*86536384*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada, Pune 411006 (India)

Welcome to Bajaj Allianz Family

Policy Issuing Office 4th Floor Destination, Near Shoppers Stop, M.G.Road, Ghatkopar(East), Mumbai-400089,Phone No: 022-67443100
Insured Name MR ABHINAY JAGDISH BADHAN Policy Number OG-19-1907-9910-00001606

MR ABHINAY JAGDISH BADHAN

202/A,PRATIBHA CHS,AGARKAR ROAD, DOMBIVIL *OG-19-1907-9910-00001606*
EAST, THANE. 421201
Mobile No :NA
Customer ID : 117521188

Dear Customer,
Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz
General Insurance Company Limited, a consistently profitable insurer enjoys a reputation of
expertise, stability and strength. We are a customer focused market leader present in over 200
locations across India. As an organization we strive to understand the risk management needs of
our consumers and translate it into affordable products and services of global quality that deliver
value for money. Bajaj Allianz has an ISO Certified claims process and has received iAAA rating for
the last three consecutive years from ICRA Limited, an associate of Moody's Investors Service, for
claims paying ability. The rating indicates highest claims paying ability and a fundamentally strong
position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and
conditions. In case of any clarification or disagreement, please write to us at
customercare@bajajallianz.co.in within fifteen days of receipt of this policy.
We assure you the best of our services and look forward to a continual patronage and association
with you.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information: Page 1 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com

 *86536384*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada, Pune 411006 (India)

TRAVEL PRIME INDIVIDUAL SILVER 50,000 USD TRANSCRIPT OF PROPOSAL

Policy Issuing Office 4th Floor Destination, Near Shoppers Stop, M.G.Road, Ghatkopar(East), Mumbai-400089,Phone No: 022-67443100
Insured Name MR ABHINAY JAGDISH BADHAN Policy Number OG-19-1907-9910-00001606

Dear MR ABHINAY JAGDISH BADHAN,

We wish to inform you that the contract under policy number has been finalized based on the information and declaration given by you, the transcript where of is mentioned below.
You are requested to reconfirm the same. In case of any disagreement or objection or any changes with respect to information mentioned below, we request you to please revert
back within a period of 15 days from date of your receipt of this, failing which it will be deemed that you are satisfied with the with correctness of the details mentioned below.
Kindly note that the contents and declarations contained in this transcript is the basis on which we have issued the policy to you. Thus We advise you to please ensure that you have
provided/disclosed and or not withheld any material facts/information and declarations, as Policy becomes Void ab initio if material facts are not provided/disclosed and or withheld
and in such case no claim, if any, will be considered by us apart from forfeiture of the premium.

Details provided by you:

A. Proposer details :(other than Student Companion plan)
1. Proposer Name : MR ABHINAY JAGDISH BADHAN
2. Proposer Address : 202/A,PRATIBHA CHS,AGARKAR ROAD, DOMBIVIL EAST, THANE. 421201
3. Proposer Mobile Number : NA
4. Proposer Residential Number : 0
5. Proposer e-mail id : TRAVELDESK.HAFELE@RIYA.TRAVEL

B. Member Details

Member Name Date of Birth Gender Passport Number Nominee Name / Relation Member Relation
MR ABHINAY JAGDISH BADHAN 04-JAN-1985 MALE Z3483299 LEGAL HEIR -

Any Pre Existing Disease

C. Coverage opted
1 Period Departure date: 03-JUN-2018 00:00 Arrival date: 16-JUN-2018
2 Plan Chosen Travel Prime Individual Silver 50,000 USD
3 Geographical Coverage WORLDWIDE EXCLUDING USA AND CANADA

We understand that this policy has been issued based on the information provided to us / our representative and the policy is not valid if any of the information provided is incorrect.

We understand that you hereby declare & warrant that the above statement is true and complete in all respects and that information relevant to your application for insurance has
been disclosed to you. You understand that this policy does not cover any pre-existing medical condition/injury/illness/deformity and complications arising from them that are
declared or undeclared. You will not be travelling against the advice of a physician for the purpose of obtaining medical treatment. You consent to Bajaj Allianz seeking medical
information from any doctor in respect of any matter relating to my physical or mental health and you authorize and consent to him giving such information to Bajaj Allianz and / or to
the claims administrator or medical advisors.

