COMPREHENSIVE TRAVEL PROTECTION

TRAVEL PROTECTION CARD

NAME : VIDYA VILAS EKBOTE
A S S I S T N O.
1100101368785
ADDRESS : SAISARANG APARTMENT, FLAT NO 101, DR
KETKAR ROAD, NEAR GHODKE CLASSIC PUNE OFF PRABHAT S TA RT D AT E E N D D AT E

ROAD, PUNE CITY MAHARASHTRA-411004 02/01/2025 15/01/2025

Assist Fees : 7077( Incl GST @ 18% ) STYLE PRO

You can now enjoy exclusive travel assistance including insurance benefits on your trip. Kindly
ensure to carry this document for a pleasant travel experience.

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TRAVEL ASSISTANCE TRAVEL INSURANCE

24x7 Medical Lifestyle Domestic Roadside Arranged with an IRDAI authorised underwriter - ICICI
Assistance Assistance Assistance Lombard General Insurance Company Ltd.

Travel Support Services

Emergency Assistance Expert Intensive Care & Consultation 24/7 Customer Helpline

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24x7 helpline: +91 8448582205 Note: Assistance provided by ASEGO TRAVEL LLP,
Insurance underwritten by ICICI Lombard General
Assistance: [email protected] Insurance Company Ltd.
Claims: [email protected] Customer will bear any cost or expenses arising
from availing the assistance services through a
Whatsapp message only for claims: +91 86478 34444 third par ty service provider.

asego.in

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 ICICI LOMBARD GENERAL INSURANCE COMPANY LTD.
ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi,Mumbai – 400025
IRDAI Registration No: 115
Telephone: 1800 2666
Certificate Of Insurance

Customer Details:
Insured Name :VIDYA VILAS EKBOTE Date of Birth:23/04/1950 Passport Number:A06725316
Address :Saisarang Apartment, Flat no 101, Dr Ketkar Road, Near Ghodke Classic Pune Off Prabhat Road, Pune City Pune Maharashtra-
411004
Travel Assure - Group Overseas Travel Insurance Mobile no :919822378505 Landline no :919822378505
E Mail :[email protected] CR no :
Issue Date :27/12/2024

Certificate No : SX101368785 Intermediary Code :IM-1335344

Travel Assure - Group Overseas Travel Insurance Intermediary Name : ASEGO INSURANCE LLP
Th is Group Trave l I nsu rance p olicy 4 1 9 8 /O/3 2 0 1 5 4 8 9 0 /0 0 /0 0 0 dated 2 1 - 1 2 - 2 0 2 3 has be en issued at Mum b ai by I C I C I Lom b ard Ge n e ral I n su ran ce C om pany Ltd. to t h e master
policy h olde r, A SEGO TRAVEL LLP. an d govern ed by t he terms, condit ions and exclusions t he rein conta in e d or ot h e r wise expre sse d in t h e said ce r t ificate , b ut n ot exce e din g t he
Sum I n su red a s spe cified in t he Sch ed ule. This Ce rt ificate , issu ed un d er t he facsim ile sig n at ure of I C I C I Lomb ard G en era l I nsu rance C om pany Ltd. re p re se nt s t h e availa bilit y of
be nefit to t he above ment ion ed I n su re d Pe rson . Th roug h t he maste r policy holder I C I C I Lomba rd Ge ne ral I n su rance C om p any Ltd. has re ce ive d an am ou nt of Rs. 1 1 5 0 .6 2 (Incl
GST @ 1 8 %) towa rds cover in g t h e risk be nefit s, on behalf of t he above ment ione d insure d.

