Servicing Office :

IFFCO TOKIO General Insurance Co. Ltd

4th & 5th Floor IFFCO Tower, Plot No-3 Sector-
29, GURGAON, HARYANA
Agent Name: 74 - DIRECT SBU CODE
IFFCO-TOKIO GENERAL INSURANCE Agent #: 74000002
Phone No.: 1800-103-5499
CO. LTD
GSTIN:06AAACI7573H1ZG
Regd. Office: IFFCO SADAN,C1 Dist Centre, Saket ,New Delhi-110017
Corporate Identification Number (CIN) U74899DL2000PLC107621, IRDA Reg. No. 106
PRAVASI BHARTIYA VAHANA YOJNA CERTIFICATE OF INSURANCE CUM SCHEDULE CUM TAX INVOICE
Insured's Name: NARESHPRAJAPAT CRM ID/ Invoice Number:1-SD5A32E
Insured Mobile No.: 8106268864, Policy Number:1-SD5A32E
Insured Address: D-509, Date of Issuance: 26-Oct-2019
URMILA CHS, Period of Insurance From: 26-Oct-2019 To:
Midnight on 25-Oct-2020
SAHARA ROAD,
KLDONGRILANE,
ANDHERI,
MUMBAI-400050.
GSTIN:
Place of Supply: 37
PRAVASI BHARTIYA VAHANA YOJNA POLICY -
2006
Details of the Insured:

VECHICLE NUMBER MH-04-CD-1575 Validity of Insurance 25-Oct-2020

Sponsor NARESH PRAJAPATI State Karnataka

Date of Birth 10-Oct-1987 Nominee's Name NARESH PRAJAPATI

D-509, SAHARA ROAD, ANDHERI,
Nominee's Relation FATHER Nominee's Address
MUMBAI-400050.

Profession HELPER Nominee Mobile No.:

POLICY COVERAGE

Benefits Sum Insured

I) Personal Accident Covering Death & Permanent Total Disability Rs.38,000

II) Transportation and Airfare for Attendant Actual Economy Class Return Airfare for Attendant and Actual Transportation cost of
Mortal Remains

III) Hospitalization Expenses Covering Injuries/Diseases Rs.75,000 (Not Exceeding)

IV) Maternity Expenses Rs.25,000

V) Hospitalization Expenses of Insured's Family in India Rs.50,000

VI) Employment Contingencies Actual Economy Class Airfare

VII) Repartriation Expenses on Medical Grounds Actual Economy Class Airfare

VIII) Legal Costs Rs.30,000

Taxable Value Rs. 275.00 IGST % 18 IGST Amount 49.58

CESS % CESS Premium Paid Rs. 325.00 SAC CODE: 00440005 Description Of General Insurance
Amount Services: Services

Special Condition:
This policy is applicable to only the Emigrants who requires Emigration Check Required (ECR) endorsement on his/her passport.
This Policy has been issued based on the information provided by you and the policy will not be valid if any information prov ided is incorrect.
The Insurance Cover is subject to the terms, conditions and exclusions of Pravasi Bhartiya Bima Yojna.
The intimation of accident /physical injury is to be sent to the insurer within 30 days from the date of accident.
The documents for the claim are to be submitted to the insurer within 90 days from the date of death /permanent disability.

S.Tax.No. AAACI7573HST001 For IFFCO-TOKIO General Insurance Co. Ltd

Name Of Signatory: Subrata Mondal

Designation: Executive Vice President