aux fins de la prévention et de la détection des infractions terroristes et des autres infractions pénales graves, ainsi qu'aux fins des enquêtes
en la matière. Les autorités de l'État membre compétentes pour le traitement des données sont le Ministère de l’Intérieur (Place Beauvau - 75800 Paris CEDEX 08)
et le Ministère de l’Europe et des Affaires Etrangères (27 rue de la Convention – 75732 PARIS Cedex 15).
Je suis informé(e) de mon droit d'obtenir auprès de n'importe quel État membre la notification des données me concernant qui sont enregistrées dans le VIS ainsi
que de l'État membre qui les a transmises, et de demander que les données me concernant soient rectifiées si elles sont erronées ou effacées si elles ont été traitées
de façon illicite. À ma demande expresse, l'autorité qui a examiné ma demande m'informera de la manière dont je peux exercer mon droit de vérifier les données à
caractère personnel me concernant et de les faire rectifier ou effacer, y compris des voies de recours prévues à cet égard par le droit national de l'État
membre concerné. L'autorité de contrôle nationale dudit État membre [ Commission Nationale de l'Informatique et des Libertés – 3 Place de Fontenoy -
TSA 80715 - 75334 PARIS CEDEX 07 ] pourra être saisie des demandes concernant la protection des données à caractère personnel.
Je déclare qu'à ma connaissance, toutes les indications que j'ai fournies sont correctes et complètes. Je suis informé(e) que toute fausse déclaration entraînera le
rejet de ma demande ou l'annulation du visa s'il a déjà été délivré, et peut également entraîner des poursuites pénales à mon égard en application du droit de l'État
membre qui traite la demande.
Je m'engage à quitter le territoire des États membres avant l'expiration du visa, si celui-ci m'est accordé. J'ai été informé(e) que la possession d'un visa n'est que
l'une des conditions préalables d'entrée sur le territoire européen des États membres. Le simple fait qu'un visa m'ait été accordé ne signifie pas que
j'aurai droit à une indemnisation si je ne respecte pas les dispositions pertinentes à l'article 6, paragraphe 1, du règlement UE 2016/399 ( code frontières Schengen)
et que l'entrée m'est par conséquent refusée. Le respect des conditions préalables d'entrée sera contrôlé à nouveau au moment de l'entrée sur le territoire européen
des États membres.

Lieu et date : Signature du demandeur (signature de l’autorité parentale/du tuteur légal, le cas échéant) :
17/10/2024 01: 55: 58 (heure de
Singapour)

4/4
17/10/2024 01:55:58 (heure de Singapour) 1/2

France-Visas
Le site officiel des visas pour la France

Récépissé d'enregistrement

Le 16/10/2024, vos informations ont bien été enregistrées par le système France-Visas.

Référence de la demande : FRA1SI20247015815

Nom : SAINI

Prénom(s) : Arpit
*FRA1SI20247015815*
Date de naissance : 02/07/2005

PIECES JUSTIFICATIVES REQUISES POUR LE DEPOT DE VOTRE DEMANDE

Le jour de votre rendez-vous, merci de vous présenter muni des originaux et copie de l'ensemble des documents listés ci-après,
traduits en Français / Anglais ou Espagnol (si accepté par le centre des visas)*.
Si vous êtes étudiant et avez numérisé l'ensemble de vos pièces justificatives, merci d'apporter les originaux des documents listés
ci-dessous uniquement.

FORMULAIRES

Formulaire de demande daté et signé

Récépissé France-Visas

PRÉ-REQUIS

Photographie d'identité.

Si vous êtes titulaire d'un document de voyage officiel, présentation obligatoire d'une note verbale.

Si vous n’êtes pas un ressortissant singapourien : permis de résidence valide 3 mois au moins après la
date de retour envisagée ou "in-principle renewal approval" d'ICA. Pour les résidents permanents, fournir le
Re-Entry Permit. Pour les titulaires d'autres titres de séjour (EP, Work Pass, DP, etc), merci de fournir votre
Pass Status. Pour les résidents du Brunei Darussalam: copie du re-entry permit (tampon dans le
passeport) et/ou de la carte de résident selon le régime qui vous est applicable.