Insurance Details :
Commencement Date:From: 02/01/2025 End Date: mid-night on: :15/01/2025 No. of Days:14
Plan Name :IC Single Trip STP - 2 300000 Geographical Coverage :Excluding USA and CANADA
Assignee :Legal Heir Relation :Legal Heir
Pre-existing Illness Yes/No:No Exclusions :

Coverages Sum Insured Deductibles Coverages Sum Insured Deductibles

Emergency Medical Expenses Emergency
Medical Evacuation Repatriation of Mortal USD 300000 NA Dental Treatment Expenses USD 1000 NA
remains
USD 50 per
Daily Allowance in case of Hospitalization day upto 7 NA Compassionate Visit USD 5000 NA
days
Personal Accident Accidental Death -Common Carrier
Accidental Death Permanent Total Disability-Common Carrier
USD 25000 NA USD 5000 NA
Permanent Total Disability(PTD) Permanent partial Disability -Common
Permanent Partial Disability(PPD) Carrier
USD 100 per
Hijack Distress Allowance day upto 4 12 HRS Child Escort USD 1000 NA
days
Total Loss of checked in Baggage USD 1500 NA Delay of Checked-in Baggage USD 250 12 HRS
USD 750 per
Loss of Passport and documents USD 750 NA Mugging Benefits day upto 1 NA
day
Trip Cancellation and/or Interruption USD 1500 NA Missed connection USD 1000 3 HRS
USD 100 per
Trip Delay day upto 1 3 HRS Flight Delay(Airlines) USD 500 3 HRS
days
Over Booked-Common Carrier USD 1500 6 HRS Bounced Hotel Booking USD 1000 NA
Travel Inconvenience USD 1000 NA Overseas Travel Service Supplier Insolvency USD 1000 NA
Loss of International Driving License USD 1000 NA Car Rental Excess Insurance USD 1000 NA
Personal Liability USD 200000 NA Legal expenses USD 1500 NA
INR As per INR As per
Home Burglary Insurance (Contents) INR 300000 erst while fire Home fire Insurance (Contents) INR 300000 erst while fire
tariff tariff
Financial Emergency Assistance USD 1000 NA Bail Bond USD 5000 NA
Golf Equipment Cover USD 2000 NA Pet Care (in INR) INR 15000 NA
This policy covers adventure sports upto the limits specified under 'Other Terms & Conditions' and will be a part of Emergency Medical Expenses sum
insured
Emergency Assistance Details :
For claims, Contact ICICI Lombard 24hr Help Line number for assistance and registering your claim:
In USA & Canada (Toll Free) +1 844 871 1200;
Rest of the World (Call Back Facility) +91 124 449 8778
National Toll Free Number 1800 102 5721;
Fax Number +91 124 4006674
Email Address : [email protected]
OR Login to the e-claim link https://fgaindia.com/FalckMLink/Register.aspx

Other Terms & Conditions :

