COMPREHENSIVE TRAVEL PROTECTION

TRAVEL PROTECTION CARD

NAME : MR MD NURUZZAMAN A S S I S T N O.
110054243087

ADDRESS : B32,MEHELLA MAHALLA MADANPUR KHADAR S TA RT D AT E E N D D AT E

SARITA VIHAR DELHI B32,MEHELLA MAHALLA MADANPUR 05/02/2024 04/05/2024

KHADAR SARITA VIHAR DELHI DELHI-110076
SAVER

Assist Fees : 3066( 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.

Travel hassle-free with...

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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Note: Assistance provided by Segura Services Pvt.
24x7 helpline: +91 22 67872 037
Ltd., Insurance underwritten by ICICI Lombard
Assistance: [email protected] General 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.

www.asegotravel.com

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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 :MR MD NURUZZAMAN Date of Birth:10/11/1996 Passport Number:A12058707
Address :B32,MEHELLA MAHALLA MADANPUR KHADAR SARITA VIHAR DELHI B32,MEHELLA MAHALLA MADANPUR KHADAR SARITA VIHAR
DELHI DELHI DELHI-110076
Travel Assure - Group Overseas Travel Insurance Mobile no :7980153237 Landline no :7980153237
E Mail :[email protected] CR no :
Issue Date :05/12/2023

Certificate No : SX54243087 Intermediary Code :IM-1643817

Travel Assure - Group Overseas Travel Insurance Intermediary Name : Segura Services Private Limited
Th is Grou p Travel I n su ra nce p olicy 4 1 9 8 /O/2 6 4 0 8 9 0 7 6 /0 0 /0 0 0 d ated 2 0 - 1 0 - 2 0 2 2 h a s b een issu ed at Mu m b a i by I C I C I Lom b a rd Gen era l I n su ra n ce C om p a ny Ltd . to t h e m a ster
p olicy h old er, Seg u ra Ser vices Pr ivate Lim ited . a n d gover n ed by t h e ter m s, con d it ion s a n d exclu sion s t h erein conta in ed or ot h er wise exp ressed in t h e sa id cer t ificate, b u t n ot
exceed in g t h e Su m I n su red a s sp ecified in t h e Sch ed u le. Th is C er t ificate, issu ed u n d er t h e fa csim ile sig n at u re of I C I C I Lom b a rd Gen era l I n su ra n ce C om p a ny Ltd . rep resent s t h e
ava ila b ilit y of b en efit to t h e a b ove m ent ion ed I n su red Person . Th rou g h t h e m a ster p olicy h old er I C I C I Lom b a rd Gen era l I n su ra n ce C om p a ny Ltd . h a s received a n a m ou nt of Rs.
1 0 1 7 . 0 0 (I n cl GST @ 1 8 %) towa rd s cover in g t h e r isk b en efit s, on b eh a lf of t h e a b ove m ent ion ed in su red .

Insurance Details :
Commencement Date:From: 05/02/2024 End Date: mid-night on: :04/05/2024 No. of Days:90
Plan Name :N Single Trip: A - 2 50000 Geographical Coverage :Excluding USA and CANADA
Assignee :MR SALHA NAJEEB SAIB Relation :Legal Guardian
Exclusions :

Coverages Sum Insured Deductibles Coverages Sum Insured Deductibles

Emergency Medical Expenses Emergency
Medical Evacuation Repatriation of Mortal USD 50000 USD 100 Dental Treatment Expenses USD 250 USD 50
remains
Personal Accident
Accidental Death
USD 10000 - Total Loss of checked - in Baggage USD 500 -
Permanent Total Disability(PTD)
Permanent Partial Disability(PPD)
Delay of Checked-in Baggage USD 100 12 HRS Loss of Passport and documents USD 250 USD 25
USD 25 per
Personal Liability USD 200000 USD 100 Daily Allowance in case of Hospitalization day upto 5 2 Days
days
Accidental Death -Common Carrier
Permanent Total Disability-Common Carrier
USD 2500 - Bounced hotel booking USD 500 USD 50
Permanent partial Disability -Common
Carrier
Trip Cancellation and/or Interruption USD 300 USD 100

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/
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 Segura Ser vices Private Limited.
• Certificate is only valid to the customers who are travelling from India.
• This policy covers the insured if travelling to any Schengen & its associate countries up to the Sum insured of EUR 30000 minus deductible (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 10000 per policy or
upto 10% of Sum Insured whichever is lesser as indicated in the Policy Certificate for mentioned section..
• 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
• 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 for the age above 60 Years upto the age of 80 years for Emergency Medical Expenses.
Sublimit A pplica ble- A bove 6 0 Yea rs- 8 0 Yea rs
Room Rent in clu d in g B oa rd in g lod g in g $ 1 5 0 0 /d ay u p to 3 0 d ays
I nten sive C a re u n it $ 2 0 0 0 /d ay u p to 7 d ays
Op erat ion Th eat re ch a rges (I n clu sive su rgeon ch a rges)” Maxim u m Up to USD 7 5 0 0
An est h et ist ser vices Up to 2 5 % of Su rg ica l Treat m ent
Physicia n V isit Max $ 7 5 /d ay u p to 1 0 visit s
Dia g n ost ic a n d Ra d iolog y ser vices Max u p to USD 5 0 0
Am b u la n ce Ser vices Max u p to $ 3 0 0
Hosp ita l Miscella n eou s Exp en ses Maxim u m 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 under Emergency medical expenses is restricted to USD 5000 for age 81-85 year and USD 3000 for age 86-90 year per illness, injury &
accident.
• Subject to the terms, conditions and exclusions of the ICICI Lombard General Insurance Company Ltd.