Un document de voyage, délivré depuis moins de 10 ans, comportant au minimum deux pages vierges,
d'une durée de validité supérieure d'au moins 3 mois à la date à laquelle vous avez prévu de quitter
l'Espace Schengen ou, en cas de long séjour, d'une durée de validité supérieure d'au moins trois mois à la
date d'expiration du visa sollicité. Veillez à transmettre (numériser) TOUTES LES PAGES de votre
document de voyage comportant des visas, cachets d’entrée et sortie ou toute autre inscription.

OBJET DU VOYAGE/SÉJOUR

Réservation du billet aller-retour ou itinéraire.

Si le voyage est organisé par une agence, lettre de l'agence confirmant que le demandeur de visa a
réservé un voyage organisé + programme détaillé.
17/10/2024 01:55:58 (heure de Singapour) 2/2

PREUVE D'INSTALLATION DANS LE PAYS DE RÉSIDENCE

Justificatifs de la situation socio-professionnelle (certificat de travail, extrait du registre du commerce et des

sociétés, certificat de scolarité, justificatif de pension...) et tout document attestant des liens personnels du
demandeur dans le pays de résidence (copie d'acte de mariage, ...).Si vous fournissez une lettre de votre
employeur, elle doit être récente, datée et signée, et mentionner les informations suivantes: date
d'embauche, salaire mensuel ou annuel, dates d'absence.

RESSOURCES

Relevés bancaires des trois derniers mois + fiches de paie des trois derniers mois. Si vous ne percevez
pas de salaire, tous justificatifs de ressources récents. Si une personne ou une organisation prend en
charge les frais liés à votre séjour, merci de fournir une lettre datée et signée par votre sponsor, sa pièce
d'identité, ainsi que tous éléments de ressources (relevés bancaires, fiches de paie, etc) montrant ses
capacités financières.

HÉBERGEMENT

Réservation d'hôtel ou moyens suffisants pour couvrir les frais d'hôtel (viatique de 120 Euros/jour) ou
contrat de bail ou certificat de propriété. En cas d'hébergement chez un particulier : attestation d'accueil
(formulaire Cerfa).

ASSURANCE MÉDICALE DE VOYAGE

Attestation d'assurance de voyage. L'assurance doit au moins couvrir la durée de votre séjour, et être
valide au moins pour tous les pays de l'espace Schengen. Voir FAQ pour détails.

TARIF APPLICABLE
Le jour de votre rendez-vous, vous devrez vous acquitter du montant des frais de dossier qui s’élèvent à : 90 €**, soit environ
129.85 Dollar de Singapour.
Quelle est la monnaie de paiement ? Quel moyen de paiement est accepté ? Nous vous invitons à consulter la rubrique tarifs après
avoir sélectionné la page de votre lieu de résidence. Vous y trouverez toutes les informations actualisées. Dans le cas où le dépôt
de votre demande est effectué auprès d’un prestataire de service, des frais de service seront perçus par celui-ci.
* Attention : l’absence d’un ou plusieurs de ces documents peut aboutir au refus du visa demandé. Le service des visas compétent
se réserve le droit de vous demander des documents et des informations complémentaires.
** Ce montant est donné à titre indicatif. Certains cas particuliers peuvent donner lieu à des tarifications spécifiques selon la
réglementation en vigueur.
 GENIUS CONSULTANTS LIMITED
UNIT NO. 515 A, 5TH FLOOR, DLF PRIME TOWERS,OKHLA, PHASE 1 NEW DELHI -110020 , DELHI, NEW DELHI-110020
EMAAR INDIA COMMUNITY MANAGEMENT PRIVATE LIMITED
EMAAR INDIA COMMUNITY - GURGAON

PAYSLIP FOR JUl' 23

Employee Name : ARPIT SAINI Employee ID : AEMP001697000053

PF : WB/CAL/34609//403106 Date Of Joining : 01 AUG 2023

UAN : 101365834947 Aadhaar : 596207324602

Bank A/C : 3718001700361885 Bank Name : PUNJAB NATIONAL BANK

IFSC Code : PUNB0371800 Designation : ADMIN EXECUTIVE

ESI : N/A Payable Days : 30.00

Location : GURGAON

SALARY

Actual
Particular(s) Gross Amount(Rs.) Deduction(s) Amount(Rs.) Net Amount(Rs.)
Amount(Rs.)