You agree to this proposal and the declaration shall be the basis of the contract between you and Bajaj Allianz and you agree to accept the policy subject to the terms & conditions
prescribed by Bajaj Allianz General Insurance Company Ltd.

In case of Disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please contact our toll free number & register your
objections/changes/disagreement to the contents of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days from
date of your receipt of this transcript along with Policy.
I/we hereby unconditionally allow the Company to share all my / our information being collected in this proposal form or through telephone / email / web-inputs means or other
means, as updated from time to time within group entities.

(Details are system generated & hence no signature required).

Insurance Act, 1938 Section 41 - Prohibition of Rebates Insurance Act

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating
to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing
or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer. ANY PERSON MAKING DEFAULT
IN COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE LIABLE FOR PENALTY WHICH MAY EXTEND TO TEN LAKHS RUPEES.

Schedule ( null ) | Printed on : 30-04-2018 10:16:52 | insurance@riya.travel | WEB | 0

For help and more information: Page 2 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com

 *86536384*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada, Pune 411006 (India)

TRAVEL PRIME INDIVIDUAL SILVER 50,000 USD POLICY SCHEDULE

Policy Issuing Office 4th Floor Destination, Near Shoppers Stop, M.G.Road, Ghatkopar(East), Mumbai-400089,Phone No: 022-67443100
Insured Name MR ABHINAY JAGDISH BADHAN Policy Number OG-19-1907-9910-00001606

INSURED DETAILS POLICY DETAILS

Policy Issued on 30-APR-2018
202/A,PRATIBHA CHS,AGARKAR ROAD, DOMBIVIL EAST, From: 03-JUN-2018 00:00
Insured Address Period of Insurance
THANE. 421201 To : 16-JUN-2018 Midnight
Endorsement NA
Customer ID 117521188 Policy Status Issued

GSTIN / UIN STATE CODE /NAME

NA 27 - Maharashtra
Plan Chosen Travel Prime Individual Silver 50,000 USD Geographical Coverage WORLDWIDE EXCLUDING USA AND CANADA
Passport No Z3483299 Nominee LEGAL HEIR

BENEFITS Limits (Max for entire policy period) DEDUCTIBLE

Personal Accident* USD 15000 NIL
Medical Expenses and Evacuation USD 50000 USD 100
Emergency Dental Pain Relief included in above limits USD 500 USD 100
Repatriation USD 5000 NIL
Loss of Checked Baggage** USD 500 NIL
Accidental Death & Disability (Common Carrier) USD 2500 NIL
Loss of Passport USD 250 USD 25
Personal Liability USD 100000 USD 100
Hijack cover USD 50 per day to maximum USD 300 NIL
Trip Delay USD 25 per 12 Hrs to max USD 120 12 Hrs
Hospitalization Daily Allowance USD 20 per day to max USD 100 NIL
Golfer's Hole-in-one USD 250 NIL
Trip Cancellation USD 500 NIL
Trip Curtailment USD 200 NIL
Delay of Checked Baggage USD 100 12 hours
Home Burglary Insurance INR 100000 NIL
Emergency Cash Benefit*** USD 500 NIL
Missed Connection USD 100 12 hours
Difference in Airfare due to delayed or early return USD 500 NIL
Bounced Hotel USD 500 NIL
PA Cover in India INR 50000 NIL

Integrated GST (18%)
Gross Premium
Remarks
Preexisting disease
149 Gross Premium Base Premium INR 828
(in Words) : Nine
INR 977 hundred seventy-
seven rupees only
Please Note: INR indicates Indian National Rupees
* For benefit of Loss of Baggage- Per Baggage maximum of 50% and per item in the baggage 10%
** For benefit of Personal Accident- Proposer and earning spouse 100 % of sum assured. For Non-earning spouse and every additional adult 50% of
Sum Assured. For Child 25% of Sum Assured
*** For benefit of Emergency Cash Advance - Cash Advance would include delivery charges

