Registered Office :19, Reliance Centre , Walchand Hirachand Marg, Ballard Estate, Mumbai 400 038

RELIANCE TRAVEL CARE INSURANCE POLICY - FOR INDIVIDUAL

POLICY SCHEDULE
Policy Issuing Office : Policy Servicing Office Code & Address : 1103
570- Rectifier House, Naigaum Cross Road, Wadala- (W), Mumbai-400031, Maharashtra, Ground Floor & 1st floor, Near Malhar Talkies, Gokhale Road, Naupada , MAHARASHTRA
India
Policy No : 1103502817000157 Intermediary Code : 100001
Details of the Insured Person :
Name of the Insured Person Date of Birth Relationship Passport No Nominee Name Nominee Relationship
with Insured
Mr. Dhanasekar G 31/12/1969 self qwaszx1234 Dhanasekar G Brother
Address of the Insured : 12 MGR Nagar,Velachery,Chennai - 600041,TAMIL NADU,india
Email-ID : reliance.myinspal@gmail.com Telephone No : 04423456789 Mobile No : 09840322645
Geographical Coverage : Including USA/Canada : Yes
Name of Countries to be visited :
Policy Period : From 00:00 hour on : 24-Jun-2010 To 07-Aug-2010 midnight or Date of return of Insured whichever is earlier
Name of the Plan Opted : Gold
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Net Premium : Rs. 2,059.84/-
Service Tax(10% of Net Premium) : Rs. 205.90/-
Edu Cess(2% of Service tax) : Rs. 4.16/-
High Edu Cess(1% of service tax) : Rs. 2.10/-
Total Premium : Rs. 2,272.00/-
Service Tax Registration No : AABSR 6747 BST 001
Note:In the event of dishonour of cheque, this policy document automatically stands cancelled from inception of whether a separate communication is sent or not.
In witness whereof this policy has been signed at Mumbai on this 08 day of Jun 2010
For and on behalf of Reliance General Insurance Company Limited.

Authorised Signatory
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.
Subject otherwise to the terms,condition and exclusions of the Reliance Travel Care Insurance policy.
Medical Assistance & Emergency Services are implemented by our Service Providers.

International SOS Services (India) Pvt. Ltd

Suite No 605,606, 6th Floor,Copia Corporate Suites,Plot No 9.,Jasola District Center
New Delhi – 110025
are at your disposal for 24 hours during 365 days/year.

In case of any requirement of any emergency assistance whilst abroad,Please contact the helpline numbers given below :
International Toll Free line :
Japan-1010800 767 33333, Australia-0011800 767 33333, Singapore-001800 767 33333,So Korea -001800 767 33 333 , Colombia-90800 767 33333,USA Canada-
18666251562,,Finland-990800 767 33333 and for rest of the countries Austria,Israel,Italy, Malaysia,Netherlands,New Zealand Norway,Philippines,Portugal, Spain,
Sweden,Switzerland,Thailand and UK is 00800 767 33333
Dedicated National Toll Free Help Line : 1800 11 8841
Land Line Numbers : 011- 41898840 & 011-41898841 Fax Number : 011-41898801
Email : reliancegeneral@internationalsos.com Website : www.internationalsos.com
Consolidated Stamp duty Paid with receipt no 37867 dated 18.01.08.( Not Applicable for the State of Jammu & Kashmir.)