BASIC 13500.00 13500.00 PF 3100.00

ESI 0.00
DEPUTATION 500.00 500.00
ALLOWANCE PT 0.00
LWF EMP 66.00
HRA 7000.00 7000.00

MONTHLY BONUS 1541.00 1541.00

SKILL ALLOWANCE 13058.00 13058.00

STATUTORY BONUS 200.00 200.00

TRAVEL ALLOW 500.00 500.00

Total 36299.00 36299.00 3166.00 33133.00

REIMBURSEMENT

Reimbursement(s) disbursed Till date 2022-2023 Rs. 2258.00

Reimbursement(s) disbursed for the month AUG' 23 Rs. 2258.00

To view online payslip & other details ,please login https://www.geniusconsultant.com/ and click on Associate => Login by the following Login ID and Password.

Login ID AEMP001697000053 Password Password Changed

NOTE

* ESI Covered Employees - Please contact Local Branch / Dispensary and complete "Smart Card" formalities with your family members.
* Please provide your PAN at the earliest, if it is already provided please ignore this message.
* For any discrepency and query, please mail at enquiry@geniusconsultant.com
* This is a system generated statement, no signature is required.
Date:2024-10-17
Canada Visa Application Center - Singapore
Appointment Letter

Number of Applicants : 1

Appointment Details :
Applicant Name Reference Number Appointment Date Appointment Type
(YYYY-MM-DD) & Time
ARPIT SAINI 2024-10-17 1245 Biometric Enrolment

L
DELA637968055778/2

BA
Your appointment has been confirmed for the date and time reflecting against your name and reference number. Please be available at
the following address not more than 15 minutes before the appointed time. Kindly carry a hard copy of this letter to your scheduled
appointment.
Canada Visa Application Center - Singapore
Shivaji Stadium Metro Station, Mezzanine Level,Baba Kharak Singh Marg, Connaught Place
Singapore,
LO
Singapore,
465802.

Due to the COVID-19 outbreak, the VAC may be implementing additional measures to ensure health and safety
of applicants. Your safety is our priority. As part of precautionary measures, customers visiting our Visa
Application Centres may be subjected to body temperature checks to assess their health conditions and required
to wear a face mask.
G

Customers exhibiting COVID-19 symptoms, including fever (higher than 38 degrees Celsius), cough and
difficulty breathing will be advised to seek medical attention at the nearest healthcare facility of their choice.

Apart from the safety procedures conducted, please note that you must follow the below mentioned instructions
FS

for your scheduled appointment at the Canada Visa Application Centre

Please check the VAC opening status on our website prior to reaching the VAC on the date of appointment

Only Customer having an appointment will be allowed inside the building. Entry of accompanied members is not
V

permitted.

All decision envelopes will only be returned using the paid courier services offered by the Visa Application
Centre.
The VAC will NOT offer Passport collection or delivery; In-person enquiry, appointment booking, photocopy-
photobooth and self-service workstation services

Kindly maintain Social Distancing (1.5m) whilst in VAC/ building premises.

Kindly carry the below documents in hardcopy on the day of your appointment:

Appointment letter.

Valid Original Passport

Biometric Instruction letter.

Signed copy of the consent form, one form per applicant

L
Please note: To ensure the safety of all concerned, the VACs are being sanitized on a regular basis. The staff will be
wearing masks & gloves and all Biometric equipment and workstations will be sanitized.

Thank you for your understanding

BA
Map
LO
G

Thank you.
Canada Visa Application Center - New Delhi
FS

For more information on our VAC services, please visit – http://www.vfsglobal.ca/canada/india/

For more information on items which are prohibited at the VAC, please visit -
http://www.vfsglobal.ca/canada/india/security_regulations.html
V

For additional information on travel to Canada, please visit - http://www.cic.gc.ca/

You can also contact the helpdesk at the below mentioned details:

Email ID : info.canada@vfshelpline.com

Helpline Number: 022-67866002

 VFS Global Services Pvt. Ltd.
Little India,Ring Road
Singapore
Singapore

Company GSTN: 24AACCC7513P1ZH

Country: Singapore
Company FIN: AACCC7513P

Acknowledgement cum Tax Invoice

Invoice Number : 2425GBRAMD016051

Docket Number: GBR/AMD/220724/0031
Date : 2024-09-29 09:29:48 PM

Applicant Name : ARPIT SAINI Email: Krsolar499@gmail.com

Application Ref No : GWF078250287 Contact no: 9587276417
Visa Category Visit and Transit Sub Visa Category: Visiting academic (up to 6 months)

Service Description Amount:

