OPTIONAL TRAVEL INSURANCE FOR E-TICKET PASSENGERS

POLICY SCHEDULE/CERTIFICATE OF INSURANCE

PREAMBLE

ICICI Lombard OPTIONAL TRAVEL INSURANCE FOR E-TICKET PASSENGERS has been issued at Mumbai by ICICI Lombard General insurance Company
Limited to the customers of IRCTC enrolling under this policy D-IRCTC as specified in the Policy and is governed by the terms, conditions and exclusions
there in contained or otherwise expressed in the said policy. This cover is subject to the terms, conditions and exclusions contained or otherwise
expressed in the said policy to the extent of sum insured mentioned as maximum liability, but not exceeding the sum insured as specified below.

Policy Details (Part I of the Policy Schedule)

Policy Number D-IRCTC/90685286/00/000
Policy Period From: 07 Aug 2017 To: 08 Aug 2017(midnight)
Geographical Scope India

Proposer Name: Hemant Kumar

Details of the Insured:
Name Shobha Ram Age 69
Nominee Name Legal Heir E-mail Id sharma.hemant2312@gmail.
com
Seat No 0 Mobile No. 9418351521
From Station TUNDLA JN To Station KALKA

Benefits Sum Insured

Hospitalization expenses for Injury INR 2,00,000
Permanent Partial Disability INR 7,50,000
Permanent Total Disability INR 10,00,000
Personal Accident (Death) INR 10,00,000
Transportation of mortal remains INR 10,000

Please refer to Part II and III of the policy schedule for detailed terms and conditions of the covers described above.
Special Terms and Conditions:
Please contact our 24x7 toll free helpline for assistance and registering your claim: 1800 2666 or e-mail at ihealthcare@icicilombard.com. The
documents required in support of the claim shall be forwarded to the Company at the address mentioned below and in no case beyond a period of 4
months from the date of happening of the incident giving rise to the Claim.

Note: Insurance benefit shall become voidable at the option of the Company, in the event of any untrue or incorrect Statement, misrepresentation,
non-description or nondisclosure of material particulars in the Proposal form/personal statement, declaration and connected documents, or any
material information has been withheld by beneficiary or Anyone acting on beneficiary's behalf to obtain insurance.

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For ICICI LOMBARD GENERAL Date of Issue: 03 Aug 2017

Place of Issuance:Mumbai
INSURANCE CO. LTD.

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The stamp duty of Rs 0.05.(Five paise only) paid vide Receipt/Challan no. 3115327 dated 07 Jul 2017.
FOR CLAIMS : Please contact our 24x7 toll free helpline number at 1800 2666 for assistance and registering your claim or e-mail at
ihealthcare@icicilombard.com. Kindly send the required claim documents at the below mentioned address
ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED
ICICI Bank Tower, Plot No. 12, Financial District, Nanakram Guda,Gachibowli,
Hyderabad, Telangana, Pin Code-500032

Note:In case of any product related query please call our 24x7 toll free helpline number at 18002666. In case of any grievance related to policy/claim
kindly approach our grievance redressal channel available on our website.
In case you find any variation between the information provided by you and the details as mentioned in the policy certificate, kindly contact us
immediately.
Disclaimer: Insurance is subject matter of solicitation. Please refer to policy wordings for terms and conditions, coverage and exclusions.
ICICI Lombard General Insurance Company Limited IRDA Reg.No.115, Misc 146
ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025
www.icicilombard.com

CUSTOMER INFORMATION SHEET (CIS)

