Coverage Details

AuthorizedSignatory
IFFCO - TOKIO GENERAL INSURANCE CO. LTD
Regd. Office: IFFCO SADAN,C1 Distt Centre,Saket,New Delhi- 110017
Individual Personal Accident Policy

Servicing Office :
For IFFCO-TOKIO General Insurance Co. Ltd.
The Schedule
Toll Free : 1-800-103-5499; Other : ( 0124) 428-5499; SMS "claim" to 56161
Policy Issuing Office: Delhi
Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi
Insured / Age / Reln / Nominee
Cover Premium GrossPremium(`)
Net Premium(`)
Bonus CumSI Capital SI Add On Covers Benefit *
The Coverage is as per Policy wordings/Endorsements/Clauses attached.Please go through the Policy and in case of any discrepancy.Please inform us.Cumilative Bonus is applicable for
table of benefits from S.L.No 1 to 4 only.
Notwithstanding anything stated to contrary,It is hereby declared and agreed that the coverage under the policy excludes the risk of Terrorism damage as per printed clause attached.Benefit
tables * Death - Table 1 , PTD -Table 2 - 4 , PPD- Table 5 , TTD- Table 6.
PRM(Basic/ Add On)
Total Premium
Family Discount
Service Tax No : AAACI7573HST001
In witness whereof this policy has been signed at
Agent Name & Telephone No:
Insured's Name :
Policy No.
C / N No :
:
Address :
PinCode :
Phone Number :
Date of Declaration
Agent No :
Period Of Insurance: From hrs on
To Mid Night on
:
:
:
SHARMA DIWAS
ADD. A.B.M PUBLIC SCHOOL , FATEHPUR GANDHI ASHRAM
51244139
HALDWANI ,
18/09/2012
HALDWANI
UTTARANCHAL 263139
0001 29/09/2012
01
29B 29000081
28/09/2013
Mr.Diwas Sharma 200000 - 200000 Death +PTD +PPD +TTD 280.00
31 - - -
Self - - -
Mr.Shashank Sharma(Father) - - -
















FATEHPUR GANDHI ASHRAM




T
01 Service Tax Rs
280.00 70.00
9917255077
350.00 - 350.00 - 43.26 393
01
29/09/2012
C:/output/51244139.pdf
NEGI, PANKAJ