Digitally signed by
reliancegeneral.co.in G)
• GENERA Reliance General 022-4890 3009 (PoidJ (':)
L l Smart Insurance 1800 3009 (Toi Free) (9
Company Limited
INSURANCE Date: 2025.05.25 74004 22200 (WhatsApp) L9
11:11:47 1ST
RELIANCE TRAVEL CARE POLICY - FOR TOURISM
POLICY SCHEDULE
Policy Issuing Office : Policy Servicing Office Code 1316
RELIANCE GENERAL INSURANCE COMPANY LIMITED 6TH FLOOR, OBEROI F-17, UG FLOOR, UNIT 1/2, PREETVIHAR, DELHI INDIA
COMMERZ, INTERNATIONAL BUSINESS PARK,OBEROI GARDEN CITY, OFF
WESTERN EXPRESS HIGHWAY,GOREGAON (EAST), MUMBAl-400 063
Policy No : 3250778544009762 Intermediary Code 11BRG429
Tax Invoice No. & Date : V185497998776 & 13/06/2025
Proposer Details :
Communication Address & Place of
Name of the Proposer Date of Birth Occupation Contact No.
Supply
MS. Jiban Kumari Gupta 22/07/1987 Others RUINIBANG, SUNILSMIRITI 3, ROLPA
8294257894
GSTIN / UIN of the Proposer :
Details of the Insured Person
Insured Pre-Existing
Date of
Name of the Insured Person Relationship Passport No illness/ injury/ Suffering Since Under Medication
Birth
with the condition if any
proposer
MS. Jiban Kumari Gupta 22-Jul-1987 Self PA2587821 No NA No
Nominee Details
Nominee Name Date of Birth Nominee Relationship with proposer
GUPTA PRAMESHWAR FATHER
..
Address of the Insured : RUINIBANG, SUNILSMIRITI 3, ROLPA
Email-ID: Telephone No : Mobile No : 8294257894
Geographical Coverage : Excluding USA and Canada Group corp ID
Name of Countries to :
be visited:
Policy Period : or Date of return of Insured whichever is
Name of the Plan : From 00:00 Hrs on 30-June-2025 To 2 9 -June-2026 earlier
Opted Trip Type: midnight Standard
Single
Coverage Sum Insured (In USD) Deductible (In USD)
Medical Expenses Including Transportation 50000 50
Evacuation And Repatriation Of Mortal Remains .'
,.'
Dental Treatment 500 50
Loss of Passport 100 25
Total loss of checked Baggage 1000 100
Personal Accident 25000 NA
Accidental Death Common Carrier 2500 NA
Personal Liability 100000 200
Bail Bond 500 50
Study Interruption 10000 NA
Sponsor Protection 10000 '' NA
Compassionate Visit ' 7500 NA
Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai - 400 063
RGI/MCOM/CO/Trave/PS/VER.1.0/010218 Corporate Identity No. U66603MH2000PLC128300. UIN: RELTIOP08002V010708
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Privatelimited and used by Reliance General Insurance Company Limited under License.
Warranties/Conditions:
1 Warranted that insured is a citizen of India and has a permanent place of residence in India and is
not a NRI or OCI or foreign national and was within the territory of India at the time of issuance
of the policy and before the commencement of the trip.
2 Warranted that maximum amount payable per checked-in baggage in case more than one bag has
been checked in, is 50% (100% for only one checked-in baggage) of applicable Sum Insured and
per item in baggage max 10%.
3 Warranted that the trip is for the purpose of Study not for any other purpose including employment.
4 Warranted that any claim arising out of sporting activities in so far as they involve the training
or participation in competitions of professional or semiprofessional sports persons is
excluded
Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City,
Off Western Express Highway, Goregaon (East), Mumbai – 400 063
RGI/MCOM/CO/Trave/PS/VER.1.0/010218 Corporate Identity No. U66603MH2000PLC128300. UIN: RELTIOP08002V010708
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures PrivateLimited and used by Reliance General Insurance Company Limited under License.
Net Premium (` 4,807.00
IGST(@ 18% ) ` 865.26
Total Premium :
GSTIN: 07AABCR6747B1ZI , ` 5,672.00
HSN:997142
Descriptionof Services : Freight insuranceservices & Travel insurance services
Category-General Insurance Business Service 00440005
Note : In the event of dishonor of the cheque, this policy document automatically stands cancelled from inception, irrespective of whether a separate
communication is sent or not.
In witness whereof this policy has been signed at Mumbai on policy tax invoice date in lieu of Proposal No. as mentioned
in the policy. This document shall be treated as a Tax Invoice as per Rule 46 of the Central Goods and Services TaxRules
2017.
The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in
Policy wordings link : https://www.reliancegeneral.co.in/Insurance/About-Us/Downloads.aspx)
You can also write to us at
[email protected] or call us on 1800 3009 (toll free)/ 022 4890 3009 (Paid) to avail the policy wording.
