COMPREHENSIVE TRAVEL PROTECTION

TRAVEL PROTECTION
CARD
NAME : BHAGAWATI KARKI AS S I S T NO.
110054557719

ADDRESS : HOTEL SWEET DREAM INN,PAHARGANJ,MAIN S TART DAT E END DAT E

BAZAR,NEW DELHI DELHI-110055 30/05/2024 29/05/2025

SMAR
T

Assist Fees : 4561(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 TRAVEL
ASSISTANCE 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

Ask for help

24x7 helpline: +91 22 67872 037 Assistance provided by Segura Services Pvt.
Ltd., Insurance underwritten by ICICI Lombard General
Assistance: [email protected] Claims: Insurance Company Ltd.
[email protected] Customer will bear any cost or expenses arising from
availing the assistance services through a third party
Whatsapp message only for claims: +91 86478 34444 service provider.

www.asegotravel.com

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BON VOYAGE!

Click here or scan the QR code for detailed information about our assistance services.
 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 :BHAGAWATI KARKI Date of Birth:18/10/2002 Passport Number: PA0153542

Address :HOTEL SWEET DREAM INN,PAHARGANJ,MAIN BAZAR,NEW DELHI DELHI DELHI-110055
Travel Assure - Group Overseas Travel Insurance Mobile no :1302321593 Landline no 1302321593
E Mail :[email protected] CR no :
Issue Date :22/04/2024

Certificate No : SX54557719 Intermediary Code :IM-1643817

Travel Assure - Group Overseas Travel Insurance Intermediary Name : Segura Services Private Limited
This Group Travel Insurance policy 4198 / O/ 320154881 / 00 / 000 dated 21 - 12 - 2023 has been i ssued at Mumbai by ICICI Lombard General Insurance Company Ltd. to the master
policy holder, Segura Services Private Limited. and governed by the terms, conditions and exclusions therein contained or otherwise expressed in the said certificate, but not
exceeding the Sum Insured as specified in the Schedule. This Certificate, i ssued under the facsimile s ignature of ICICI Lombard General Insurance Company Ltd. represents the
availability of benefit to the above mentioned Insured Person. Through the master policy holder ICICI Lombard General Insurance Company Ltd. has received an amount of Rs.
1240 . 00 ( Incl GST @ 18 %) towards covering the r i sk benefits, on behalf of the above mentioned insured.

Insurance Details :

Commencement Date:From: 30/05/2024 End Date: mid-night on: :29/05/2025 No. of Days:365
Plan Name :N Multi Trip B-1 (30 Days)- 250000 Geographical Coverage :Including USA and CANADA (Worldwide)
Assignee :KHADGA BAHADUR KARKI Relation :Father
Exclusions :

Coverages Sum Insured Deductibles Coverages Sum Insured Deductibles

Emergency Medical Expenses Emergency
Medical Evacuation Repatriation of Mortal USD 250000 USD 100 Dental Treatment Expenses USD 250 USD 50
remains
Personal Accident
Accidental Death
USD 10000 NA Total Loss of checked - in Baggage USD 1000 NA
Permanent Total Disability(PTD)
Permanent Partial Disability(PPD)
Delay of Checked-in Baggage USD 150 12 HRS Loss of Passport and documents USD 250 USD 25
USD 75 per
Personal Liability USD 200000 USD 100 Hijack Distress Allowance day upto 4 12 HRS
days
Accidental Death -Common Carrier
USD 25 per
Permanent Total Disability-Common Carrier
Daily Allowance in case of Hospitalization day upto 5 2 Days USD 2500 NA
Permanent partial Disability -Common
days
Carrier
Bounced Hotel Booking USD 1000 USD 100 Child Escort USD 500 NA
Trip Cancellation and/or Interruption USD 1000 USD 100 Missed connection USD 500 3 HRS
USD 100 per
Trip Delay day upto 1 6 HRS Home Burglary Insurance (Contents) INR 200000 NA
day
Loss of International Driving Licence USD 500 USD 50 Loss of Gadgets USD 1000 USD 100
Car Rental Excess Insurance USD 500 USD
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/
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 l imits as mentioned in the policy schedule.
• This Travel Insurance policy is only l imited to customers of Segura Services Private Limited.
• This policy covers the insured i f travelling to any Schengen & i ts associate countries up to the Sum insured of EUR 30000 minus deductible ( i f 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 l imited to l i fe threatening conditions to save the Insured/ Insured person’s l i fe. 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 This exclusion has been waived to the extent of USD 20000 per policy i f specifically opted or mentioned above.
• Sanctions Limitation and Exclusion Clause : Not applicable for sanctioned countries l isted in certificate of insurance.
• No ( re) insurer shall be deemed to provide cover and no ( re) insurer shall be l iable 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 Applicable- Above 60 Years- 80 Years
Room Rent including Boarding lodging $ 1500 / day up to 30 days
Intensive Care unit $ 3000 / day up to 7 days
Operation Theatre charges ( Inclusive surgeon charges)” Maximum Up to USD 10000
Anesthetist services Up to 25 % of Surgical Treatment
Physician Visit Max $ 75 / day up to 10 visits
Diagnostic and Radiology services Max up to USD 1000
Ambulance Services Max up to $ 500
Hospital Miscellaneous Expenses Maximum of USD 1000
• Above mentioned sub l imits are not applicable for Emergency medical Expenses section i f 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 85 years & only l imited to Emergency Medical Expenses is restricted to USD 5000 per i l lness &
Injury.
• Subject to the terms, conditions and exclusions of the ICICI Lombard General Insurance Company Ltd.

