COMPREHENSIVE TRAVEL PROTECTION
TRAVEL PROTECTION CARD
ASSIST NO.
Name: Ankit 4168/O-TSPRT/408185312/00/000
START DATE END DATE
Address: Vpo - Jawahra 50 , SONIPAT , HARYANA ,
22/10/2025 28/10/2025
131301
Silver
Assist. Fees : 760.00 (Incl. GST@ 18%)
You can now enjoy exclusive travel assistance including insurance benefits on your trip. Kindly ensure to carry this
document for a pleasant travel experience.
PEACE OF MIND ON THE GO
Ask for help
Note: Assistance provided by COUVRIR ROAM ASSIST
24x7 helpline: +91 8860535000 PVT. LTD., Insurance underwritten by ICICI Lombard
Assistance: customercare@roamassist.in General Insurance Company Ltd.
Claims: claims@roamassist.in
Customer will bear any cost or expenses arising from
Whatsapp message only for claims: +91 availing the assistance services through a third party
8860535000 service provider.
www.roamassist.in
Keep travelling, because the world is waiting for you and we are always by your side.
BON VOYAGE!
VOYAGER GROUP TRAVEL INSURANCE
PART I OF THE POLICY SCHEDULE
(UIN : ICITGBP22095V032122)
Date: 17/09/2025
To,
ANKIT
Mobile Number: 8979125736
Email ID: ANKIT.2000.07.19@GMAIL.COM
Dear Mr. / Ms. ANKIT ,
Sub: Issuance of Policy Certificate no. 4168/O-TSPRT/408185312/00/000 under your application for Group Travel Insurance
Policy dated 22/Oct/2025.
We would like to thank you for investing your faith in us. Please find enclosed herewith your Policy Certificate, Policy wordings &
Customer Information Sheet based on which your insurance Policy has been issued.
Insured Person Details:
Name of Proposer ANKIT
Overseas Overseas
Geographical Scope of Policy Excluding US & Canada (Including Schengen Countries)
No. of Travel Days 7
Countries being visited SPAIN
Period of Insurance Overseas - From 22/10/2025 To: 28/10/2025
Date of Birth of
Name of Insured ANKIT 19/07/2000
Insured
Passport No. of
PAN No. of Insured Y9200591
Insured
VPO - JAWAHRA 50,
Relationship of Insured with
SELF Address of the Insured SONIPAT - 131301,
Proposer
HARYANA, INDIA
Country of issue of
Resident Status INDIAN INDIA
Passport
Politically Exposed Person (PEP)/close relative of PEP: No
Medical expenses due to Covid-19 is covered if contracted during the travel period as per policy terms and conditions.
Please go through the details as furnished in the format and also as provided in the Policy document 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
customersupport@icicilombard.com or call at 1800 2666 for necessary changes/rectification. In the absence of any communication
from you within 15 days of receipt of Policy, we would take it that you have accepted the contents and the coverage to be
confirming to your proposal.
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICITGBP22095V032122
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Marg, Near Siddhi Vinayak Temple, E-mail : Customersupport@icicilombard.com
Mumbai - 400 064 Prabhadevi, Mumbai 400 025 Website : www.icicilombard.com
ICICI Lombard General Insurance Company Limited (IRDAI Regn. No. : 115) CIN No. L67200MH2000PLC129408
Master Policy Number - 4168/O-TSPRT/295438555/00/004 UIN: ICITGBP22095V032122
Voyager Group Travel Insurance
Policy Certificate
On receipt of full premium from the Policyholder as named in this Schedule, Group Travel Insurance 4168/O-TSPRT/295438555/00/004
dated 15/06/2023 has been issued at Mumbai, by ICICI Lombard General Insurance Company Limited to the Policyholder, ANKIT as
specified in the Policy, and is governed by, and is subject to, the terms, conditions & exclusions therein contained or otherwise expressed in
the said Policy.
The certificate issued to the customers/ employees/ members of ANKIT under the signature of an authorized signatory of ICICI Lombard
General Insurance Company Limited, represents the availability of the Benefits under the Policy to the Insured Person named below,
subject to the terms, conditions and exclusions expressed in the said Policy, but not exceeding the Sum Insured as specified below.