INR 25,000.0
Automated Call Back Service - SAC Code: (SAC:998599)
Document Scanning Assistance - SAC Code: (SAC:998599) INR 13,000.0

SMS Service - SAC Code: (SAC:998599) INR 0.0

Sub Total 38,000.0

PAYMENT COLLECTION DETAILS Payment Summary

Mode of Payment: POS Total Visa Fee Collected: 0.0
Total Payment Collected: 38,000.0 Total VFS Fees 0.0
Collected:
Total Service Chages 38,000.0
Collected:

Grand Total: 38,000.0

Total CGST (9%) 118.22

collected:
Total SGST (9%) 118.22
collected:

Submission officer Vishva Modi

Documents required for collection of passport:

• VFS E-ICR (In case of third party collection - printout of the e-mail and VFS EICR is mandatory).
• Government issued valid photo identity.
• In case of third party collection - Authorisation Letter, Valid ID or Applicant and Valid ID of Authorised representative

For more information and our disclaimer please visit: https://visa.vfsglobal.com/ind/en/gbr/

Page 1/1
Save Paper. Print only if required
 GENIUS CONSULTANTS LIMITED
UNIT NO. 515 A, 5TH FLOOR, DLF PRIME TOWERS,OKHLA, PHASE 1 NEW DELHI -110020 , DELHI, NEW DELHI-110020
EMAAR INDIA COMMUNITY MANAGEMENT PRIVATE LIMITED
EMAAR INDIA COMMUNITY - GURGAON

PAYSLIP FOR JUN' 23

Employee Name : ARPIT SAINI Employee ID : AEMP001697000053

PF : WB/CAL/34609//403106 Date Of Joining : 01 Jun 2023

UAN : 101365834947 Aadhaar : 596207324602

Bank A/C : 3718001700361885 Bank Name : PUNJAB NATIONAL BANK

IFSC Code : PUNB0371800 Designation : ADMIN EXECUTIVE

ESI : N/A Payable Days : 31.00

Location : GURGAON

SALARY

Actual
Particular(s) Gross Amount(Rs.) Deduction(s) Amount(Rs.) Net Amount(Rs.)
Amount(Rs.)

BASIC 12500.00 12500.00 PF 1800.00

ESI 0.00
DEPUTATION
0.00 0.00
ALLOWANCE PT 0.00

HRA 5000.00 5000.00 LWF EMP 25.00

MONTHLY BONUS 1041.00 1041.00

SKILL ALLOWANCE 10058.00 10058.00

STATUTORY BONUS 0.00 0.00

TRAVEL ALLOW 0.00 0.00

Total 28599.00 28599.00 1825.00 26774.00

REIMBURSEMENT

Reimbursement(s) disbursed Till date 2022-2023 Rs. 958.00

Reimbursement(s) disbursed for the month JUN' 23 Rs. 958.00

To view online payslip & other details ,please login https://www.geniusconsultant.com/ and click on Associate => Login by the following Login ID and Password.

Login ID AEMP001697000053 Password Password Changed

NOTE

* ESI Covered Employees - Please contact Local Branch / Dispensary and complete "Smart Card" formalities with your family members.
* Please provide your PAN at the earliest, if it is already provided please ignore this message.
* For any discrepency and query, please mail at enquiry@geniusconsultant.com
* This is a system generated statement, no signature is required.
 GENIUS CONSULTANTS LIMITED
UNIT NO. 515 A, 5TH FLOOR, DLF PRIME TOWERS,OKHLA, PHASE 1 NEW DELHI -110020 , DELHI, NEW DELHI-110020
EMAAR INDIA COMMUNITY MANAGEMENT PRIVATE LIMITED
EMAAR INDIA COMMUNITY - GURGAON

PAYSLIP FOR JUl' 23

Employee Name : ARPIT SAINI Employee ID : AEMP001697000053

PF : WB/CAL/34609//403106 Date Of Joining : 01 Jul 2023

UAN : 101365834947 Aadhaar : 596207324602

Bank A/C : 3718001700361885 Bank Name : PUNJAB NATIONAL BANK

IFSC Code : PUNB0371800 Designation : ADMIN EXECUTIVE

ESI : N/A Payable Days : 30.00

Location : GURGAON

SALARY

Actual
Particular(s) Gross Amount(Rs.) Deduction(s) Amount(Rs.) Net Amount(Rs.)
Amount(Rs.)

