Signed

by:Reliance
General Insurance
Company Limited
Date:2024.09.27

Reliance Travel Care Policy - Corporate Short Term

Policy Issuing Office : Policy Servicing Office Name & Address - CORPORATE OFFICE
(SERVICING)
Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, 6th Floor, Oberoi Commerz, Oberoi Garden City, Off. Western Express Highway,
International Business Park,Oberoi Garden City, Off Western Express Goregaon (East), MUMBAI, MUMBAI, MAHARASHTRA - 400063 Phone No. : 022-
Highway, Goregaon (East), Mumbai – 400 063. 41732000
Branch Contact No. : 022-41732000
Certificate No. - 920292428221394880 Master Policy No. - 920292328220000270
Br. Code- 22BRG690-924513- PSO No. - 5K4AZ5 Dept. - CPL Intermediary Code - 22BRG690
92021
Tax Invoice No & Date : Y092724160727 & 27-Sep-2024
Details of the Insured
Name of the Policy Holder CLEARTRIP PRIVATE LIMITED

Address of the policy holder GODREJ PLANT NO.6, GODREJ BUSINESS DISTRICT, PIROJSHANAGAR, VIKHROLI, MUMBAI CITY, MAHARASHTRA,
400079
Details of the Insured Person
Name of the Insured Person Passport No. Gender Nominee Relationship of the Nominee with the Insured
Name Person
SHRUTI KULKARNI -- FEMALE LEGAL LEGAL HEIR
HEIR
Communication Address & Place of Supply GODREJ PLANT NO.6, GODREJ BUSINESS DISTRICT, PIROJSHANAGAR, VIKHROLI, MUMBAI CITY, MAHARASHTRA,
400079
E mail id GAURAVSD95@GMAIL.COM
Telephone Number 9503338676
GSTIN / UIN Of Insured : 23AAECT7614G1ZH
Geographical Coverage EXCLUDING USA / CANADA
Country Visiting MAURITIUS
Policy Period From 09-Feb-2025 time to 14-Feb-2025 time 6 Days
Name of the Plan opted CLEARTRIP EXCLUDING USA & CANADA
Any Pre existing disease NO

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

Medical Expenses Including Transportation, Evacuation & Repatriation of Mortal 100000 50
Remains
Dental Treatment 500 50
Loss of Passport 300 25
Total Loss of Checked in baggage 500 Nil
Delay of checked in Baggage 100 12hours
Personal Accident 20000 Nil
Accidental Death - Common Carrier 2500 Nil
Personal Liability 100000 Nil
Daily Allowance in case of Hospitalisation 25 per day (5 days max) 2days
Financial Emergency Assistance 500 Nil
Hijack Distress Allowance 60 per day (7 days max) 12hours
Trip Delay 30 per day (6 days max) 12hours
Trip Cancellation and Interruption 750 Nil
Compassionate Visit Return fare for any one accompanying person- Nil
child/ spouse/ family doctor
Any one illness applicable only for age 61 to 70 years 13500 Nil
Any one accident applicable only for age 61 to 70 years 25000 Nil
Consolidated Stamp duty Paid vide Letter of Authorization No. NO LOA/ENF-1/CSD/50/2024-25/(Validity Period Dt.01/09/2024 to Dt.01/12/2025)/4240 Date 20-
08-2024 dated : 20 Aug 2024 at General Stamp Office, Mumbai.
** Not Applicable for the State of Jammu & Kashmir.
#Warranted that:

