3/7/2024

OPTIONAL TRAVEL INSURANCE COVER FOR E-TICKET PASSENGERS OF IRCTC

Certificate of Insurance

Certificate Number 2111188930-2403-01

Name and Address of the Group Indian Railway Catering and Tourism Corporation
Organizer/Group Policy holder 11th floor,B-148 IRCTC Corporate Office Statesman House,
Barakhamba Road, New Delhi
Pin 110001
Name of the Insured VISHAL SINGH
Trip: From 24/03/2024 21:30:00 To 25/03/2024 08:50:00
Originating Station : JAIPUR
Destination Station : BHOPAL JN

INSURED DETAILS
PNR No. 2111188930
Name Age Gender
Vishal Singh 18 M
PREMIUM
Premium Rs. 0.3814
SGST Rs. 0.0343
CGST Rs. 0.0343
Total Rs. 0.45

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 Optional Travel Insurance Cover for E-ticket Passengers of IRCTC Policy Terms and Conditions
attached to the Policy No. IRCTC02324

The premium for this Policy is received from the Group Policy Holder – Indian Railway Catering and
Tourism Corporation

Encl : Annexure 1 – Claims procedure & documentation and Important Exclusions under the Policy
Please quote the Certificate Number in all your correspondence.

IN WITNESS WHEREOF, this Certificate of Insurance has been signed on 07/03/2024

Service Tax No. AABCR7106GST001 PAN Number : AABCR 7106G

For Royal Sundaram General Insurance Co. Limited

Duly Authorised Signatory

OPTIONAL TRAVEL INSURANCE COVER FOR E-TICKET PASSENGERS OF IRCTC

UIN: RSAPAGP24157V022324
IRDAI Registration Number:102

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Annexure 1
Claims Procedure & Documentation
(i) The Insured or his nominee or legal heir shall deliver to the nearest office of the Company, not later
than 4 months from the date of occurrence of the Insured Event, a detailed statement in writing as per
the claim form and any other material particular, relevant to the making of such claim. The Insured or his
nominee or legal heir shall tender to the Company all reasonable information, assistance and proofs in
connection with any claim hereunder.

(ii)Proof as required in the Policy shall be furnished in connection with all matters upon which a claim is
based.
(iii)If the Company requests that bills/ vouchers / Reports in a language, other than English /Hindi be
accompanied by an appropriate translation then the costs of such translation must be borne by the
Insured.

Claim Documentation
Death Claim:
Submit the duly filled in claim form signed by nominee/legal heir alongwith the NEFT mandate details and
cancelled cheque with the following documents:
• Report of the Railway Authority confirming the Accident of the train or Untoward incident

• Report of the Railway Authority carrying the details of the passengers declared dead
• Photo identity proof of nominee
• Claim will be settled only to the nominee declared at the time of buying this insurance through IRCTC
portal

• Succession Order/legal heir certificate/legal documents to establish identification of legal heir in the
absence of nomination under the policy

Disablement Claim:
- Submit the duly filled in Claim form signed by Insured/nominee with NEFT details and cancelled cheque
of the beneficiary with the following documents
• Report of the Railway Authority confirming the Accident of the train or Untoward incident

• Report of the attending doctor confirming the extent of disability

• Attested copy of FIR
• Medical bills corresponding to doctor’s prescription
Attested copy of disability certificate from Civil Surgeon of that Hospital in which the treatment has
undergone stating percentage of disability

All X-Ray / Investigation reports and films supporting disablement

• Photograph before and after disability

Hospitalisation Expenses for Injury:

1. Report of the Railway Authority confirming the Accident of the train or Untoward incident
2. Discharge summary
3. Original Hospital Bills and medical bills corresponding to doctor’s prescription

4. Advance and final receipts (All receipts to be numbered, signed and stamped)
5. Prescriptions for medicines
6. Diagnostic Test Reports, X-Ray, Scan, ECG, and others (including doctor’s advice demanding such tests)
7. Cash memos/bills for medicines purchased from outside

The claim documents should be sent to the Claims department of the nearest Office of the
Company through which this insurance is effected. List of addresses of offices to be obtained
from the website of the Company.

OPTIONAL TRAVEL INSURANCE COVER FOR E-TICKET PASSENGERS OF IRCTC

UIN: RSAPAGP24157V022324
IRDAI Registration Number:102

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Important Exclusions under the Policy:

The Company shall not be liable under this Policy for

(1) Payment of Benefit in respect of accident, death, injury or disablement of the Insured

(a) from intentional self-injury, suicide or attempted suicide

(b) whilst under the influence of intoxicating liquor or drugs

(c) arising or resulting from the Insured committing any breach of law with criminal intent

(d) while crossing the railway tracks

(e) due to mental disorders or disturbance of conscious, strokes, fits or convulsions which affect
the entire body and pathological disturbances caused by the mental reaction to the same and
damage of health caused by curative measures, radiations, infection, poisoning except where
arising from accident

(f) Whilst engaging in any sort or form of adventurous sport

(g) Directly or indirectly caused or contributed by congenital anomaly, venereal disease, sexually
transmitted disease, AIDS or insanity

(2) Any payment in respect of death or disablement resulting directly or indirectly from, caused by,
contributed to or aggravated or prolonged by child birth or pregnancy or in consequence thereof.

(3) Any natural cause or disease or medical or surgical treatment unless such treatment becomes
necessary due to injury caused by the said Untoward incident.

(4) Persons whilst engaged in Hazardous sports or Hazardous Activities.

(5) Claim on account of injury due to Accident or Untoward incident prior to the date and time of
journey and post the date and time of journey would be excluded from the scope of the policy,
however any delay in the time of departure and arrival of the respective train would be taken into
consideration

(6) Claim in instances wherein ticket was booked by the Insured; however the train was not
boarded. This is irrespective of whether the train ticket was cancelled or not.

(7) Claim in instances wherein ticket was booked by the Insured; however the ticket was not
confirmed but still the passenger boarded the train.

(8) The treatment of any illness even if caused by the Accident or Untoward incident suffered by
the Insured except any caused by Accident or Untoward incident and requiring immediate medical
treatment in order to maintain life or relieve immediate pain or distress.

(9) Any medical treatment which was not medically necessary.

(10) Plastic or cosmetic surgery unless this is certified by the attending Medical Practitioner to be
medically necessary for reconstruction following an Accident or Untoward incident.

(11) Dental treatment or surgery of any kind, unless to sound natural teeth and necessitated by an
Accident or Untoward incident.

(12) Any health check-ups or examinations or measures primarily carried out for diagnostic or
investigative reasons for any purpose other than treatment related to an Accident or Untoward
incident.

(13) Any costs relating to physiotherapy unless undertaken while the Insured is hospitalized.

(14) Any costs or periods of residence incurred in connection with rest cures or recuperation at
spas or health resorts, sanatorium, convalescence homes or any similar institution.

(15) Any costs in any way related to psychiatric or mental disorders.

(16) Any costs relating to the Insured’s pregnancy, childbirth or the consequences of either.

(17) Any congenital internal or external diseases, defects or anomalies.

OPTIONAL TRAVEL INSURANCE COVER FOR E-TICKET PASSENGERS OF IRCTC

UIN: RSAPAGP24157V022324
IRDAI Registration Number:102

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