Au t h or ised Sig n ator y

Sca n t h e cod e of a u t h ent icate (I C I C I Lom b a rd Gen era l
p olicy I n su ra n ce C om p a 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.
•• Treat m ent a b roa d if t h at is t h e sole rea son or on e of t h e rea son s for t h e I n su red /I n su red p erson ' s tem p ora r y stay
a b roa d • Any cla im if t h e I n su red Person 1 . I s t ravellin g a ga in st t h e a d vice of a Med ica l Pra ct it ion er ; 2 . I s receivin g , or is
on a wa it in g list to receive, sp ecified m ed ica l t reat m ent d ecla red in t h e Med ica l Pra ct it ion er ’s rep or t or cer t ificate;

• Ha s received ter m in a I p rog n osis for a m ed ica l con d it ion ; I s ta k in g p a r t in a n ava I , m ilita r y or a ir force Op erat ion . •
1 Gen era l Exclu sion s
C on gen ita l ex ter n a l d isea ses, d elect s or a n om a lies • Disea ses, illn ess a n d a ccid ent s t h at a re resu lt s of wa r a n d wa r like
occu r ren ce or inva sion , a ct s of foreig n en em ies, h ost ilit ies, civil wa r, reb ellion , in su r rect ion , civil com m ot ion a ssu m in g
t h e p rop or t ion s of or a m ou nt in g to a n u p r isin g , m ilita r y or u su r p ed p ower, a ct ive p a r t icip at ion in r iot s, confiscat ion or
n at ion a lizat ion or req u isit ion of or d est r u ct ion of or d a m a ge to p rop er t y by or u n d er t h e ord er of a ny gover n m ent or
loca l a u t h or it y.
For a ny cla im related q u er y, int im at ion of cla im a n d su b m ission of cla im related d ocu m ent s you m ay conta ct ou r
Em ergen cy Assista n ce Ser vice Provid er.
I n ca se of a cla im , you m ay rea ch u s at 8 4 4 - 6 9 1 - 8 8 8 3 (For C a n a d 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 C la im ot h er p a r t s of t h e wor ld ) or em a il u s at cu stom ersu p p or t @icicilom b a rd . com
Alter n at ively you ca n conta ct u s t h rou g h : Toll Free - 1 8 0 0 2 6 6 6
Em a il - cu stom ersu p p or t @icicilom b a rd . com Post /cou r ier to C om p a ny - I C I C I Lom b a rd Gen era l I n su ra n ce C om p a ny Ltd . ,
I C I C I B a n k Tower, Plot N o. 1 2 , Fin a n cia l Dist r ict , N a n a k ra m Gu d a , Ga ch ib owli, Hyd era b a d - 5 0 0 0 3 2
Cla ims Proc edure
1 . I n t h e event of a n a ccid ent or su d d en illn ess wh ich is likely to g ive r ise to a cla im u n d er t h is Policy, t h e I n su red Person
sh a ll im m ed iately conta ct t h e Em ergen cy Assista n ce Ser vice Provid er g ivin g d eta ils of t h e Policy issu ed to h im /h er. Th e
d eta ils of p h on e n u m b ers a n d Help Lin e a re g iven in t h e N ot ice of cla im sect ion .
2 . All n ecessa r y cla im d ocu m ent s sh ou ld b e fu r n ish ed to t h e C om p a ny / Em ergen cy Assista n ce Ser vice Provid er by t h e
p olicy h old er /in su red to m a ke a cla im . However, cla im s filed even b eyon d su ch p er iod sh ou ld b e con sid ered if t h ere a re
va lid rea son s of a ny d elay.
3 Cla im Proc edure & Docu m entat ion 3 . C la im Ser vice Gu a ra ntee: Th e C om p a ny sh a ll sett le t h e cla im wit h in 3 0 d ays from t h e d ate of receipt of la st n ecessa r y
d ocu m ent in a ccord a n ce wit h t h e p rovision of reg u lat ion 2 7 of I RDAI (Hea lt h I n su ra n ce) Reg u lat ion s, 2 0 1 6 . I n t h e ca se of
d elay in t h e p ay m ent of a cla im , t h e C om p a ny sh a ll b e lia b le to p ay interest from t h e d ate of receipt of la st n ecessa r y
d ocu m ent to t h e d ate of p ay m ent of cla im at a rate 2 % a b ove t h e b a n k rate
Cla ims Doc umentation-
• Du ly filled in a n d sig n ed cla im for m • C er t ificate of I n su ra n ce •Any a d d it ion a l d ocu m ent releva nt to cla im a n d sp ecified
in t h e Policy word in g s Th is is on ly a su m m a r y of t h e p rod u ct feat u res. Th e a ct u a l b en efit s ava ila b le a re a s d escr ib ed in
t h e p olicy word in g s a n d will b e su b j ect to t h e p olicy ter m s, con d it ion s a n d exclu sion s.
For Deta iled Ter m s & C on d it ion s of you r Travel I n su ra n ce Policy Kin d ly C lick h ere
or p a ste t h e lin k " htt ps: //a sego. co/a segot ravel/n ew/Travel- Assu re- Grou p - Oversea s- Travel- I n su ra n ce- Policy- Word in g s. p d f" on you r b rowser.
Website: w w w. icicilom b a rd . com ; I RDAI Reg ist rat ion N o: 1 1 5 , Em a il: cu stom ersu p p or t @icicilom b a rd . com
I C I C I Lom b a rd Gen era l I n su ra n ce C om p a ny Ltd . , , I C I C I Lom b a rd Hou se, 4 1 4 , Veer Sava r ka r Ma rg , Pra b h a d evi, Mu m b a i – 4 0 0 0 2 5
UI N : I C I TGOP2 2 2 0 3 V 0 2 2 1 2 2 , C I N : L6 7 2 0 0 MH2 0 0 0 PLC 1 2 9 4 0 8