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

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

Page 1 of 10
1) This policy is exclusively for registered customers who sucessfully booked flight ticket through official website or app of Clear Trip only.
2)Warranted that every customer shall have a unique membership ID issued by ClearTrip Private Limited.
3) Warranted that insured is a citizen of India and has a permanent place of residence in India and is not a NRI or OCI or foreign national and was within the
territory of India at the time of issuance of the certificate and before the commencement of the trip.
4) Warranted that Purpose of visit will be for leisure or personal business only.
5) The policy will not covered insured/ Insured person who is less than 06 months and more than 70 years of age(as on completed birthday)
6) Warranted that the Insured / Insured Person(s) has no past history of any illness / hospitalization.
7) If Point No. 6 is "Yes" Warranted that Declaration of any Pre existing Condition, using words / terms which mean any disease/illness which are same or similar
to - Cancer/ Leukemia / Malignant Tumor, Cardiac ailments, COPD, HIV /AIDS, Insulin Dependent Diabetes, Kidney Ailment, Liver Disease, Neurological
Disorder / Stroke /Paralysis, Thalasemia will render this policy null and Void-ab-initio and the Company shall have no liability under the policy clean health history.
8) Any expenses related to pre existing illness/ disability/diseases and its related complications/ consequences are not payable under the policy.
9) Warranted that maximum amount payable per checked-in baggage in case more than one bag has been checked in, is 50% (100% for only one checked-in
baggage) of applicable Sum Insured and per item in baggage max 10%.
10) Repatriation of Mortal remains USD 7,000
11) Any claim arising out of sporting activities in so far as they involve the training or participation in competitions of professional or semiprofessional sports
persons is excluded.
12) For details on coverage, exclusion, terms and conditions the certificate should be read with master policy issued to CLEARTRIP PRIVATE LIMITED vide
policy no. 920292328220000143
13) Proposal form is mandatory
Net Premium: Rs. 452.52
CGST : (9.00% ) Rs.40.73
SGST : (9.00% ) Rs.40.73
Total Premium: Rs.533.97
In witness whereof this policy has been signed at Mumbai on : 27-Sep-2024
Subject to the terms, conditions and exclusions of the Reliance Travel Care Insurance Policy issued vide Master Policy indicated above.

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

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

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

Please provide Immediate intimation of any claim / requirement for emergency assistance while abroad to ensure that the
Claim is not prejudiced. Please contact the International Toll Free Helpline numbers given below.
In case of any requirement for emergency assistance whilst abroad, please contact the toll free helpline numbers given below:
This document shall be treated as a Tax Invoice as per Rule 46 of the Central Goods and Services Tax Rules 2017

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

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

Page 2 of 10
Singapore and Thailand — 001-80099441111, Hong Kong — 001-80099441111 and 006-80099441111, USA — 18337426673, Canada -011-80099441111 , Australia —0011-
80099441111, Japan — 001-010-80099441111 and 010-80099441111, Israel — 00-80099441111 and 014-80099441111, Greece —86002038017, Argentina, Austria, Belgium, China,
Czech Republic, Denmark, France, Germany, Hungary, Italy, Malaysia, Netherlands, New
Zealand, Norway, Philippines, Poland, Portugal, South Africa, Spain, Sweden, Switzerland, Taiwan & United Kingdom — 00-80099441111
Dedicated National Toll Free Help Line : 1800 209 5522 Land Line : +91 22 67347843 & +91 22 67347844 Fax Number: +91 22 67347888
Email : reliance@europ-assistance.in Website: www.europ-assistance.com

Intermediary Code/Name : 22BRG690 / ZOPPER INSURANCE BROKERS

PRIVATE LIMITED
Intermediary ContactNo: 8929876286

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

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

Page 3 of 10
Reliance Travel Care Insurance Policy - Online Proposal Form
Proposal Form No..: Y092724160727

Proposer/Insured Details

1.Name of the Proposer/Insured

SHRUTI KULKARNI
(Mr./Mrs./Ms.)
GODREJ PLANT NO.6, GODREJ BUSINESS DISTRICT, PIROJSHANAGAR, VIKHROLI, MUMBAI CITY,
2.Address
MAHARASHTRA, 400079
Residence Number
Gender FEMALE Passport No. -- Mobile No. 9503338676
PAN No. UID Aadhar No.
GAURAVSD95@GMAIL.C
Email Id Nationality DOB
OM

Nominee Details

Name of Nominee DOB Relationship with Proposer

LEGAL HEIR LEGAL HEIR

Details of Pre-existing Condition

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

No

Trip Details

1. Master Policy No. - 920292328220000270

2. Name of Master Policy Holder CLEARTRIP PRIVATE LIMITED
4. Geographical
3. Sum Insured Opted 100000 EXCLUDING USA / CANADA
Scope
5. Name of the Plan opted CLEARTRIP EXCLUDING USA & CANADA
6. Date of Journey 09 Feb 2025 Date of Return 14 Feb 2025
7. Does the plan trip involve any kind of sporting
activity
8. Countries that you are visiting MAURITIUS
9. Trip Duration 6

