Hey Jasveer Singh Ubeja,

Your travel policy is ready for a take off.

Travel Details

Policy Number ACKTR96126 Policy Issue Date 01-09-2025

Travel Start Date 30-09-2025 Travel End Date 15-10-2025

Geography Covered Schengen region Visiting Country Czech Republic, Germany,

Netherlands

Coverages Selected Comfort Medical Sum Insured $50,000 per person

Mobile Number (Primary 8839601581

Insured)

Travellers Covered

Name DOB Gender Passport Number Nominee GST

Number

Jasveer Singh Ubeja 01-01- Male S5433404 Vibhor Kansal Not

1997 Provided

Parth Shyara 02-04- Male T0266079 Vibhor Kansal Not

1996 Provided

Ekansh Gupta 29-08- Male S9667594 Vibhor Kansal Not

1996 Provided

Himanshu Maurya 19-02- Male W5681683 Vibhor Kansal Not

1997 Provided

Rishank Verma 16-09- Male P0116376 Vibhor Kansal Not

1996 Provided

Abhishek Rajesh 04-03- Male Z3816211 Vibhor Kansal Not

Khetrapal 1998 Provided

Premium Breakup

Total Package Premium ₹5,582

Discount ₹465

IGST(18%) ₹921

Total Premium ₹6,038

When things go south, this plan
puts you back on track

You are covered for

Hospitalisation due to illness

Sum Insured Upto$50,000

If you fall sick, you can either get your medical bills reimbursed or avail cashless treatment in our
network hospitals (where we settle your bill directly with the hospital). To avail cashless treatment,
give us a missed call on:
Toll-free number (for United States):1833-813-8772
Call (for all countries, except the US):022-69635374

Please note:
1. Pre-existing diseases are not covered
2. Hospitalisation due to covid-19 is also covered
3. The coverage amount is common with other medical benefits where this condition is specified.

This does not cover treatment of any pre-existing disease

Hospitalisation due to accident

Sum Insured Upto$50,000

If you get injured, you can either get all your medical bills reimbursed or avail cashless treatment in
our network hospitals (where we settle your bill directly with the hospital). To avail cashless
treatment, give us a missed call on:
Toll-free number (for United States):1833-813-8772
Call (for all countries, except the US):022-69635374

Please note:
1. Injuries incurred during adventure sports activity like skiing, skydiving, etc. are not covered (unless
you opt for the adventure sports cover separately)
2. The coverage amount is common with other medical benefits where this condition is specified.

Daily hospitalisation allowance

Sum Insured $50

If you get hospitalised for more than 24 hours, you will receive a daily payout of $50 per day (for a
maximum of 10 days) over and above the reimbursement of your medical expenses.

Doctor consultation
Sum Insured Upto$500

If you fell sick/ got injured while travelling, you can avail reimbursement upto $500 for the doctor
fees, lab tests or any other treatments.
Flight delay
Sum Insured $50

If your flight gets delayed by more than 6 hours at arrival, we will pay $50 to cover for your
discomfort.

Please note:
1. Rescheduling of flights by the airlines is not covered under this benefit.

Missed flight
Sum Insured $150

If you miss your international flight, we will pay $150 to cover the cost of your new booking.

Please note:

1. The claim can be paid only if you book a new flight that departs within 48 hours of the scheduled
departure time of the original flight
2. Flight cancellation and rescheduling by the airline will not be covered under this benefit.

Trip cancellation
Sum Insured Upto$500

We will cover the cost of your flight cancellation charges of upto $500 if you cancel your flight due
to-

1. Hospitalisation of any of the travellers for 48 hours or more, or

2. Death of an immediate relative (within 20 days of your take off date), or
3. Any natural catastrophe.

Delay of checked-in baggage

Sum Insured $100

If your baggage is delayed for more than 3 hours, we will pay $100 to cover for your discomfort.

Please note:
1. This cover is not applicable for flights arriving in India.

Total loss of checked-in baggage

Sum Insured $500

If your airline confirms complete loss of your checked-in baggage, we will pay $500 to compensate
for your loss.