In case of a renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be subject to change
Grievance Clause : For resolution of any query or grievance, Insured may contact the respective branch office of the Company or may call at
1800 3009 or may write an email at [email protected]. In case the insured is not satisfied with the response
of the office, insured may contact the Nodal Grievance Officer of the Company at [email protected]. In the
event of unsatisfactory response from the Nodal Grievance Officer, insured may email to Head Grievance Officer at
[email protected]. In the event of unsatisfactory response from the Head Grievance Officer, he/she
may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of the
offices of the Insurance Ombudsman are available at IRDAI website www.irda.gov.in or on company website
www.reliancegeneral.co.in or on www.gbic.co.in. The insured may also contact the following office of the Insurance
Ombudsman within whose territorial jurisdiction the branch or office of the Company is located.
Smt. Sandhya Baliga Office of the Insurance Ombudsman,2/2 A,Universal Insurance Building,Asaf Ali Road,NewDelhi –
110 002. Tel.: 011 - 23239633 / 23237532 Fax: 011 - 23230858 Email: [email protected]
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 or incomplete.
Subject otherwise to the terms, conditions and exclusions of the Reliance Travel Care Policy
Medical Assistance & Emergency Services are implemented by our Service Providers-
EUROP ASSISTANCE INDIA PVT LTD.
7th Floor, Star Hub, Bldg
No. 2, Near ITC Maratha
Hotel, Sahar,
Andheri East, Mumbai – 400 059, INDIA.
Are at your disposal for 24 hours during 365 days/year
In case of any requirement for emergency assistance whilst abroad, please contact the International Toll Free helpline numbers given below:
USA – 18337426673,Greece – 86002038017,Australia – 0011-80099441111,Canada -011-80099441111,Singapore and Thailand – 001-
80099441111, Japan – 001-010-80099441111 and 010-80099441111,Hong Kong – 001-80099441111 and 006-80099441111,
Israel – 00-80099441111 and 014-80099441111,Argentina, Austria, Belgium, China, Czech Republic, Denmark, France, Germany, Hungary, Italy, Malaysia,
Netherlands,
New Zealand, Norway, Philippines, Poland, Portugal, South Africa, Spain, Sweden, Switzerland, Taiwan & United Kingdom – 00-80099441111
Dedicated National Toll Free Help Line : 1800 209 5522 Land Line Numbers: +91 22 67347843 & +91 22 67347844
E-mail: [email protected] Fax Number: +91 22 67347888
Website: www.europ-assistance.com
Consolidated Stamp duty Paid vide Letter of Authorization “NO.LOA/CSD/151/2021/(Validity Period Dt.15/10/2021 to 30/03/2022)/4163” date 12 Oct 2021 at General Stamp
Office, Mumbai.** Not Applicable for the State of Jammu & Kashmir
PLEASE NOTE:
·Attached with this Policy Schedule are the Policy Terms and Conditions, and Annexures. Please ensure that the Policyholder has received, read and
understood all these documents. If the Policyholder has not received any of these, pleaseemail/write to the Company at
[email protected] or contact us on 1 800 3009(toll free)
.The Benefits which are mentioned in this Schedule shall only be available under the Policy.
Intermediary Name & Code HEARTBEAT INSURANCE BROKERS PVT LTD 11BRG429
Intermediary Contact No.: 8802188888
Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden
City, Off Western Express Highway, Goregaon (East), Mumbai – 400 063
RGI/MCOM/CO/Trave/PS/VER.1.0/010218 Corporate Identity No. U66603MH2000PLC128300. UIN: RELTIOP08002V010708
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures PrivateLimited and used by Reliance General Insurance Company Limited under License.
Reliance Travel Care Policy- Online Proposal Form with Proposal No V185497998776
Please find attached herewith Policy No. 3250778544009762 which has been issued based on the details furnished to us by Proposer / Insured Person:- MS.
Jiban Kumari Gupta
Proposer Details :
Communication Address & Place of
Name of the Proposer Date of Birth Occupation Contact No.
Supply
MS. Jiban Kumari Gupta 22/07/1987 Others RUINIBANG, SUNILSMIRITI 3,
ROLPA 8294257894
GSTIN / UIN of the Proposer :
Details of the Insured Person :
Pre-Existing
Date Relationship Passport Suffering Under Professional
Name illness/ injury/
of with No Since Medication Sports
condition if
Birth proposer person
any
MS. Jiban Kumari Gupta 22-Jul-1987 Self PA258782 No NA No No
1
Nominee Details
Nominee Name Date of Birth Nominee Relationship with proposer
GUPTA PRAMESHWAR FATHER
Whether Resident of India : NO
Mailing Address : RUINIBANG, SUNILSMIRITI 3, ROLPA
Address of residential property RUINIBANG, SUNILSMIRITI 3, ROLPA
: Insured
Telephone No. : Mobile No. : 8294257894
E-mail id :
Visa Type : NA Geographical : Excluding USA and Canada
Policy Period : From: 30-June-2025 To 29-June-2026 Coverage
Plan : Standard
Trip Type : Single
Purpose of Visit : Tourism
Please go through the details as furnished above and also as provided in the Policy Schedule and confirm that they are in order. Should you feel that
there are any discrepancies / variations, you are requested to write back to us immediately at [email protected] for necessary changes
/ rectification. In the absence of any written communication from you within 7 days or commencement of Policy Period whichever is earlier , it is
hereby agreed and understood that the above statements, answers and particulars are complete, correct and true in all respects and are the basis
on which this Policy is being granted and that if, after insurance is effected, it is found that the above statements, answers or particulars are incorrect
or untrue in any respect, the policy will be considered Null and Void-ab-initio and the Company shall have no liability under the policy
Declaration & Warranty on Behalf of All Persons Proposed to be Insured
I Policy has been issued basis Insured Person(s)
1) Is / are not travelling against advice of Medical Practitioner
2) Is / are not on Waiting list for any Medical treatment
3) Is / are not travelling for the purpose of obtaining Medical treatment
4) Have not received a terminal prognosis for a medical condition before Journey
5) Being in India before taking cover and commencement of Trip
6) Warranted that the Insured / Insured Person(s) has no past history of any illness / hospitalization.