• This policy covers Emergency Medical Expenses incurred due to sudden and unexpected injury or any acute Sickness including COVID-19, arising when insured
is outside the 'Republic of India' up to the limits as mentioned in the policy schedule.
• This Travel Insurance policy is only limited to customers of ASEGO TRAVEL LLP.
• This policy covers the insured if travelling to any Schengen & its associate countries to a minimum of Euro 30000 minus deductibles (if any).
• This policy consist of following coverage’s which will be treated as benefit covers i.e. Personal Accident- Accidental Death Permanent Total Disability (PTD)
Permanent Partial Disability (PPD), Accidental Death—Common Carrier, Permanent Total Disability - Common ,Permanent Partial Disability - Common carrier,
Daily Allowance in case of Hospitalization, and Hijack Distress Allowance subject to policy terms and conditions applicable to these sections. All others
coverage’s will be treated as indemnity.
• Sum insured for Emergency Medical Evacuation and Repatriation of mortal remains will be sublimited to sum insured specified in Emergency Medical Expenses.
Pre-existing condition(s) are excluded from the policy including but not limited to life threatening conditions to save the Insured/Insured person’s life. This
exclusion will apply to the following sections: Emergency Medical Expenses, Emergency Medical Evacuation, Dental Treatment Expenses, Daily Allowance in case
of Hospitalization, Permanent Total Disability (PTD), Permanent Partial Disability (PPD). This exclusion has been waived to the extent of USD 20000 per policy or
upto 15% Sum Insured whichever is lesser & limited to section as indicated in the Policy Certificate for mentioned section for the age of upto 80 Years and USD
3000 for the above 80 Years
• Any claim arising out of sporting activities in so far as they involve the training or participation in competitions of professional or semi-professional sports
persons, Adventure Sports is not covered This exclusion has been waived to the extent of USD 20000 per policy if specifically opted or mentioned above.
• Sanctions Limitation and Exclusion Clause: Not applicable for sanctioned countries listed in certificate of insurance.
• No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the
prevision of such cover, payment or such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United
Nations resolutions or the trade or economic sanction, laws or regulations of the European Union, United Kingdom or United States of America. Excluding
from/to and or countries places prohibited by GOI & also Specifically Excluding Iran I Iraq/Syria/ Sudan/ North Korea/Cuba/Crimea.
• Below Sublimit is applicable from the age 61 Years up to the age of 80 years for Emergency Medical Expenses.
Sublimit A p p lica b le- from 6 1 Yea rs- 8 0 Yea rs
Room Rent includ in g B oa rd in g lod g ing $ 1 7 5 0 /day up to 3 0 days
I nte nsive Care u nit $ 3 2 5 0 /day up to 7 days
O pe rat ion The at re ch arges (I nclu sive su rgeon ch arge s)” Maxim u m Up to USD 1 5 0 0 0
An est het ist se r vices Up to 2 5 % of Surg ica l Treat m e nt
Physicia n V isit Max $ 1 0 0 /day up to 1 0 visit s
D ia g n ost ic and Radiolog y ser vice s Max up to USD 1 0 0 0
Am bu lance Ser vices Max u p to $ 5 0 0
H osp ital Misce llan eous Exp enses Maxim um of USD 1 0 0 0
• Above mentioned sub limits are not applicable for Emergency medical Expenses section if sublimit waiver has been opted by insured & clearly mentioned on
above coverage section
• Sublimit applicable for age group above 80 years upto the age of 90 years & only limited to Emergency Medical Expenses is restricted to USD 5000 per illness &
Injury.
• Subject to the terms, conditions and exclusions of the ICICI Lombard General Insurance Company Ltd.

A ut hor ise d Sig n ator y

Scan t h e cod e of aut h ent icate (I C I C I Lom bard Gen eral
p olicy I nsuran ce C ompa ny Ltd.)
The certificate 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, subject otherwise to the Terms, Conditions and Exclusions mentioned in the policy.
Certificate is only valid to the customers who are travelling from India.
•• Tre at m ent ab roa d if t hat is t h e sole rea son or one of t h e rea son s for t h e I nsu re d /I nsu red pe rson ' s te m porar y stay
abroad • Any cla im if t he I nsu re d Pe rson 1 . I s t rave lling a ga inst t he a dvice of a Me d ical Pract it ione r; 2 . I s re ceivin g , or is
on a wa it ing list to rece ive, spe cified m ed ica l t reat m e nt de clared in t he Me dical Pra ct it ion er ’s repor t or ce r t ificate ;