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

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

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

Declaration & Warranty by the Proposer

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

1) Is/are not travelling against advice of medical practitioner
2) Is/are not on waiting list for any medical treatment
3) Is/are not travelling for the purpose of obtaining medical treatment
4) Have not received a terminal prognosis for a medical condition before journey
5) Being in India before taking cover & commencement of trip.
6) Being resident Indian.
ii. Declared of any Pre existing Condition, using words / terms which mean any disease/illness which are same or similar to - Cancer / Leukemia /
Malignant Tumor,Cardiac ailments, COPD, HIV /AIDS, Insulin Dependent Diabetes, Kidney Ailment, Liver Disease, Neurological Disorder / Stroke
/ Paralysis, Thalasemia will render this policy null and Void-ab-initio and the Company shall have no liability under the policy (Applicable if
declared PED).
iii. Purpose of visit either Leisure or Business
iv. I have read and understood the brochure, prospectus, sales literature & Policy wordings and confirm to abide by the same.
v. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting
policy of the insurance company and that the policy will come into force only after full receipt of the premium chargeable.
vi. I/We further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured / proposer
after the proposal has been submitted but before communication of the risk acceptance by the Company.
vii. I/We declare and consent to the Company seeking medical information from any Doctor or from a hospital who at anytime has attended on the
life to be insured /proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to
be assured / proposer and seeking information from any insurance company to which an application for insurance on the life to be assured /
proposer has been made for the purpose of underwriting the proposal and / or claim settlement.
viii. I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal
underwriting and/or claims settlement and with any Governmental and / or Regulatory Authority.
ix. Receipt of the Proposal form by the Company shall not be construed as acceptance of proposal. I hereby agree that the insurance coverage shall
commence only on realization of full premium and on receipt of complete medical reports (wherever applicable) and subject to individual
underwriting by the Company. The Company at its sole discretion reserves the right to accept or reject or load any proposal without assigning
any reason thereof.
x. I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement, misrepresentation,
non-description or nondisclosure of any material fact in the Proposal form/personal statement, declaration and connected documents or any
material information having been withheld by me or anyone acting on my behalf.
xi. I hereby declare that the person(s) proposed to be insured would submit to medical examinations, before the nominated doctors of the
Company, or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting.
xii. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company.
xiii I/We consent to receive information from the Company through physical, electronic or telecommunication means from time to time.
xiv I hereby declare on my behalf & on behalf of all persons proposed to be insured that the above statements, answers and/or particulars given by
me in this proposal form are true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on
behalf of these other persons.
xv I/We here by state that the above mentioned address shall be taken as address on record for the purpose of GST.
xvi I/We hereby confirm that the contents of the proposal form and connected documents have been fully explained to me/us and I/We have fully
understood the significance of the proposed contact.
Place CORPORATE OFFICE(SERVICING) Date: 27 Sep 2024 Signature __________________________________

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

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

Page 5 of 10
AML Guidelines

I/We hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been /will be paid out of
1.
proceeds of crimerelated to any of the offense listed in Prevention of Money Laundering Act,2002.
2. I Understand that the Company has the right to call for document to established sources of funds
The Insurance Company has right to cancel the insurance contract in case I am/have been found guilty by competent court of law under any of
3.
thestatutes, directly or indirectly governing the prevention of money laundering in India.
CORPORATE OFFICE
Signature: ____________________________ Date 27 Sep 2024 Place
(SERVICING)

Vernacular Declaration stating that the contents of this proposal form have been read over & fully explained to me in _ _ _ _ _ _ _ _ _ _language. I
further confirm & declare that contents read over & explained to me have been understood by me.
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Signature/Thumb Impression of the Proposer::________________________
Identified by Name & Signature :________________________
Date: 27 Sep 2024 Place CORPORATE OFFICE(SERVICING)

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

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

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

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

Page 6 of 10
 CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY
This document provides key information about your policy. You are also advised to go through your policy document.
SI NO Title Description Policy Clause
Number
1 Name of Reliance Travel Care Policy - Corporate Short Term Plan
Insurance
Product/Policy
2 Policy number 920292428221394880