(PART I OF THE POLICY SCHEDULE)
POLICY CERTIFICATE NUMBER : 4168/O-TSPRT/408185312/00/000
Alternate Policy No
Master Policy Number : 4168/O-TSPRT/295438555/00/004
Issued At : Mumbai Stamp Duty :1
GSTIN Number : 23AAJCT0389D1ZG Invoice No : 1010243485310
Domestic/Overseas : Overseas
Geographical Scope : Excluding US & Canada (Including Schengen Countries)
Trip Details
Type of Trip For Overseas- Single Trip
From 22/Oct/2025 To 28/Oct/2025 No. of Days 7
Details of Trip* 1
Place of Origin INDIA Destination SPAIN
Common Carrier/Public Carrier
Opted
Adventure sports Activities to be
undertaken while on trip
Detailed Itinerary of the Trip* Overseas -
Proposer/Policyholder Details
Name of the Proposer ANKIT
Insured Details
Name of the Insured ANKIT
Gender of the Insured Male
Age as on Policy Start Date 25
Mailing address/ Residential Address of the Insured VPO - JAWAHRA 50, SONIPAT - 131301, HARYANA, INDIA
Occupation Others
Mobile Number 8979125736
Email ID ANKIT.2000.07.19@GMAIL.COM
Passport Number Y9200591
Country of Issue of Passport INDIA
Resident Status INDIAN
PAN Number/ National ID No.
Pre-Existing Disease (if any): NA
Debit/Credit Card Number (if any):
Name of Nominee JAGDISH
Relationship of Nominee with Insured FATHER
Politically Exposed Person (PEP)/close relative of PEP: No
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICITGBP22095V032122
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Marg, Near Siddhi Vinayak Temple, E-mail : Customersupport@icicilombard.com
Mumbai - 400 064 Prabhadevi, Mumbai 400 025 Website : www.icicilombard.com
0
COVERAGE TABLE - FOR OVERSEAS POLICY
Overseas
(Coverage Table to be customized in accordance to the Covers & Extensions opted)
Cover-specific
Section and Indemnity/ Deductible, if Franchise, if
Sum Insured Co-Pay, if any Condition, if
Coverage Benefit any any
any
Medical Expenses for Illness & Accidental Injury
Hospitalization USD 50,000 Indemnity USD 100 NA NIL NA
Expenses for
Illness & Injury
Outpatient USD 50,000 Indemnity USD 100 na NIL na
Treatment for
Illness & Injury
Pre-existing USD 1,500 Indemnity USD 100 NA NIL NA
Diseases Cover
Non Medical Covers
Loss of USD 500 Indemnity Nil na NIL na
Checked In
Baggage
Electronic USD 300 Indemnity NIL NA NIL NA
Equipment Loss
Delay of USD 100 Benefit 8 HRS na NIL na
Checked-In
Baggage
Trip Cancellation USD 1,250 Indemnity Nil na NIL na
Trip Interruption USD 1,250 Indemnity Nil na NIL na
or Curtailment
Personal Liability USD 1,00,000 Indemnity Nil na 5% OF ACTUAL na
Hijack Distress USD 875 Benefit 12 HRS na NIL USD 125 Per
Allowance day upto 7 days
Personal USD 20,000 Benefit Nil na NIL na
Accident
Financial USD 1,000 Benefit Nil na NIL na
Emergency
Cash Allowance
(lump sum)
Common USD 500 Benefit 8 HRS na NIL na
Carrier/Public
Carrier delay
Missed USD 500 Indemnity 3 HRS na NIL na
Connection (All
Common
Carrier/Public
Carrier)
Burglary (Home INR 1,00,000 Indemnity Nil na NIL na
contents)
Loss of USD 300 Benefit Nil na NIL na
Passport /
International
Driving License
102/20141021/66
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : ICITGBP22095V032122
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Savarkar Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Marg, Near Siddhi Vinayak Temple, E-mail : Customersupport@icicilombard.com
Mumbai - 400 064 Prabhadevi, Mumbai 400 025 Website : www.icicilombard.com