Authorised Signatory
Scan the code of authenticate
( ICICI Lombard General
policy
Insurance Company 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.
C e r t i f i cate i s o n l y va l i d to t h e c u sto m e rs w h o a re t rave l l i n g f ro m I n d i a .
•• Treatment abroad i f that i s the sole reason or one of the reasons for the Insured/ Insured person' s temporary stay
abroad• Any claim i f the Insured Person 1 . I s travelling against the advice of a Medical Practitioner; 2 . I s receiving, or i
s on a waiting l i st to receive, specified medical treatment declared in the Medical Practitioner ’s report or certificate;

• Has received termina Iprognosis for a medical condition; I s taking part in a nava I , military or air force Operation.•
1 General Exclusions
Congenital external diseases, delects or anomalies • Diseases, i l lness and accidents that are results of war and warlike
occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, insurrection, civil commotion assuming
the proportions of or amounting to an uprising, military or usurped power, active participation in r iots, confiscation or
nationalization or requisition of or destruction of or damage to property by or under the order of any government or
local authority.
For any claim related query, intimation of claim and submission of claim related documents you may contact our
Emergency Assistance Service Provider.
In case of a claim, you may reach us at 844 - 691 - 8883 ( For Canada), 844 - 691 - 8885 ( For USA) or + 91 11 42221403 ( For
2 Notice of Claim other parts of the world) or email us at [email protected]
Alternatively you can contact us through: Toll Free - 1800 2666
Email [email protected] Post/courier to Company - ICICI Lombard General Insurance Company Ltd.,
ICICI Bank Tower, Plot No. 12 , Financial District, Nanakram Guda, Gachibowli, Hyderabad- 500032
Claims Procedure
1. In the event of an accident or sudden i l lness which i s l ikely to give r i se to a claim under this Policy, the Insured Person
shall immediately contact the Emergency Assistance Service Provider giving details of the Policy i ssued to him/ her. The
details of phone numbers and Help Line are given in the Notice of claim section.
2. All necessary claim documents should be furnished to the Company/ Emergency Assistance Service Provider by the
policy holder/ insured to make a claim. However, claims f i led even beyond such period should be considered i f there are
valid reasons of any delay.
3 Claim Procedure & Documentation 3. Claim Service Guarantee: The Company shall settle the claim within 30 days from the date of receipt of last necessary
document in accordance with the provision of regulation 27 of IRDAI ( Health Insurance) Regulations, 2016 . In the case of
delay in the payment of a claim, the Company shall be l iable to pay interest from the date of receipt of last necessary
document to the date of payment of claim at a rate 2 % above the bank rate
Claims Documentation-
• Duly f i l led in and s igned claim form• Certificate of Insurance • Any additional document relevant to claim and specified
in the Policy wordings This i s only a summary of the product features. The actual benefits available are as described in
the policy wordings and will be subject to the policy terms, conditions and exclusions .
For Detailed Terms & Conditions of your Travel Insurance Policy Kindly Click here
or paste the l ink " https://asego. co/asegotravel/ new/ Travel- Assure- Group- Overseas- Travel- Insurance- Policy- Wordings. pdf" on your browser.
Website: www. icicilombard. com; IRDAI Registration No: 115 , Email:[email protected]
ICICI Lombard General Insurance Company Ltd.,, ICICI Lombard House, 414 , Veer Savarkar Marg, Prabhadevi, Mumbai – 400025
UIN: ICITGOP 22203 V 022122 , CIN: L 67200 MH 2000 PLC 129408