GROUP PERSONAL ACCIDENT POLICY FOR OPTIONAL TRAVEL INSURANCE

FOR E-TICKET PASSENGERS OF IRCTC

Certificate of Insurance

Certificate Number AG56051135436529

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

Trip : From 09/03/2017 21:25:00 To 10/03/2017 17:00:00

Originating Station : BHUBANESWAR

Destination Station : CHENNAI CENTRAL

INSURED DETAILS
PNR NO. 6161976670
Name Age Gender
NITHEESH KUMAR 19 Male

PREMIUM
Premium 0.800
Service Tax 0.112
Swachh Bharat Cess 0.004
Krishi Kalyan Cess 0.004
Total 0.920

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 process of entraining
and process of detraining the train

SUM INSURED DETAILS

Permanent total Permanent partial Hospitalisation Transportation of

Death
disability disability expenses for Injury mortal remains
Rs.10,00,000/- Rs.10,00,000/- Rs.7,50,000/- Rs.2,00,000/- Rs.10,000/-
Table of Benefits
As per Group Personal Accident Policy Terms and Conditions attached to the Policy No. AG00056051000100

Encl : Annexure 1 Claims procedure & documentation and Important Exclusions under the Policy
Please quote the Certificate Number in all your correspondence.
25/02/2017
IN WITNESS WHEREOF, this Policy of Insurance has been signed on ________________.
Service Tax No.AABCR7106GST001 PAN Number : AABCR 7106G

For Royal Sundaram General Insurance Co. Limited

Duly Authorised Signatory

Group Personal Accident Policy for Optional Travel Insurance for E-ticket Passengers of IRCTC
UIN: IRDAI/HLT/RSGI/P-H(G)/V.I/44/2016-17
IRDAI Registration Number:102