Damage of checked-in baggage

Sum Insured $50

If your airline confirms damage of your checked-in baggage, we will pay $50 to compensate for
your discomfort
Loss of passport
Sum Insured Upto$250

If you lose your passport, we will cover the expenses incurred upto $250 to obtain a new passport
or emergency certificate.

Please note:
1. Any loss after your arrival in India will not be covered under this benefit.

Trip rescheduling
Sum Insured Upto$500

We will cover the additional flight expenses of upto $500 if you reschedule your flight due to -
1. Hospitalisation of any of the travellers for 48 hours or more, or
2. Death of an immediate relative (within 20 days of your take off date), or
3. Any natural catastrophe.

Trip cancellation due to covid

Sum Insured Upto$500

If your trip gets cancelled because you got tested covid+ and are quarantined (the trip start date falls
within the quarantine period specified by the govt), we will cover the expense of your flight tickets
upto $500.

Death due to accident

Sum Insured $10,000

In case of your untimely death due to any accident or injury during the trip, we will pay $10,000 to
your immediate relative or nominee.

Note:
1. The coverage amount is common with other medical benefits where this condition is specified.

Total disability
Sum Insured $10,000

We will pay $10,000 in case you are left with any permanent disabilities due to any injury during the
trip.

Note:
1. The coverage amount is common with other medical benefits where this condition is specified.
Physiotherapy
Sum Insured Upto$50,000

We will reimburse upto $50,000 for physiotherapy sessions required of incident solely because of
any accident or injuries during your trip.

Note:
1. The coverage amount is common with other medical benefits where this condition is specified.
2. The treatment should be medically necessary and undertaken on the written advice of the treating
medical practitioner.

Missed connecting flight

Sum Insured Upto$500

In case you miss your connecting flight due to a delay of more than 6 hours of your original flight, we
will pay upto $500 to cover for your next booking (excluding refunds by the flight operator).

Please note:

1. This benefit is not applicable if you miss your connecting flight due to cancellation or rescheduling
of the first flight.
2. The gap between the two flights should be atleast 6 hours

Home cover
Sum Insured Upto₹50,000

In case there was any theft at your place while you were on trip, we will reimburse the actual loss
amount (excluding cash or any valuables) upto ₹50,000.

Note:
1. The coverage amount is common with other domestic property benefits where this condition is
specified

Emergency trip extension

Sum Insured Upto$500

If you are hospitalised during your travel period and have to extend your stay, we will reimburse upto
$500 to cover for your hotel charges for a maximum of 7 days and any expenses incurred on
rescheduling your flight (one time).

Legal liability
Sum Insured Upto$20,000

We will reimburse any actual legal liability upto $20,000, including costs incurred on litigation and
bail bond by you to pay damages to a third party arising out of the third partyʼs death, injury or
property being damaged during the travel period- just let us know within 7 days from the date of
incident to avail this benefit.
Emergency evacuation
Sum Insured Upto$50,000

If, due to an extreme situation (medical condition or a catastrophe in your place of travel), you need
air/water/surface transportation to any place, your costs incurred will be reimbursed upto $50,000.

Note:
1. The coverage amount is common with other medical benefits where this condition is specified.

Travel expenses of immediate relative

Sum Insured Upto$2,500

If you are hospitalized for more than 48 hours during your travel period, we will reimburse upto
$2,500 for direct route economy class two-way tickets for your immediate relative.

Repatriation of mortal remains in case of death

Sum Insured Upto$50,000

If any injury or illness during the travel period leads to your unfortunate death, we will pay upto
$50,000 for the expenses incurred on the transportation of mortal remains.

Note:
1. The coverage amount is common with other medical benefits where this condition is specified.
If you're ever in a difficult spot (we hope not),
Acko makes it easy to raise a claim.

Get cashless treatment (if medical cover is Claim for other covers
applicable)
Login to the Acko app with your
Select this travel policy from the 'Your policies' registered mobile number and
section on your Acko app to get the list of select your travel policy from the
cashless network hospitals around you or call us ‘Your Policiesʼ section
on 18338138772 (for US) and on 022-69635374
(for other regions) In the ‘claimsʼ section of your
policy, select what you need to
We will immediately send a list of claim for, share details about what
cashless hospitals near you. happened and upload your
supporting documents
Show this policy document at the
hospital desk and proceed with Track the progress of your claim
the treatment. We will settle the directly from the Acko app
bill with the hospital directly.

