FUTURE GENERALI INDIA

Insurance Company Limited

TRAVEL INDIVIDUAL
Policy Issuing Office : FUTURE GENERALI INDIA INSURANCE COMPANY LIMITED, BBR Forum, 3rd Flr,, Banjara Hills, Road No-2, Hyderabad, ANDHRA
PRADESH, 500034
Policy and Certificate Number : 2009-T0031200-FTI Period of Insurance : From 00:00 hrs of 29/12/2009 To midnight of
26/06/2010.
Insured : Dr. Sandeep Raparla
Address : Dr No-4-5-49/30/30, Upstair, Saibaba Road, Guntur
Town, Guntun Dist, Andhra Pradesh, 522007

Details of the Plan

Plan Name : Standard Worldwide Nominee : RAPARLA SESHAGIRI RAO
Geographical Scope : Africa, Antartica, Asia, Australia, Europe, North AmericaSouth America

Details of Insured Person(s)

Name Age Gender Relation with Insured Occupation Passport Number
Raparla Sandeep 22 Years M Primary Insured Student G6808397

Schedule of Benefits
Limits (Maximum for the Policy
Main Benefits Sub Benefit Deductible
Period)
PERSONAL ACCIDENT - - -
- A.D & PTD USD 5,000 -
MEDICAL CARE - - -
- MEDICAL CARE USD 50,000 USD 75
- ACCIDENTAL MEDICAL EXPENSES - -
- REPATRIATION OF REMAINS - -
- EMERGENCY EVACUATION - -
- SICKNESS MEDICAL EXPENSES - -
- EMERGENCY DENTAL RELIEF USD 300 USD 100
PERSONAL CARE - - -
- BAGGAGE LOSS (CHECKED BAGGAGE) USD 250 USD 25
SPECIAL CARE - - -
- GOLFER HOLE IN ONE CELEBRATION USD 100 -
TRAVEL INCONVENIENCE - - -
- LOSS OF PASSPORT USD 200 USD 25

Premium Details
Basic Premium Rs. 6,159.00
Service Tax (including Cess) Rs. 635.00
Total Premium Rs. 6,794.00

Important:-
1. In case of payment by cheque, in the event of dishonor of cheque for any reason whatsoever cover provided under this documnet automatically stand cancelled from the inception.
Irrespective of whether a separate communication is sent or not.
2. This 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. This policy doesn’t cover any
pre-existing illness or disability or conditions arising there from.
3. The above records the information of pre-existing illness / hospitalisation etc. details given by the insured pursuant to Clause 4(4) of the IRDA (Policyholder's interest) Regulations,2002.If the information
shown above is found to be either incomplete or incorrect at the time claim , the same shall be construed as non disclosure of material information.
4. This Policy of Insurance is Contract between the Company and the Insured Person(s).The Insured Person(s) shall not transfer ,assign ,alienate or in any way pass the benefits and /or liabilities to any other
person, Institution ,Hospital, Company or Body Corporate without specific approval in writing by a duly authorised officer of the Company .However ,if the Insured Person(s) is permananently
incapacitated or deceased, the legal heirs of the Insured may represent him in respect of Claim under the Policy.
5. Terms, Conditions and exclusions as per applicable memos and policy clause attached.
Declaration: We understand that this policy has been issued based on the information provided by me/my representative and the policy is not valid if any of the information provided is incorrect. We also
understand that this policy doesn't cover any pre-existing illness or disability or conditions arising there from.
This policy is valid only when signed by an authorised signatory of insurer and the insured.
Claims Assistance:
Please contact the international SOS numbers as given in your travel kit. Signature of the Insured
Note: It is mandatory to first contact the 24 hours helpline and prior authorization from HELPLINE before incurring any expense.

For Future Generali India Insurance Company Limited

Date of Issue :30/09/2009

Place :HYDERABAD BRANCH OFFICE

(Authorised Signatory)
The stamp duty of Rs. 0.50 (Fifty Paise) consolidatedstamp duty towards policy stamps paid vide C and IG or Rand S, AP, Hyderabad. Process No. S4/9716/2008 dated03/07/2008.

Corporate & Registered Office: 001, Trade Plaza, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025
Care Lines:- MTNL/BSNL subscribers- 1800-220-233, Any other service provider:- 1860-500-3333, Email: care@futuregenerali.in, Website: www.futuregenerali.in
Service Tax Registration Number: AABCF0191RST001