Business Travel Accident - Schedule of Travel Insuranc e Issued at Mumbai

Schedule Number:

PG478449

Master Policy No.:

Insurance Plan: Company Name: Travel Date:

Plus Others Plan Including America

Producer Code:

Duration:

IBM India Pvt Ltd From 29-Mar-2016

to 2-Apr-2016

BTA0001065

(Both days inclusive) Occupation:

Applicant Name:

5 days NISHIT LADHA

Passport No.:

M0255789

Date of Birth:

Employee No.:

115255744 11-Nov-1981

Benefits subject to terms and conditions for the policy Accident & Sickness Medical Expenses Reimbursement (Including accident dental expenses) Deductible Dental Limit ($500 Per occurance and $100 per tooth) Emergency Eye Treatment (Without cost of spectacles) No Coverage For Cost Of Spectacles, Contact Lenses Limit Per Occurrence Deductible Assistance Services Emergency Evacuation Repatriation Of Remains Hijack Benefits ($30 per day upto $300) Deductible Personal Liability Deductible (Third party property damage only) Hospitalization Benefit Deductible AD & D 24 Hours (During business trip) AD & D 24 Common Carrier Baggage Loss (Checked) Per Article Baggage Delay (After 12 hours only) Loss Of Passport Deductible Trip Delay Maximum For Every 8 Hours Replacement & Rearrangement Of Staff OPD Cashless Worldwide Terrorism Additional Insured:

1).

$250,000

Deductible

$20 $20 $500 $20 Included Included Included Included 1 day $500,000 $200 $500 $50 $25,000 $15,000 $1,500 10% / 50% $150 $250 $30 $500 $10 $5,000 Included Included

NISHIT LADHA

Tata AIG General Insurance Company Limited Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013. IRDA Regn. No. 108. CIN - U85110MH2000PLC128425 www.tataaiginsurance.in Toll free Helpline 1800-266-7780 Email: [email protected]

Business Travel Accident - Schedule of Travel Insuranc e Issued at Mumbai

ASSISTANT CONTACT (For Insureds Only)

Address for Claims/US Non Medical (For Insureds Only)

For Rest of the world policies excluding the Americas:

Claims Department Tata AIG General Insurance company Ltd. A-501, 5th Floor, Building No. 4, Infinity Park, Gen. A. K. Vaidya Marg, Dindoshi, Malad (E), Mumbai, India - 400 097.

Call:+603-2118-0783 or +603-2118-0784 (Toll Worldwide) Email (assitance): [email protected]

For the Americas Policies:

Please Call:+1-866-866-2620 (Toll Free within US & Canada) +1-817-826-7018(Reverse Charge/Collect from other places) Email: [email protected] 0800 169 9884 (Toll free from UK); 0120-593700 (Toll free from Japan)

US MEDICAL CLAIMS (For Providers only) To verify eligibility: Plan Type: Policy Certificate #:

Please Call: 1-877-456-5498 Tata Business Travel PG478449

Mail Medical Claims to:

Travel Guard Attn: Tata AIG Claims PO Box 8003 Stevens Point, WI 54481

Visit our website :www.tataaiginsurance.in OR Email at [email protected] OR Call our 24x7 toll free helpline 1800-266-7780 (Accessible from all lines)

* Important: Any Pre-Existing Medical condition will be excluded from the policy Insurance ** Notice of a medical condition/event must be provided to your assistance contact (see below) at time of care or as soon as possible after emergency care; failure to do so may affect benefits and coverage. Insurance Stamp Duty Paid: Rs.1/- vide receipt/Challan No. MH001559912201314E dated 11th February 2014 Signed for & on Behalf of TATA AIG General Insurance

Shared Savings

Benefits subject to the terms and conditions of the master policy BTA0001065

Authorized Signatory Date Issued: 29-Mar-2016

Tata AIG General Insurance Company Limited Registered Office: Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013. IRDA Regn. No. 108. CIN - U85110MH2000PLC128425 www.tataaiginsurance.in Toll free Helpline 1800-266-7780 Email: [email protected]