Description is illustrative and not exhaustive
S.No. Title Description Refer to Clause
1 Product Name OPTIONAL TRAVEL INSURANCE FOR E-TICKET PASSENGERS
2 What am I covered Part II of the Schedule
for 1. Accidental injury leading to Death, Permanent total disability, Permanent
partial disability during the trip.
If the insured person dies as a result of the accident within 12
months of its occurrence, or thereafter for any other covered
reason, and a claim for permanent impairment had been made
prior to the death, then payment will be made of the sum
insured less any sum paid for the permanent impairment, and
any sum that was due to be paid for the permanent
impairment shall not be paid.
If the insured person is not found within 7 years of the
disappearance, sinking or wrecking of the scheduled railway
carrier in which he was travelling as a fare paying passenger,
the insured person will be presumed to have died as a result of
the accident.
2. Hospitalisation expenses for Injury during the trip

3. Cost of transportation of mortal remains in the event of death during the

3 What are the major
exclusions in the
policy
trip.
4. Coverage shall begin from the actual boarding of the train to the actual
arrival of train at the destination stations including the process of
entraining and detraining
Part II of the Schedule and Exclusions
1. Accident while crossing the railway tracks. Applicable to respective benefits
2. Claim arising or resulting from Insured committing any breach of law
with criminal intent
3. Accident under influence of intoxicating liquor or drugs

4. Intentional self injury, suicide or attempted suicide

5. Any natural cause or disease or medical or surgical treatment unless

such treatment becomes necessary due to injury caused by the said
untoward incident
6. Claim in instances where ticket was booked but train was not boarded

4 Waiting period
5 Payment basis
6 Loss Sharing
7 Renewal Conditions
8 Renewal Benefits
9 Cancellation
10 Claims Contact and
procedure
11 Policy
Servicing/Grievances/
Complaints
12 Insured's Rights
13 Insured's Obligations At the time of claim settlement, Insurance Company may insist on KYC d ocuments
of the insured/nominee/legal heir as per the relevant AML guidelines in force.
Legal Disclaimer Note: The information must be read in conjunction with the prospectus and policy document. In case of any conflict between the CIS
and the policy document, the terms and conditions mentioned in the policy document shall prevail.
7. Claim in instances where ticket was booked, but the ticket was not
confirmed
8. Treatment of any illness even if caused by Accident or untoward incident
suffered by insured except any caused by accident or untoward incident
and requiring immediate medical treatment in order to maintain life or
relieve immediate pain or distress
9. Compensation under more than one of the foregoing benefits i n respect
of same accident or period of disablement of the insured
(Note: The above mentioned is a partial listing of the policy exclusions. P
lease
refer to the policy wordings for the full listing)
Not applicable
Hospitalisation expenses for injury are indemnity based cover whereas accidental
injury leading to Death, Permanent total disability, Permanent partial disability and
cost of Transportation of mortal remains in the event of death are benefit based
covers.
Not applicable
Not applicable
Not applicable
In case of cancellation of tickets, the refund of premium after deduction of Please r efer to the cancellation grid in
administrative/cancellation charges will be made. Part II o
f the Schedule
Please contact our 24x7 toll free helpline for assistance and registering your claim: Claims Procedure in Part II of the
1800 2666 or e-mail-ihealthcare@icicilombard.com. The documents required in Schedule
support of the claim shall be forwarded to the Company at the address mentioned
below immediately and in no case beyond a period of 4 months from the date of
happening of the incident giving rise to the Claim.
Customer to send documents to Company at :- ICICI Lombard General
Insurance Company Limited
ICICI Bank Tower, Plot No. 12, Financial District, Nanakram Guda, Gachibowli,
Hyderabad, Telangana, Pin Code-500032
Grievances in Part III of the Schedule
1. Call the Company at toll free number: 1800 2666 or email us at
customersupport@icicilombard.com
2. If the insured is not satisfied with the resolution then he/she may
successively write to the Manager- Service Quality, Corporate Manager-
Service Quality, National Manager- Operations & finally Director-services
and Business development at the following address:
ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi
Vinayak Temple, Prabhadevi, Mumbai 400 025
3. Please refer to the policy wordings for the details of Insurance
Ombudsman offices.
Benefits payable under this policy will be paid within 15 days of the receipt of last
necessary document.