STAR TRAVEL PROTECT INSURANCE

Policy Schedule
The Proposal and Declaration and Annexure thereto together with any statement, report or other document leading to the issue of this Policy shall form
the basis of this policy and are deemed to be incorporated herein. In consideration of the payment of the required premium the Company agrees subject
to the terms, conditions and deductibles provided under this Policy to pay the sum insured or the appropriate benefit to the Insured Person named in the
Schedule or his/her legal representatives.
Provided the insurance hereunder is only with respect to such benefits as are indicated by specific amount set against each benefit mentioned in the
Schedule. The Policy, Schedule, attached proposal forms, endosements, procedures and riders shall be read together.
Policy No. : P/161125/03/2011/000920 Previous Policy No. :

Proposer's Code/Name : 1187697 - MR. PARAMJIT SINGH Issue Office Code Branch Office - Jallandhar
:
VPO. - CHAKDANA, Address : Vijay Towers Next to State Bank Of India
Address : DISTT. - NAWANSHAHR, PB. Civil Lines, Jalandhar

, ,
Tel/Mobile : NIL/NIL/ Tel/Mobile : 0181- 4606269/4606369 / /
E-mail Id : pankaj.durga@starhealth.in,puneet.wason
Dep. Prem. Recpt. No. : Dep. Prem. Recpt. Dt. : @starhealth.in

Fulfiller Code : SH8227 Intermediary Code : BA0000062712

Collection No. : 1192000918 - 20/07/2010 IRDA details : Social
Gross Premium : 1,029 Service Tax : 106 Stamp Duty : 1 Total : 1,135

Name of the Insured : MR. PARAMJIT SINGH Plan : Worldwide including USA and
CANADA - PLAN A1 USD 50000
Sex : MALE No of Days : 28 both days inclusive

Date of Birth : 30/05/1971 Date of departure from India : 16/08/2010

Age - Yrs : 39 Date of return to India : 12/09/2010

Passport Number : F 1109404 Purpose of Visit : HOLIDAY

Date of Expiry : 29/11/2014 Assignee Name : MR. BALDEV SINGH / FATHER

Visa Type : VISITOR Copay : Nil

Place of Visit : CANADA, U.K., Compulsory Exclusion : Nil

Benefits Sum Insured in Deductible Excess per claim in Special Exclusions:

USD USD It is hereby declared and agreed that the
expenses directly or indirectly arising out
Emergency Medical Expenses M1 50,000 100 of PED is specifically excluded from the
Emergency Medical Transportation M4 (Included in M1) scope of the Policy.
Transportation of Mortal remains M3 (Included in M1)
Dental Emergency Assitance M2 250 25 Applicable for Benefit A1:
Personal Accident A1 5,000 Where the Insured person is aged 18 yrs
Loss of Checked in Baggage T1 250 or below, the maximum principle sum
Loss of Passport T2 150 15 payable under this Section is restricted to
USD 2500 as per PA Section 3 of this
Delay of Checked in Baggage T3 50 12 Hours Policy.
Flight Delay T4 100 20
Missed Departure/ Connection T5 0
Trip Cancel/Interrupt on death of family member T6 1,000 50
Hijack T7 100 12 Hours
Personal Liability L1 10,000
Important:
1. The benefit under this Policy is not applicable for Indian citizens going abroad for the purpose of any employment includiing but not limited to persons
holding Emigrant Visa(s).
2. It is mandatory to contact first the 24 hr Alarm Centre / Claims Assistance Company's Nos. stated below and take prior authorisation from the Claims
Assistance Company before incurring any expense.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void abinitio (from
inception).
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms attached.
In witness whereof the undersigned being authorised by and on behalf of the company has / have herein to set his/ their hands at Branch Office -
Jallandhar on 20th Day of July 2010 .
Overseas Assistance Company
The Contact details of the Overseas Assistance Company is given in the sheet enclosed.

For and on behalf of

Star Health and Allied Insurance Company Ltd.

Entered by : SH7758
Approved by : SH7758
Place :
Date : 18/08/2010 Authorised Signatory

Please see overleaf

Attached to and forming part of policy No : P/161125/03/2011/000920

List of Overseas Assistance Company Centres

M/S CORIS HERITAGE ASIA PACIFIC PVT.LTD.
1102, Raheja Chambers, 213, Free Press Journal Road,
Nariman Point, Mumbai - 400 021

Location of Centre Coris - Miami Coris - Paris Coris Heritage - Mumbai

For Continental Europe, UK For

Jurisdiction For
& Ireland, Africa, Pakistan South & South East Asia,
North central & South America
Middle East, Australia & New Zealand

Coris USA Inc Coris Assistance Coris Heritage Asia Pacific Pvt. Ltd.
11900 Biscayne Blvd # 510 19-21 Rue Poissonniere 1102, Raheja Chambers
Miami, Fl 33181 75002 Paris 213, Free Press Journal
Address France
USA Road, Nariman Point,
Mumbai- 400 021 India

Toll - Free +1 877 536 7264 +1 800 358 9105 + 800 41 41 44 44 (Toll Free from
Number for (Toll Free Within US and Canada) Within Europe) 1800 22 4004 (Toll Free within India)
Assistance

Other +91 (22) 6654 7965 (24 hrs) - with call back
+1 305 698 7757 +33 (1) 41 61 23 07 facility
Telephone +1 305 357 2100 +33 (1) 41 61 23 00
Numbers +91 (22) 6654 7960
+91 (22) 6654 7967

+1 305 698 0176

Fax Number(s) +1 305 891 7840 +33 (1) 53 56 09 08 +91 (22) 6654 6812

assistance@corisamerica.com ops@coris.fr starhealth@coris-heritage.com

E-Mail ID

The Name, Address / Contact Details of the Service Provider / Overseas Assistance Company mentioned in other places of the policy / Annexure shall read as
above only and not as originally stated therein.

For and on behalf of

Star Health and Allied Insurance Company Ltd.

Entered by : SH7758
Approved by : SH7758
Place :
Date : 18/08/2010 Authorised Signatory

Please see overleaf