3 Type of Payment on Indemnity and Benefit Basis (As per plan coverage opted)
Insurance
Product/Policy
4 Sum Insured Individual Sum Insured- $ 1,00,000
(Basis)
Along with
amount
5 Policy Coverage POLICY COVERAGE Section 4
(What the policy Medical Expenses Including Transportation, Evacuation & Repatriation of Mortal Remains
covers?) Dental Treatment
(Policy clause Loss of Passport
Number/s) Total Loss of Checked in baggage
Delay of checked in Baggage
Personal Accident
Accidental Death - Common Carrier
Personal Liability
Daily Allowance in case of Hospitalisation
Financial Emergency Assistance
Hijack Distress Allowance
Trip Delay
Trip Cancellation and Interruption
Compassionate Visit
Any one illness applicable only for age 61 to 70 years
Any one accident applicable only for age 61 to 70 years

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

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

Page 7 of 10
6 Exclusions (What 1) This policy is exclusively for registered customers who sucessfully booked flight ticket Section 5
the policy does through official website or app of Clear Trip only.
not covers) 2)Warranted that every customer shall have a unique membership ID issued by ClearTrip
Private Limited.
3) Warranted that insured is a citizen of India and has a permanent place of residence in India
and is not a NRI or OCI or foreign national and was within the territory of India at the time of
issuance of the certificate and before the commencement of the trip.
4) Warranted that Purpose of visit will be for leisure or personal business only.
5) The policy will not covered insured/ Insured person who is less than 06 months and more
than 70 years of age(as on completed birthday)
6) Warranted that the Insured / Insured Person(s) has no past history of any illness /
hospitalization.
7) If Point No. 6 is "Yes" Warranted that Declaration of any Pre existing Condition, using words
/ terms which mean any disease/illness which are same or similar to - Cancer/ Leukemia /
Malignant Tumor, Cardiac ailments, COPD, HIV /AIDS, Insulin Dependent Diabetes, Kidney
Ailment, Liver Disease, Neurological Disorder / Stroke /Paralysis, Thalasemia will render this
policy null and Void-ab-initio and the Company shall have no liability under the policy clean
health history.
8) Any expenses related to pre existing illness/ disability/diseases and its related complications/
consequences are not payable under the policy.
9) Warranted that maximum amount payable per checked-in baggage in case more than one
bag has been checked in, is 50% (100% for only one checked-in baggage) of applicable Sum
Insured and per item in baggage max 10%.
10) Repatriation of Mortal remains USD 7,000
11) Any claim arising out of sporting activities in so far as they involve the training or
participation in competitions of professional or semiprofessional sports persons is excluded.
12) For details on coverage, exclusion, terms and conditions the certificate should be read with
master policy issued to CLEARTRIP PRIVATE LIMITED vide policy no. 920292328220000143
13) Proposal form is mandatory

“Please note that the sales process will be reviewed by the Insurer on interval of every quarter
as per direction issued by IRDAI vide its Circular Ref. No. IRDAI/HLT/CIR/MISC/174/09/2019
dated 27th September 2019”

EXCLUSIONS :
1. Any Pre-existing medical conditions and its related complications/ consequences.
2. Travelling against the advice of a physician.
3. Receiving or are on a waiting list for a specified medical treatment.
4. Travelling to receive treatment abroad.
5. Under given terminal prognosis for a medical condition.
6. Partial loss of checked baggage – Only the loss of your entire baggage is covered, not partial
loss.
7. War or nuclear perils in the country you’re visiting.
8. Treatment which could reasonably be delayed until the Insured/Insured Person's return to
the Republic of India
9. Any claim relating to events occurring before the commencement of the cover or otherwise
outside of the period of insurance.
For complete list of exclusion, terms and conditions kindly refer policy wordings .
7 Waiting period Daily Allowance in case of Hospitalisation - 2days -
Time period
during which
specified
diseases/treatme
nts are not
covered
It is counted from
the beginning of
the policy
coverage.

