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ICICILOMBARDGENERALINSURANCECOMPANYLTD.
ICICILombardHouse,414,VeerSavarkarMarg,Prabhadevi,Mumbai–
400025IRDAIRegistrationNo:115
CertificateOfInsurance
Wewould liketo informyou thatBhartiAXAGeneralInsurancehas
mergedwithICICILombardGeneralInsurancew.e.f.Sept8,2021.Enjoyour
seamlessserviceswhileexploringourenhancedofferingsanddiversenon-lifeinsurancesolutions
InsuredName:YOGESWARI BALASUBRAMANIYAM DateofBirth: 25/09/1990 PassportNumber: N9385328
TravelAssure-GroupOverseasTravelInsurance Mobileno:9510725621 Landlineno 8510555621
EMail :starworld23@gmail.com CR :
noIssueD :31/05/2025
ate
CertificateNo :SW949967 IntermediaryCode:IM-1335344
TravelAssure-GroupOverseasTravelInsurance IntermediaryName:ASEGOINSURANCELLP
ThisGroupTravelInsurancepolicy4198/ ST/264088793/00 /000dated20- 10- 2022hasbeeni ssuedatMumbaibyICICILombardGeneralInsuranceCompanyLtd.tothemaster
policyholder,ASEGOTRAVELLLPandgovernedbytheterms,conditionsandexclusionsthereincontainedorotherwiseexpressedinthesaidcertificate,butnotexceedingtheSumInsuredas
specifiedintheSchedule. ThisCertificate,issuedunderthefacsimilesignatureofICICILombardGeneralInsuranceCompanyLtd.representstheavailabilityof
benefittotheabovementionedInsuredPerson.ThroughthemasterpolicyholderICICILombardGeneralInsuranceCompanyLtd.hasreceivedanamountofRs.778.00(
InclGST@18%)towardscovering theriskbenefits, on behalfof theabovementionedinsured.
CommencementDate:From:30/06/2025 EndDate:mid-nighton:27/09/2025 No.ofDays:89
PlanName :Tourist:A+150000 GeographicalCoverage:ExcludinUSAandCANADA(Worldwide)
Assignee :KEERTHIKA Relation:Mother Exclusions:
SponsorName:KEERTHIKA,RelationwithSponsor:SISTER
RestoftheWorld(CallBackFacility)+911244498778
NationalTollFreeNumber18001025721;
FaxNumber+911244006674
EmailAddress:icicilombard@falck.com
ORLogintothee-claimlinkhttps://fgaindia.com/FalckMLink/
ThispolicycoversEmergencyMedicalExpensesincurredduetosuddenandunexpectedinjuryoranyacuteSic-k1n9,easrsisin
incgluwdhin
egnC
inO
suVrIeDdisoutthse
id'R
e epublic
ofIndia'uptothelimitsasmentionedin thepolicy schedule.
ThisTravelInsurancepolicyisonlylimitedtostudenttravellingabroadandcustomersofAsegoTraveltravellingthroughAirMode.
Theapplicableageofthispolicyfrom11yearsupto60yearsandlimitedtosingletrip.
CertificateisonlyvalidtothecustomerswhoaretravellingfromIndia.
Thispolicyconsistoffollowingcoverageswhichwillbetreatedasbenefitcoversi.e.PersonalAccident-
AccidentalDeathPermanentTotalDisability(PTD)PermanentPartialDisability( PPD),AccidentalDeath-CommonCarrier,PermanentTotalDisability-
Common,PermanentPartialDisability-Commoncarrier,DailyAllowanceincaseofHospitalization,andHijackDistressAllowan
cesubjecttopolicytermsandconditionsapplicabletothesesections.Allotherscoverageswillbetreatedasindemnity.
SuminsuredforEmergencyMedicalEvacuationandRepatriationofmortalremainswillbesublimitedtosuminsuredspecifiedinEmergencyMedicalExpenses.
WarrantedthattheHijackDistressAllowance,TripDelay,Totallossofcheckedinbaggage,AccidentalDeath-CommonCarrier,PermanentTotalDisability-
CommonCarrier,PermanentPartialDisability-CommonCarrier,Tripcancellationand/orinterruption,Missedconnection,TravelInconvenience,f l
ightdelayforAirTravelonly.
Pre- existingcondition(s)areexcludedfromthepolicyincludingbutnotlimitedtounforeseenemergencymeasurestosavetheInsured/Insuredperson’
slife.Thisexclusionwillapplytothefollowingsections:EmergencyMedicalExpenses,EmergencyMedicalEvacuation,DentalTreatmentExpenses,andDailyAllowancei
ncaseofHospitalization,Pe rmanentTotalDisability(PTD),andPermanentPartialDisability( PPD).Thisexclusionhasbeenwaivedtotheextentof10%of
EmergencymedicalsuminsuredperpolicyorUSD10000 perpolicywhicheverislesserasindicatedinthePolicyCertificateformentionedsectionuptotheageof 60Years
SuminsuredforInpatientEmergencymedicalexpensesforinjuriesduringinter-collegiatesports,OutpatientPhysiotherapyrelatedtodisease/illnes
s/injury,Cancerscreeningandmammographyexaminations,ChiropracticTreatmentrelatedtodisease/illness/injuryrequiringoutpatient/inpatientcare,Skillednursingf
acilityrelatedtodisease/i llness/injuryrequiringoutpatientCare,AdventuresportsExpensesduetoInjury,DrugandAlcoholabuse,MentalandNervous
disorderandIn-
patientmedicalexpensesrelatedtopregnancy/childbirth(afterawaitingperiodof10months)willbesublimitedtosuminsuredspecifiedinEmergencymedicalExpensesan
donlyava ilable ifspecifically mentioned above.