This is to certify that Acko International Travel Insurance has been issued to the Proposer as mentioned in the ‘policy holder detailsʼ
section for the policy period as indicated. It is to be noted that the insurance accorded by the Policy described herein is subject to all the
terms, exclusions and conditions contained within the Policy wordings. The Policy provides for the sum insured to the insured in the
unfortunate event of having faced loss or damage by any insured perils in the coverage period. The summary of benefits of the same is
mentioned under the “You are covered for” section

For Acko General Insurance

Company Authorised Representative Signature

Consolidated Stamp Duty is paid with the Department of Stamps, Bengaluru – Karnataka

For further details, refer to the detailed policy wordings

Acko General Insurance Limited

Somasandra Palya, 36/5, Haralukunte village, adjacent 27th main road,sector 2 HSR Layout, Bangalore, Karnataka,560102
CIN: U66000KA2016PLC138288
GSTIN: 29AAOCA9055C1ZF

If you need any assistance

travelinsurance@[Link]
 Within India Outside India
1800-266- 18338138772 (for US) and 022-69635374 (for other
2256 regions)

Premium receipt

Received with thanks from Jasveer Singh Ubeja a sum of ₹6,038 towards premium on International Travel
Insurance Policy

INSURED DETAILS

Name of Insured: Jasveer Singh Ubeja

GST: Not Provided

Policy Number: ACKTR96126

Payment Date: 01-09-2025

PREMIUM DETAILS (₹)

Total Package Premium ₹5,582

Discount ₹465

IGST(18%) ₹921

Total Premium ₹6,038

TERMS & CONDITIONS

Issuance of this receipt does not amount to acceptance of the risk by Acko General Insurance Limited. The insurance
cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
Proposal Form
Dear Jasveer Singh Ubeja,
We wish to inform you that the Insurance policy number ACKTR96126 has been issued on the basis of the information
and declaration given by you, the transcript whereof is mentioned below.

Please be informed that this Policy shall be construed to be void ab initio/invalid in the event we find that you have not
disclosed material or correct information required for the purpose of providing the below insurance cover and in case
of any claim arising under the policy in such a scenario, we shall be under no obligation whatsoever to settle such claim
to you and the premium paid by you under this policy shall stand fully forfeited.

Travel Details

Policy Number ACKTR96126 Policy Issue Date 01-09-2025

Travel Start Date 30-09-2025 Travel End Date 15-10-2025

Geography Covered Schengen region Visiting Country Czech Republic, Germany,

Netherlands

Coverages Selected Comfort Medical Sum Insured $50,000 per person

Mobile Number (Primary 8839601581

Insured)

Travellers Covered

Name DOB Gender Passport Number Nominee GST

Number

Jasveer Singh Ubeja 01-01- Male S5433404 Vibhor Kansal Not

1997 Provided

Parth Shyara 02-04- Male T0266079 Vibhor Kansal Not

1996 Provided

Ekansh Gupta 29-08- Male S9667594 Vibhor Kansal Not

1996 Provided

Himanshu Maurya 19-02- Male W5681683 Vibhor Kansal Not

1997 Provided

Rishank Verma 16-09- Male P0116376 Vibhor Kansal Not

1996 Provided

Abhishek Rajesh 04-03- Male Z3816211 Vibhor Kansal Not

Khetrapal 1998 Provided

Premium Breakup

Total Package Premium ₹5,582

Discount ₹465
IGST(18%) ₹921

Total Premium ₹6,038

 Acko General Insurance Limited
International Travel Insurance

CUSTOMER INFORMATION SHEET

(Description is illustrative and not exhaustive)

