BusinessTravelAccident- ScheduleofTravelInsuranc e

IssuedatMumbai

Schedule Number:

PG285394

Master Policy No.:

Insurance Plan:
Company Name:
Travel Date:

PlusOthersPlanExcludingAmericas

Producer Code:

Duration:

BTA0002099
BTA0002099

ComputerSciencesCorporationIndiaPvt.Ltd
From 11-Mar-2016
(Bothdaysinclusive)
to 9-Apr-2016
30days
RAJIV KUMAR SHARMA

Occupation:

Applicant Name:
Passport No.:

H6796603

Date of Birth:

Employee No.:

11512157
19-Mar-1987

Benefits subject to terms and conditions for the policy

Accident&SicknessMedicalExpensesReimbursement(Includingaccident
dentalexpenses)
Deductible
DentalLimit($300peroccurrenceand$100pertooth)
Deductible
AssistanceServices
EmergencyEvacuation
RepatriationOfRemains
HijackBenefit(For$30perdayandmaximumof$300)
Deductible
PersonalLiability
Deductible
HospitalizationBenefit
Deductible
AD&D24Hours(Duringbusinesstrip)
AD&DCommonCarrier
BaggageLoss(Checked)
PerArticle&PerBag
BaggageDelay(After12hoursonly)
LossOfPassport
Deductible
TripDelay(Deductible-8hours)(Maximum)
ForEvery8Hours
Replacement&RearrangementOfStaff
TripCancellation
Deductible
TripInterruption
Deductible
Pre-existingDisease(Maximum5casesinthepolicyyear)
Maternity(Maximum5casesinthepolicyyear)
Additional Insured:

1).

$500,000
$50
$300
$50
Included
Included
Included
Included
1Day
$500,000
$200
$500
$50
$25,000
$25,000
$1,500
10%&50%
$150
$250
$30
$500
$10
$5,000
$500
$50
$500
$50
$2000PerCase
$2000PerCase

RAJIV KUMAR SHARMA

Tata AIG General Insurance Company Limited

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013.
IRDA Regn. No. 108. CIN - U85110MH2000PLC128425
www.tataaiginsurance.in Toll free Helpline 1800-266-7780 Email: customersupport@tata-aig.com

BusinessTravelAccident- ScheduleofTravelInsuranc e
IssuedatMumbai

ASSISTANT CONTACT (For Insureds Only)

Address for Claims/US Non Medical (For Insureds Only)

For Rest of the world policies excluding the Americas:

Claims Department
TataAIGGeneralInsurancecompanyLtd.
A-501,5thFloor,BuildingNo.4,InfinityPark,
Gen.A.K.VaidyaMarg,Dindoshi,Malad(E),
Mumbai,India-400097.

Call:+603-2118-0783or+603-2118-0784(TollWorldwide)
Email(assitance): TGAP.TATAmedical@travelguard.com

For the Americas Policies:

PleaseCall:+1-866-866-2620(TollFreewithinUS&Canada)
+1-817-826-7018(ReverseCharge/Collectfromotherplaces)
Email:tata.aig@aig.com
08001699884(TollfreefromUK);
0120-593700(TollfreefromJapan)

US MEDICAL CLAIMS (For Providers only)

To verify eligibility:
PlanType:
PolicyCertificate#:

PleaseCall:1-877-456-5498
TataBusinessTravel
PG285394

Mail Medical Claims to:

TravelGuard
Attn:TataAIGClaims
POBox8003
StevensPoint,WI54481

Visit our website :www.tataaiginsurance.in

OR Email at customersupport@tata-aig.com
OR Call our 24x7 toll free helpline 1800-266-7780 (Accessible from all lines)

*Important:AnyPre-ExistingMedicalconditionwillbe
excludedfromthepolicyInsurance
**Noticeofamedicalcondition/eventmustbeprovidedtoyour
assistancecontact(seebelow)attimeof careorassoonas
possibleafteremergencycare;failuretodosomayaffect
benefitsandcoverage.
InsuranceStampDutyPaid:Rs.1/-videreceipt/ChallanNo.
MH001559912201314Edated11thFebruary2014
Signedfor&onBehalfofTATAAIGGeneralInsurance

Shared Savings

Benefits subject to the terms and conditions of the

master policy BTA0002099

AuthorizedSignatory
Date Issued: 7-Mar-2016

Tata AIG General Insurance Company Limited

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013.
IRDA Regn. No. 108. CIN - U85110MH2000PLC128425
www.tataaiginsurance.in Toll free Helpline 1800-266-7780 Email: customersupport@tata-aig.com