Special terms & condition -

Declaration by Insured
Important
Extension of policy period
For Claims Assistance
We understand that this policy has been issued based on the information provided to 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 medical condition/injury/illness/deformity and
complications arising from them that are declared or undeclared.
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.
In case of policy extension & other policy related issues please contact on below mentioned toll free number and/or write on mail ID.
Domestic Contact (Chargeable): E-Mail: travel@bajajallianz.co.in , Address: Bajaj Allianz General Insurance Co. Ltd., 2nd Floor,
+91 20 3030 5858 customercare@bajajallianz.co.in Bajaj Finserv Building, Survey No. 208 / B - 1, Behind Weik
(Toll Free): 1800 209 5858 Fax: +91 20 3051 2207 field IT Park, Off Nagar Road, Viman Nagar, Pune - 411014

Receipt Number:NF | Date:30-APR-18 | Premium Payer ID:10041095 | Float: AF

Premium Details ** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque.

Broker Code & 10041095/Investacc Contact No. 0/00000000000

For help and more information: Page 3 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com

 *86536384*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada, Pune 411006 (India)

TRAVEL PRIME INDIVIDUAL SILVER 50,000 USD POLICY SCHEDULE

Policy Issuing Office 4th Floor Destination, Near Shoppers Stop, M.G.Road, Ghatkopar(East), Mumbai-400089,Phone No: 022-67443100
Insured Name MR ABHINAY JAGDISH BADHAN Policy Number OG-19-1907-9910-00001606

Name Insurance Brokers Pvt E-Mail ID.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd. QR Code

Authorized Signatory (This is system generated document and need not be countersigned.)
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH012474147201718M Defaced No. 0006825599201718 dated 28-MAR-18 timing 17:26:07 of
General Stamp Office,Mumbai,India.
BAGIC GST No : 27AABCB5730G1ZX | Principal Location : GE Plaza, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code :
997136 - Freight insurance services & Travel insurance services. No reverse charge is payable on these services. | Invoice No. : 96880217/1

Schedule ( null ) | Printed on : 30-04-2018 10:16:52 | insurance@riya.travel | WEB | 0

For help and more information: Page 4 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com

 *86536384*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada, Pune 411006 (India)

TRAVEL PRIME INDIVIDUAL SILVER 50,000 USD ANNEXURE

Policy Issuing Office 4th Floor Destination, Near Shoppers Stop, M.G.Road, Ghatkopar(East), Mumbai-400089,Phone No: 022-67443100
Insured Name MR ABHINAY JAGDISH BADHAN Policy Number OG-19-1907-9910-00001606

IMPORTANT NOTICE: Our overseas travel assistance department

When dialling a universal toll free number the caller must Our overseas travel assistance department
first dial the appropriate country's int'l access code (+) as Tel : +91 20 3030 5858
illustrated below. Fax : +91 20 3051 2207
e-mail: travel@bajajallianz.co.in
USA (001) 186658 76903
Canada (001) 186691 43705
Contact Details
Austria (043)
Bajaj Allianz General Insurance Co. Ltd., 2nd Floor, Bajaj
Belgium (032) Finserv Building, Survey No. 208 / B - 1, Behind Weik field IT
Denmark (045) Park, Off Nagar Road, Viman Nagar, Pune - 411014
www.bajajallianz.co.in
France (033)
Germany (049)
For any queries please contact:
Hungary (036)
Any Mobile & Landline (Toll free) : 1800 209 5858
Ireland (353)
Other (Chargeable) : +91 20 3030 5858
Italy (039)
Email : customercare@bajajallianz.co.in
Malaysia (060) 00+800 10002005
Netherlands (031)
New Zealand (064)
Norway (047)
Philippines (063)
Portugal (351)
Spain (034)
UK (044)
Finland (358) - carrier TS 990+800 10002005
Finland (358) - carrier Elisa 999+800 10002005
Hong Kong (852) 001+800 10002005
Israel (972) 014+800 10002005
Singapore (065) 001+800 10002005
So. Korea (082) - carrier Telecom 001+800 10002005
So. Korea (082) - carrier Dacom 002+800 10002005
Thailand (066) 001+800 10002005
Japan (081) - carrier Tele 0041-010+800 10002005
Japan (081) - carrier IDC 0061-010+800 10002005
Japan (081) - carrier NTT 0033-010+800 10002005
Japan (081) - carrier KDD 001-010+800 10002005
Australia (061) 0011+800 10002005

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information: Page 5 of 5

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com