Bajaj Allianz General Insurance Company Ltd.

Regd.Office - GE Plaza, Airport Road, Yerwada, Pune - 411006 (India)
CORPORATE TRAVEL COMPANION IDENTIFICATION AND SCHEDULE

Master Policy No : IO OG-10-2401-9911-00000009 Imdcode : 10009392

Certificate No : OG-11-2401-7001-00000256 SubImd code : 93920005
Insurance Plan Chosen : USHA C Plans Geographical Coverage : Worldwide excluding USA , Canada

Proposer Name : GAURAV ASTHANA Partner Id: 36639188

Address : B-38, 13/7-PLOT NO-7, NAVODIT NAGAR,MAHMOORGNJ,VARANASI

Date Of Birth: 08-JAN-1982 Pincode : 0

Passport No : H 4705570
Assignee : Kusum Asthana
Scrutiny No : 7778702 Application No :

BENEFITS Limits (Max for entire policy period) DEDUCTIBLE

Loss Of Passport USD 250 USD 30
Delay Of Checked Baggage USD 100 12 HRS
Total Loss of checked Baggage USD 1000 NIL
Personal Accident USD 25000 NIL
Medical Expenses, Evacuation & Repatriation USD 500000 USD 50
Personal Liability USD 200000 USD 2000 (TPPD ONLY)
(*Max. limit for Emergency dental Treatment is USD 500 (included in Medical Expenses))**Maximum liability per baggage is 50% of the limit and maximum liab-
ility per item in a baggage is 10% of the limit as mentioned in the Schedule *** Reimbursement of Emergency Purchases While Overseas Only
Date of Purchase of Policy : 04-NOV-2010
From Commencement date: 08-NOV-2010
To Expiry Date : Till Date Of Return .

Claims Assistance Department : Health Administration Team

24 hours Helpline : Telephone No +91 20 3030 5858,Fax No: +91 20 3051 2207
Email : travel@bajajallianz.co.in
Policy Servicing Office : Bajaj Allianz General Insurance Company Limited,
Ground Floor, Ashoka Plaza, 32/2, Nagar Road, Nr. Weikfield Company, Pune 411014
IMPORTANT : The policy coverages are as per the policy terms and conditions mentioned in the Travel Kit provided with this policy schedule. You may refer
the same on our website as well. Always and COMPULSORILY first contact the 24 hours helpline and obtain prior notification number from HELP LINE before
incurring any expense. For all claims Please quote the claims notification number and submit claim forms with original medical bills. The coverage provided
is subject to details and declaration in the proposal form given prior to taking this policy and attached policy wordings.
Extension Process :
In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858
(chargeable, add area code before this number in case of mobile call) or email us at 'info@bajajallianz.co.in'.
For any claim or policy related queries, please call us at +91 20 3030 5858(chargeable) or Toll Free Nos. mentioned on the travel kit. Alternately you may mail
us your query at travel@bajajallianz.co.in.

For & On Behalf of Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty
Rs. 0.5

Authorized Signatory
Consolidated stamp Duty paid vide Receipt No:
.20228 dated 13-AUG-10
Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)

ReceiptNo / Collection No / Amt(INR) := 1. 2401-00565807/ 1/208(INR) (If Premium is paid through cheque the policy is void ab-initio in case of dishonor of chq.)
Declaration by the insured : We understand that this policy has been issued based on the information provided by us/our representative and the policy is
not valid if any of the information provided is incorrect. We also understand that this policy does not cover any pre-existing illness or disability or conditions
arising therefrom.

Policy is valid only if countersigned by the insured in the space above Signature of Insured
accepting this declaration
-------------------------------------------------------------------------------- List of Toll-Free number for CFT Master Policy--------------------------------------------------------------------------------
Australia(061)-- 0011+800 10002005,USA(001)--18665876903,Canada(001)--18669143705.
For Counties Austria(043),Belgium(032),Denmark(045),France(033),Germany(049),Hungary(036),Ireland(353),Italy(039),Malaysia(060),Netherlands(031),NewZealand(064)
,Norway(047),Philippines(063),Portugal(351),Spain(034),Sweden(046),Swizerland(041),UK(044)--00+800 10002005.
For Countires Hong Kong(852),Singapore(065),So.Korea(082)-Carrier Tele,Thailand(066)--001+800 10002005.
Finland(358)-Carrier Elisa--999+800 10002005,Finland(358)-Carrier TS--990+800 10002005,Israel(972)--014+800 10002005.
Japan(081)-Carrier IDC--0061-010+800 10002005,Japan(081)-Carrier KDD--001-010+800 10002005,Japan(081)-Carrier NTT--0033-010+800 10002005.
Japan(081)-Carrier Tele--0041-010+800 10002005,So.Korea(082)-Carrier Daco--002+800 10002005.
WHEN DIALING A UNIVERSAL TOLL FREE NUMBER THE CALLER MUST FIRST DIAL THE APPROPRIATE COUNTRY'S INT'L ACCESS CODE(+) AS ILLUSTRATED ABOVE.