7) Being Indian Citizen
8) Purpose of visit "Study" Only
Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City,
Off Western Express Highway, Goregaon (East), Mumbai – 400 063
RGI/MCOM/CO/Trave/PS/VER.1.0/010218 Corporate Identity No. U66603MH2000PLC128300. UIN: RELTIOP08002V010708Trade Logo displayed above
belongs to Anil Dhirubhai Ambani Ventures PrivateLimited and used by Reliance General Insurance Company Limited under License.
II.I have read and understood the brochure, prospectus, sales literature & Policy wordings and confirm to abide by the same.
III.I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting
policy of the insurance company and that the policy will come into force only after full receipt of the premium chargeable.
IV. I/We further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured / proposer
after the proposal has been submitted but before communication of the risk acceptance by the Company.
V.I/We declare and consent to the Company seeking medical information from any Doctor or from a hospital who at anytime has attended on the life
to be insured / proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be
assured / proposer and seeking information from any insurance company to which an application for insurance on the life to be assured / proposer has
been made for the purpose of underwriting the proposal and / or claim settlement.
VI. I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal
underwriting and/or claims settlement and with any Governmental and / or Regulatory Authority.
VII. Receipt of the Proposal form by the Company shall not be construed as acceptance of proposal. I hereby agree that the insurance coverage shall
commence only on realization of full premium and on receipt of complete medical reports (wherever applicable) and subject to individual
underwriting by the Company. The Company at its sole discretion reserves the right to accept or reject or load any proposal without assigning any
reason thereof.
VIII.I understand that the Policy shall become void at the Company's option, in the event of any untrue or incorrect statement, misrepresentation,
non-description or nondisclosure of any material fact in the Proposal form/personal statement, declaration and connected documents or any material
information having been withheld by me or anyone acting on my behalf.
IX.I hereby declare that the person(s) proposed to be insured would submit to medical examinations, before the nominated doctors of the Company,
or undergo diagnostic or other medical tests, as suggested by the Company for its underwriting.
X. I consent to provide a valid age proof and identity proof at the time of claims or any other time when required by the Company.
XI. I/We consent to receive information from the Company through physical, electronic or telecommunication means from time to time.
XII. I hereby declare on my behalf & on behalf of all persons proposed to be insured that the above statements, answers and/or particulars given by
me in this proposal form are true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on behalf of
these other persons.
XIII. I further declare that the premium is being paid from my credit/debit card/internet bank account.
AML GUIDELINES
1. I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of proceeds of
crime related to any of the offence listed in Prevention of Money Laundering Act, 2002
2.I understand that the Company has the right to call for documents to establish sources of funds.
3. The insurance company has right to cancel the insurance contract in case I am/ have been found guilty by any competent court of law under any of
the statutes, directly or indirectly governing the prevention of money laundering in India.
Online Transaction Facility - Terms and Conditions:
I have read and understood the terms and conditions governing the Online Transaction Facility of Reliance General Insurance Company Ltd. I have
also read and understood the salient features, terms and conditions of the policy as stated in the Brochure.
IMPORTANT:
The information that you give to Reliance General Insurance Company Ltd in this online form will be treated as the proposal form and details in any
supplemental information form or documentation supplied by you or on behalf will influence our decision to offer insurance and the terms upon
which to offer it. Further, any policy we issue will be based on what you have told us. It is there for important that your answers are complete and
accurate in all respects.
• The questions in this online form are indicative rather than exhaustive. You must provide us with all information relative to the risk to be
insured, even if it is not the subject of a question in this online form. If you are in any doubt as to what information should be given, please email us
[email protected] Any failure to provide us with full and accurate material information may mean that your policy can be declared as void.
• No insurance cover will be in force until we have approved it and the premium has been paid.
Statutory Warning - PROHIBITION OF REBATES - Section 41 of the Inusurance Act,1938 as ammended by Insurance Laws(Ammendment) Act,2015.
• 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 prospectuses or tables of the insurer
• Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered & Corporate Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City,
Off Western Express Highway, Goregaon (East), Mumbai – 400 063
RGI/MCOM/CO/Trave/PS/VER.1.0/010218 Corporate Identity No. U66603MH2000PLC128300. UIN: RELTIOP08002V010708
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures PrivateLimited and used by Reliance General Insurance Company Limited under License.