Policy
Sr.
Title Description Clause
No
Number

Name of the
1 Acko International Travel Insurance
Product

Policy
2 ACKTR96126
Number

Type of
3 Insurance Both Indemnity and Benefit
Product/Policy

Sum
Cover
insured

Hospitalisation due to illness $50,000

Hospitalisation due to accident $50,000

Daily hospitalisation allowance $50

Doctor consultation $500

Flight delay $50

Missed flight $150

Trip cancellation $500

Delay of checked-in baggage $100

Total loss of checked-in baggage $500

Damage of checked-in baggage $50

Loss of passport $250

Sum Insured
Trip rescheduling $500
4 (Individual
Basis) Trip cancellation due to covid $500

Death due to accident $10,000

Total disability $10,000

Physiotherapy $50,000

Missed connecting flight $500

Home cover ₹50,000

Emergency trip extension $500

Legal liability $20,000

Emergency evacuation $50,000

 Travel expenses of immediate relative $2,500

Repatriation of mortal remains in case of death $50,000

All the below mentioned benefits are covered up to sum insured & conditions as
specified in the policy schedule unless specified otherwise

Section
Accidental and Medical Benefits
3.1

Section
Illness during the Travel Period that leads to Hospitalisation
3.1.2

Injury due to an Accident that occurs during the Travel Period that Section
leads to Hospitalisation or Day Care Treatment 3.1.1

Daily allowance amount specified in the Policy Schedule for Section

Hospitalisation 3.1.5

OPD Treatment for any of the treatments/tests/consultations due to Section

Injury or Illness during Travel Period 3.1.7

Accidental Death within 365 days because of Injury due to an Section

Accident during Travel Period 3.1.12

Injury due to an Accident that occurs during the Travel Period that Section
leads to Permanent Total Disability 3.1.13

Injury due to an Accident that occurs during the Travel Period which Section
requires Physiotherapy 3.1.6

Stay of the Insured Person in a hotel due to the Insured Person or a Section
co-traveller suffering Injury in an Accident or Illness 3.1.10

Air or surface transportation of the Insured Person during the Travel

Section
Period including costs incurred for medical care during a situation
3.1.11
which requires Evacuation

Direct route two-way tickets up to Economy Class for an Immediate Section

Relative of the Insured Person for Compassionate Visit 3.1.8

Transportation of mortal remains from the place of death of the

Section
Insured Person during the Travel Period to the residence of the
3.1.15
Insured Person
Policy
5 Section
Coverage Flight Related Benefits
3.2

Section
Delay of Journey on a Booked Flight during Travel Period
3.2.1

Missed Flight due to failure to reach the original departure point of Section
the booked journey 3.2.4

Delayed Delivery of the Insured Person’s accompanying Checked-in Section

Baggage for more than 3 Hours by the Flight operator 3.2.9
Permanent and Total loss of the Insured Person’s Checked-in Section
Baggage, by the Flight Operator 3.2.7

Damages Requiring Repairs OR Loss of Contents of the Insured Section

Person’s Checked-in Baggage 3.2.8

Additional Travel and Accommodation Expenses due to a Missed Section

Connection 3.2.5

Section
Other Trip Benefits
3.3

Section
Unavoidable Cancellation of Insured Person’s Common Carrier
3.3.3

Section
Loss of original passport during the Travel Period
3.3.5

Section
Postponement or Reschedule of Insured Person’s Common Carrier
3.3.2

Unavoidable Cancellation of Insured Person’s Common Carrier due Section

to Insured Person being detected with Covid-19 3.3.4

Theft of Personal Possessions or Property Stored within the Insured Section

Person’s usual place of residence during Travel Period 3.3.12

Legal Liability towards Defence of Litigation and Bail Bond during Section
the Travel Period 3.3.9

Section
Suicide, Self-Inflicted Injury etc.
4(a)

Section
Any Pre-Existing Disease unless disclosed to us in advance
4(b)

Section
Abuse of any Substance, Intoxicant, Drug, Alcohol or Hallucinogen
4(c)

Section
Any breach of law
4(d)

Certification of disability by a Medical Practitioner who shares the Section

same residence as the Insured Person 4(e)

Section
Childbirth or Pregnancy
4(f)

Participation of the Insured Person in any flying activity, except as a Section

bona fide passenger on a public aircraft 4(g)

Section
Any change of profession after inception of the Policy
4(h)

Section
Engaging in any Hazardous Activities
4(i)
 Section
Any act of foreign invasion
4(j)

Ionizing radiation or contamination by radioactivity from any Section

nuclear fuel 4(k)
6 Exclusions
Section
Nuclear, chemical or biological attack
4(l)

Any physical or medical condition, or treatment, or service that is

Section
specifically excluded in the Policy Schedule under special
4(m)
conditions.