SanctionsLimitationandExclusionClause:Notapplicableforsanctionedcountrieslistedincertificateofinsurance.
NotapplicableifinsuredistravelingtosanctionedcountriesasspecifiedunderCOI,No(re)insurershallbedeemedtoprovidecoverandno(re)insurershallbeliableto
payanyclaimorprovi
deanybenefithereundertotheextentthattheprevisionofsuchcover,paymentorsuchclaimorprovisionofsuchbenefit
wouldexposethat(re)insurertoanysanction,prohibitionorrestrictionunderUnitedNationsresolutionsorthetradeoreconomicsanction,lawsorregulations
oftheEuropeanUnion,UnitedKingdomorUnitedStatesofAmerica.Excludingfrom/toandorcountriesplacesprohibitedbyGOI&alsoSpecificallyExcluding
Iran,Iraq,Syria,Sudan, NorthKorea,Cuba,Crimea.
Anyclaimrelatingtoeventsoccurringbeforethecommencementofthecoverorotherwiseoutsideoftheperiodofinsurance.
Authorised
Signatory
(ICICILombardGeneralInsu
ranceCompanyLtd.)
Thecertificatehasbeenissuedbasedontheinformationprovidedbyyou/yourrepresentativeandthepolicyisnotvalidifanyoftheinformationprovided is
incorrect,subjectotherwise to the Terms, Conditions and Exclusions mentioned in the policy.
••TreatmentabroadifthatisthesolereasonoroneofthereasonsfortheInsured/Insuredperson'stemporarystayabroad•
AnyclaimiftheInsuredPerson1.IstravellingagainsttheadviceofaMedicalPractitioner;2.Isreceiving,orisonawaiting
listtoreceive,specified medicaltreatment declaredintheMedical Practitioner ’sreportorcertificate;
GeneralExclusions
Cong
enitalexternaldiseases,delectsoranomalies•
Diseases,illnessandaccidentsthatareresultsofwarandwarlikeoccurrenceorinvasion,actsofforeignenemies,hostilities,civilwar,rebelli
on,ins urrection,civilcommotionassumingthe proportionsofor amounting to an uprising,milit aryorusurpedpower,activepartic
ipationinriots,confiscationornationalizationorrequisitionofordestruction ofordamagetoproperty
byorundertheorderofanygovernment or localauthority.
Foranyclaimrelatedquery,intimationof claimandsubmissionofclaimrelateddocumentsyoumaycontactour
EmergencyAssistanceServiceProvider.
Incaseofaclaim,youmayreachusat844-691-8883(ForCanada),844-691-8885(ForUSA)or+911142221403(Forother parts of
NoticeofClaim the world) or email us atcustomersupportba@icicilombard.com
Email-customersupportba@icicilombard.comPost/couriertoCompany-
ICICILombardGeneralInsuranceCompanyLtd.,
ICICIBankTower,PlotNo.12,FinancialDistrict,NanakramGuda,Gachibowli,Hyderabad-500032
ClaimsProcedure
.Intheeventofanaccidentorsuddenillnesswhichi slikelytogiveri setoaclaimunderthisPolicy,theInsuredPersonshallimmediately
contacttheEmergencyAssistanceServiceProvidergivingdetailsof the Policy i ssuedtohim/her. The
detailsofphonenumbersandHelpLinearegivenintheNoticeofclaimsection.
.AllnecessaryclaimdocumentsshouldbefurnishedtotheCompany/EmergencyAssistanceServiceProviderbythepolicyhold
er/insuredtomakeaclaim.However,claimsfiledevenbeyondsuchperiodshouldbeconsiderediftherearevalidreasons of anydelay.
.ClaimServiceGuarantee:TheCompanyshallsettletheclaimwithin30daysfromthedateofreceiptoflastnecessarydocumentinacc
ClaimProcedure&Documentati ordancewiththeprovisionofregulation27ofIRDAI( HealthInsurance)Regulations,2016.
on Inthecaseofdelayinthepaymentofaclaim,theCompanyshallbeliabletopayinterestfromthedateofreceiptoflastnecessarydocumenttothe
dateo fpaymentofclaimatarate2%abovethebankrate
ClaimsDocumentation-
Dulyfilledinandsignedclaimform•CertificateofInsurance•
AnyadditionaldocumentrelevanttoclaimandspecifiedinthePolicywordings This isonlyasummary oftheproduct
features.Theactualbenefits available areasdescribed in
ForDetailedTerms&ConditionsofyourTravelInsurancePolicyKindlyClickhere
ICICILombardGeneralInsuranceCompanyLtd.,,ICICILombardHouse,414,VeerSavarkarMarg,Prabhadevi,Mumbai–400025UIN: ICITGOP
22203V022122 ,CIN:L 67200 MH2000PLC129408
