CIN No.

U66010RJ2006PLC029979 SHRIRAM GENERAL INSURANCE COMPANY LIMITED

IRDA Registration Number: 137
IN PARTNERSHIP WITH THE Sanlam GROUP
Regd. & Corpt. Office: E-8, EPIP, RIICO INDUSTRIAL AREA, SITAPURA
JAIPUR (Rajasthan) - 302022
Website: www.shriramgi.com
E-mail: customer.feedback@shriramgi.in
Toll Free: 1800-100-3009, 1800-300-30000, ISO/IEC 27001:2013 certified

PA Insurance for E-Ticket Passengers of IRCTC

Certificate of Insurance

Master Policy No: 10031/48/19/000001 Certificate No: 201901220096227

Name and Address of the Group Indian Railway Catering and Tourism Corporation 12th floor,
Organizer/Group Policy holder IRCTC Corporate Office Statesman House, Barakhamba Road,
New Delhi, Pin Code 110001.

Originating Station: BHAGALPUR Destination Station: PATNA JN

Trip# details : Departure date and time: 16/02/2019 23:37:00 Arrival date and time: 17/02/2019 04:45:00

#Trip means the actual departure of train from the originating station to actual arrival of train at the destination station as
mentioned in booked ticket through which insurance cover has been opted and premium paid, including µprocess of
entraining¶and µprocess of detraining¶the train. For other T&C and Policy wording please visit our website
www.shriramgi.com

Insured Details
PNR NO. 6624686845
Name Age Gender Mobile No. Email ID
Mr. MD FAZLUR RAHMAN 22 Male 9852438515 mdfazlur786@gmail.com

Nominee Details*
Name of Nominee Age Relationship with Insured
MD MOJIB AHMAD 27 BROTHER

* In case if nominee details have not been provided then claim will be payable to Legal heir.

Sum Insured (IN INR)

Death Permanent total Permanent partial Hospitalization Transportation of
disability disability upto expenses for Injury mortal remains
upto
1000000 1000000 750000 200000 10000

Please quote the PNR No. & Certificate Number in all your correspondence.

Premium: We have received premium of INR 0.49 (Including GST) at the time of booking your ticket.

IN WITNESS WHEREOF, this Policy of Insurance has been signed on 22/01/2019

GST No.: 08AAKCS2509K1Z3 PAN Number: AAKCS2509K

For Shriram General Insurance Company Limited.

Duly Authorized Signatory

Shriram General Insurance Co. Ltd.