Section
Any form of non-allopathic treatment.
4(n)

Any loss of eye-glasses or power lenses in respect of any Insured Section

Person. 4(o)

Section
Any loss of Valuables, Money, any kinds of securities or tickets.
4(p)

Any journey where the Insured Person is travelling as a commercial Section

driver, operator or crew member etc. 4(q)

Section
Any intentional illegal or unlawful act
4(r)

Section
Any failure to take reasonable precautions to avoid a claim
4(s)

Any journey commenced with the Insured Person:

1. Not being fit to travel or traveling against the advice of a
Medical Practitioner; or
2. Receiving, or is supposed to receive, medical treatment; or
Section
3. Having received terminal prognosis for a medical condition; or
4(t)
4. Travelling for the purpose of obtaining medical care, treatment
or advice of any kind whether this is the sole purpose of the
journey or not; or
5. Traveling to any country for which his/her visa is not allotted.

Initial waiting Period: NA

Waiting
7 Specific Illness (Standard list) waiting period: NA
Period
Pre-Existing Diseases exclusion / waiting period: NA

Financial
limits of
coverage

i. Sub-limit
This product has no copay or sub-limits applicable on any
ii. Co-
8 reasonable costs for treatments covered.
payment
Deductible : NA
iii. Deductible
iv. Any other
limit (as
applicable)
 Cashless claim facility can be availed in all network hospitals. The
list of network hospitals are available on our website or can be
checked at the customer care centre.

For reimbursement of a claim, please submit all necessary

documents on our App or email to us. We may ask for original hard
Claims/Claims copy of the documents in some cases. Section
9
Procedure 5
Please find the important links/numbers below :-
i. Network Hospital Details: Acko App or [Link]
ii. Helpline Number: 1800 266 2256
iii. Hospitals which are blacklisted or from where no claims will be
accepted by the insurer: Acko App or [Link]
iv. Downloading getting the claim form: Acko App or [Link]

Company Officials: Acko General Insurance Limited, 2nd floor,

Policy #36/5, Hustlehub One East, 27th Main Rd, Sector 2, HSR
Servicing Layout, Bengaluru, Karnataka - 560102 Section
10
/Grievances Our website: [Link] 7
/Complaints Email: grievance@[Link]
Toll Free: 1800 266 2256

You may terminate this Policy at any time before the travel start
date by giving Us written notice.
Section
If no claim has been made under the Policy, then We will refund
6(6)
premium after deducting ₹100 (Including applicable taxes) per
Things to
11 member in the policy.
Remember

No change or alteration will be effective or valid unless approved in

Section
writing which will be evidenced by a written endorsement, signed
6(4)
and stamped by the company

If any of the facts provided to us to purchase this Policy are found to

Section
Your be incorrect, incomplete, suppressed or not disclosed, the policy
12 6 (1),
Obligations shall be canceled without refund of premium after 30 days’ notice.
(2), (3)
Any claim made under such Policy, shall be rejected.

Legal Disclaimer Note: The information must be read in conjunction with the product brochure
andpolicy document. In case of any conflict between the CIS and the policy document, the terms and
conditions mentioned in the policy document shall prevail.

Declaration by the Policy Holder:

I have read the above and confirm having noted the details.

Place: __________________

Date: Signature of the Policy Holder

Acko General Insurance Limited

36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, 560102
IRDAI Reg No: 157 | CIN: U66000KA2016PLC138288 | UIN: ACKTIOP25036V022425
[Link] | Toll-free: 1800 266 2256 | Mail: travel@[Link]