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

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

Page 8 of 10
8 Financial limits of POLICY COVERAGE Sum Insured ( in USD )
coverage Medical Expenses Including Transportation, Evacuation & Repatriation of 100000
I Sub-limit (It is a Mortal Remains
pre-defined limit Dental Treatment 500
and the Loss of Passport 300
Total Loss of Checked in baggage 500
insurance
Delay of checked in Baggage 100
company will not
Personal Accident 20000
pay any amount
Accidental Death - Common Carrier 2500
in excess of this
Personal Liability 100000
limit)
Daily Allowance in case of Hospitalisation 25 per day (5 days max)
Financial Emergency Assistance 500
Hijack Distress Allowance 60 per day (7 days max)
Trip Delay 30 per day (6 days max)
Trip Cancellation and Interruption 750
Compassionate Visit Return fare for any one accompanying person-
child/ spouse/ family doctor
Any one illness applicable only for age 61 to 70 years 13500
Any one accident applicable only for age 61 to 70 years 25000
ii Co-payment (It Not applicable
is a specified
amount/percenta
ge of the
admissible claim
amount to be
paid by
policyholder/insur
ed).
iii Deductible (It POLICY COVERAGE Deductible
is a specified Medical Expenses Including Transportation, Evacuation & Repatriation of Mortal 50
amount: Remains
-up to which an Dental Treatment 50
insurance Loss of Passport 25
Delay of checked in Baggage 12hours
company will not
Daily Allowance in case of Hospitalisation 2days
pay any claim,
Hijack Distress Allowance 12hours
and
Trip Delay 12hours
-which will be
deducted from
total claim
amount (if claim
amount is more
than the
specified
amount)
iv. Any other limit Not applicable
(as applicable)
9 Claims/Claims Details of procedure to be followed for cashless service as well as for reimbursement of claim Section 6.11
Procedure including pre and post hospitalization.
Turn Around Time (TAT) for claims settlements
i. TAT for preauthorization of cashless facility – 6 hours from receipt of complete documents.
ii. TAT for cashless final bill authorization – 4 hours from receipt of complete documents.
iii. For reimbursement claims - TAT for Reimbursement Claims – 7 to 10 workings days from the
date of receipt of last necessary document.
Please find below the details /link -
i. Network Hospital details- www.reliancegeneral.co.in / For email correspondence while in
overseas/India customers can write to us at: reliance@europ-assistance.in
ii. Helpline number- (91-22-67347843, 91-22-67347844) / For customers who are calling from
India, National Toll-Free Number (1800 209 5522)
iii. Hospitals which are blacklisted or from where no claims will be accepted by insurer-
www.reliancegeneral.co.in / For email correspondence while in overseas/India customers can
write to us at: reliance@europ-assistance.in
iv. Downloading/getting claim form- www.reliancegeneral.co.in
10 Policy Servicing Any issues related with respect to policy, kindly E-mail us at rgicl.services@relianceada.com
and for correspondence contact us Reliance General Insurance Company Limited
Correspondence Address – Reliance General Insurance., Winway Building 2nd & 3rd Floor,
11/12 Block No-4, Old no-67, South Tukoganj, Indore (M.P) - 452001 Contact No.- 022-
41112600

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

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

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11 Grievances/Com a. Details of Grievance redressal officer refer the link (https://www.reliancegeneral.co.in/ Section 7.27
plaints Insurance/About-Us/Grievance-Redressal.aspx
b. IRDAI Integrated Grievance Management System-https://igms.irda.gov.in/
c. Insurance Ombudsman - The contact details of the Insurance Ombudsman offices have
been provided as Annexure-B of Policy document.
12 Things to Free Look cancellation: Not Applicable
remember Policy renewal: Not Applicable
Migration and Portability: Not Applicable
Change in Sum Insured:Not Applicable
Moratorium Period: Not Applicable
13 Your Obligations Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-disclosure Section 7.1
may affect the claim settlement.
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in the
event of misrepresentation, mis description or non-disclosure of any material fact by the
Policyholder
“Material facts” for the purpose of this policy shall mean all relevant information sought by the
Company in the proposal form and other connected documents to enable it to take informed
decision in the context of underwriting the risk
The enclosed Customer Information Sheet bearing reference number CIS\policy number 920292428221394880 is an essential part of your
policy schedule, please acknowledge that you have read and understood the CIS on the communication sent on your registered mobile
number/e-mail ID.
Disclaimer : The information must be read in conjunction with the policy document. In case of any conflict between the CIS and the
policy document, the terms and conditions mentioned in the policy document shall prevail.
Declaration by the Policy Holder:
I have read and understood the benefits and details of the product as mentioned in this sheet.

Place:MUMBAI
Date:9/27/2024 (Signature of the Policyholder)

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

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

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