• Has received te rminaI p rog nosis for a m edical cond it ion ; I s ta k in g part in a n avaI , m ilita r y or a ir force O p erat ion .•
1 G e neral Exclusion s
Con genital ex te rnal dise ase s, d ele ct s or a nom alies • Disea se s, illne ss a nd accid e nt s t hat are result s of war an d warlike
occurre nce or inva sion, act s of foreig n e ne m ie s, host ilit ie s, civil war, re bellion, insurre ct ion, civil comm ot ion assum in g
t he p rop ort ion s of or a mount ing to a n upr ising , m ilitar y or usur ped powe r, act ive pa rt icipat ion in r iot s, confiscat ion or
nat ionalizat ion or requisit ion of or d est r u ct ion of or d am age to p rop e rt y by or und e r t h e order of a ny gover nm ent or
loca l aut hor it y.
For any claim related que r y, int im at ion of cla im and su bmission of claim related docum e nt s you may contact our
Emerge ncy Assista nce Ser vice Provide r.
I n case of a claim, you m ay re ach u s at 8 4 4 - 6 9 1 - 8 8 8 3 (For C an ad a), 8 4 4 - 6 9 1 - 8 8 8 5 (For USA ) or +9 1 1 1 4 2 2 2 1 4 0 3 (For
2 N ot ice of Claim ot he r pa rt s of t he world) or e ma il us at cu stome rsuppor t @icicilom bard. com
Alter nat ive ly you can contact us t h roug h: Toll Free - 1 8 0 0 2 6 6 6
Email - cu stom ersu ppor t @icicilom bard .com Post /cou rie r to C om pany - I CI C I Lom b ard G ene ral I nsurance C omp any Ltd.,
I C I CI B ank Towe r, Plot N o. 1 2 , Fin ancial D ist r ict , N ana k ra m Guda, Gach ibowli, Hyd era bad- 5 0 0 0 3 2
Cla ims Proc edure
1 . I n t he event of an accid ent or sud de n illness which is like ly to g ive rise to a claim un der t his Policy, t h e I nsu red Pe rson
sha ll immediately contact t he Em e rge ncy Assistan ce Ser vice Provide r g ivin g d eta ils of t he Policy issued to h im/h e r. Th e
details of p hone num be rs and H elp Line are g ive n in t h e Not ice of cla im se ct ion.
2 . All ne cessar y claim docume nt s shou ld b e fur n ishe d to t he Company / Eme rgency A ssistan ce Ser vice Provide r by t he
policy h old er/insured to make a cla im . Howeve r, claim s file d eve n b eyond such per iod sh ould be con sid e re d if t h ere a re
va lid reason s of any de lay.
3 Cla im Proc edure & Docu mentat ion 3 . Cla im Ser vice Guarante e: T he C ompa ny sh all sett le t h e cla im wit h in 3 0 days from t he date of receipt of last ne ce ssa r y
docu me nt in accordance wit h t he p rovision of reg u lat ion 2 7 of I RDA I (H e alt h I nsurance) Re g ulat ions, 2 0 1 6 .I n t h e ca se of
delay in t he p ay me nt of a claim, t he C om pany shall be liable to pay interest from t he d ate of receipt of last n e ce ssar y
docu me nt to t he d ate of pay m ent of claim at a rate 2 % ab ove t he bank rate
Cla ims Doc umentation -
• Du ly filled in and sig ne d claim form • C e rt ificate of I n sura nce •Any ad dit iona l d ocu ment relevant to claim an d sp e cifie d
in t he Policy word in g s T his is on ly a su mma r y of t h e p rodu ct fe at u re s. T h e act u al be n efit s ava ila ble a re as describ e d in
t he p olicy wording s and will b e sub j ect to t he policy ter m s, cond it ions an d exclu sion s.
For Detailed Te rms & Cond it ions of you r Travel I nsurance Policy Kindly C lick he re
or pa ste t he lin k "htt ps: //asego.co/asegot ravel/new/Trave l- A ssure- Group- O versea s- Trave l- I nsurance- Policy- Word ing s. pd f" on you r browse r.
Website: w w w.icicilomb ard. com; I RDAI Reg ist rat ion No: 1 1 5 , Ema il: cu stom ersu ppor t @icicilomb ard.com
I CI C I Lomba rd Ge neral I nsu rance C omp any Ltd ., , I C I CI Lomb ard House, 4 1 4 , Ve er Savar kar Marg , Prabhad evi, Mu m bai – 4 0 0 0 2 5
UI N: I CI TGOP2 2 2 0 3 V 0 2 2 1 2 2 , C I N: L6 7 2 0 0 MH 2 0 0 0 PLC 1 2 9 4 0 8