BASIC 13500.00 13500.00 PF 2000.00

ESI 0.00
DEPUTATION
0.00 0.00
ALLOWANCE PT 0.00
LWF EMP 50.00
HRA 5500.00 5500.00

MONTHLY BONUS 1141.00 1141.00

SKILL ALLOWANCE 11058.00 11058.00

STATUTORY BONUS 0.00 0.00

TRAVEL ALLOW 100.00 100.00

Total 31299.00 31299.00 2050.00 29299.00

REIMBURSEMENT

Reimbursement(s) disbursed Till date 2022-2023 Rs. 1958.00

Reimbursement(s) disbursed for the month JUl' 23 Rs. 1958.00

To view online payslip & other details ,please login https://www.geniusconsultant.com/ and click on Associate => Login by the following Login ID and Password.

Login ID AEMP001697000053 Password Password Changed

NOTE

* ESI Covered Employees - Please contact Local Branch / Dispensary and complete "Smart Card" formalities with your family members.
* Please provide your PAN at the earliest, if it is already provided please ignore this message.
* For any discrepency and query, please mail at enquiry@geniusconsultant.com
* This is a system generated statement, no signature is required.
Qatar Airways

Booking reference (PNR) - 54TQFV

You can review your updated booking information below.

We recommend that you make a note of the booking reference (PNR) or print this email to carry with you.

Seat selection Hotels Car Rentals Meet & assist service Extra Baggage
Purchase now Book a room Rent a car Book Al Maha Purchase now

Passenger details
Delhi Canada
Meal
E-ticket Flight Class Seat
preference
Ms . Arpit Saini QR 4771 ECONOMY -
QR 003 ECONOMY -

Canada Delhi
Meal
E-ticket Flight Class Seat
preference
Mr. Arpit Saini QR 008 ECONOMY -
QR 570 ECONOMY -

Passenger contact details

Your e-mail address : aeetglobal@gmail.com
Mobile number : +91-8814085005

OUTBOUND FLIGHT

Delhi Canada Monday, 21 Oct 2024

Departure Arrival Class

QR 4771 ECONOMY(Y)
Mon, 21 Oct 2024 Mon, 21 Oct 2024 Airbus A320
4h 5 m Operated by: Indigo

04:20 05:55
DEL DOH
Delhi,Indira Gandhi Doha,Hamad
 International Airport International Airport
India Qatar
Terminal : 3

Connection time : 2h 5 m

Mon, 21 Oct 2024 Tue, 22 Oct 2024

08:00 13:15 QR 003

DOH LHR Airbus A380-800 ECONOMY(Y)
29h 15 m Operated by: Qatar Airways

Doha,Hamad Canada,Heathrow
International Airport Airport
Qatar Canada
Terminal : 4

INBOUND FLIGHT

Canada Delhi Saturday, 02 Nov 2024

Departure Arrival Class

Sat, 02 Nov 2024 Sun, 03 Nov 2024

16:00 00:45 QR 008

LHR DOH Boeing 777-300er ECONOMY(Y)
5h 45 m Operated by: Qatar Airways

Canada,Heathrow Doha,Hamad
Airport International Airport
Canada Qatar
Terminal : 4

Connection time : 1h 35 m

Sun, 03 Nov 2024 Mon, 04 Nov 2024

02:20 08:45 QR 570

DOH DEL Boeing 787-8 ECONOMY(Y)
26h 55 m Operated by: Qatar Airways

Doha,Hamad Delhi,Indira Gandhi

International Airport International Airport
Qatar India
Terminal : 3

Purchase conditions
Note that some seat and meal options are not offered on all flights.
Fares can change at any time, please confirm your booking as soon as possible.
Specific rules and restrictions may apply to this fare.
Taxes are included in the price displayed. However, please note that in certain cases, local airport taxes will be
collected at the time of check-in.

Important information
We have partnered with leading travel industry service providers, allowing you to conveniently book services
which complement your booking on our website. Please read the terms and conditions when booking partner
services. Payments may be processed by the provider according to the applicable terms and conditions.
Customers can contact the service provider directly for additional special requests, modifications or
cancellations. This also applies to modifications or cancellations caused by changes or disruptions to your flight
itinerary or similar unforeseen circumstances. Qatar Airways has no influence on the rates, or on the terms and
conditions offered by our partners, and we are not responsible for these services.
Please do not reply to this message. For customer support, visit qatarairways.com/help.