Parents Details:

Fath er' s Name: ~(l(ly\l\WI Ck.J~a.¾j Occupation: ~'42~{_y.__f?J>,__ry Organ ization : <;1 VgaWttl\b.-\·1 .r~wz.\k.,~
I

Designation: ~ "'fi)fi~5 -\O'Y Mobile No: '\'6bb c:i ~ \O(lii; Ema il: 1~v\ • fllOI-\O.m ~½~ @jw,o8 ~ l0"'1

Mother' s Name: }4a \,~.\a._ G..~ Occupation: :\-!""M,{'_ t'--F\oJ(e.--1 Organization:

Any previous Medical History: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Financial Details:
How are you going to fund your SAP trip:

Family Incom e:
Contact Details:
- -- -- - - - - - - - - -
Resident ial Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -Mobile No:
_ _ _ _ _ _ _ __ Em ai I ld:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Emergency Contact
Details:_ __ _ _ _ _ _ _ _Mobile: _ _ _ _ _ _ _ __

Undertaking:

All the informat ion given above is t rue to the best of my knowledge and belief and I have submitted the
undertaking for St udy Abroad Programme in prescribed format of the Amity University.

Date: ....................... Signature: .. 1~..... .

Recommendation of Programme Coordinator/Programme Leader:

Signature: .. ............. ... .... .

Name: _ _ _ _ _ _ __
Designation: _ _ _ _ __
Dat e: .............. Contact No: _ _ _ _ __

Approval by Head of Institution:

Signature : ........ ......... ...... ..

Date: ........... . Name:
 Annexure B
INDEMNITY BOND

am the fathe r/ natural guardian of M r./[Link],:-;·\.\t\ --:SfuV\ , r/o ,3 -"4-{0 %,~,('\(., 1 l. 1SI f\ J

~ '\.c_\\~'(' R,u,~Je.»LJ j tJ"-.o.)Q," about \ C\ years, who is studying at

1-J~aged
A\1¼1 't\'1~~--~~nstitut e's Name) in its
\
s~ kwl()\A Programme bearing enrolment no.

-1\'1<::l~'O~ '"i)..'\..()'\')._j.s now proceeding to .. ....M,\J.~ ............................................ as a part of Study Abroad Programme
(SAP) 2024.

I have understood that Am ity and .. A~.~ ...½..~ ..... (Visit ing Institution for SAP) have made the necessary
arrangement for the conduct of said program. I have gone th ro ugh the rules and regulation s prescribed by the

Amity and ........................... ....... ........ to be followed by the students, while on an outstation t our, which I have

found very appropriate, and the same has also been read and understood by my son/ daughter who has also

executed an undertaking for the same. I have fully understood that my son/daughter is going entirely at his/her

own accord and Amity and .. A.:~½ . ~ .~~~(Visit ing Institution for SAP) shall not be responsible for his/her

own actions and deeds during their stay in .. ... h9.~.~ ······--·····--······(Place of visit)
I hereby promise to keep indemnified and harmless th e Amity and.... ~.~ ..~ ~.(Visiting Institution for
SAP), its Parents body, their Employees /officia ls, from every type of loss(s) or damage(s) which may arise out from

t he action or inaction of my son/daughter, during t he said tours, and al so from any claim arising from t hose action

or inaction of my son/daughter.

Signature of the lndemnifier---!~~-::;__l.,-·- - - - -

Name of the lndemnifier

1. Signature of Witness: ~ ' 2. Signature of Witness: t-/,~

:>

1 '¼
Name: _i=a=h_ __¼""- -
_,__,___°f_,_O, i:_,-'- Name: \.h~().._
Date : ~c')_y_~\~o«~\_t.>_'-{_ _ _ __ Date: h \o'{ \ i.4
 Annexu re D

UNDERTAKING

I 1~'1\AV\ -Set"" {;d/o Yoo~g~ (ka_J TJw r/o ?.-,-S"<r/g 1rei G1) 1'), ~
Ste__~ llv -.!aged about (j yrs, is studying at

A..,..;,. (Institut ion's Name) in its $f\-? N:> ~ Program me bearing

enrolme nt no A-'?,o.(,pl:Jlj ')_')....()C\. ')_ , and now proceed ing to ~~ ""'9 ~ (Visiting

.......................... till ....... .................. ..

Instituti on for SAP), for 'Study Abroad Program me (SAP) 2024 from

/Gua rdian, for my travel to this

I have taken the necessary permiss ion/conc urrence from my Parents

study abroad program me .

I hereby undert ake that:

1. I shall follow.. the rules. and regulations as laid by Amity & -A-.v; i ~"\Mb
2024 which have
(V1s1tmg lnst1tut1on for SAP) for the Study Abroad Progrc1mme (SAP)

been clea rly read and underst ood by me.

of the Country where I am
2. I shall not break any of the rules & regulatio ns and also the laws

proceed ing.
my dutiEs & obligatio ns.
3. I sha:I not indulge in any unlawfu l activity and any activity other than
me or to any other person.
4. I shall not do anything which may cause any injury or damage to

5. I shall keep my visa papers with full security & always ready.
Teacher s/Profes sors/Att endants
6. I shall observe strict disciplin e and follow the instructi ons of my

and other authorit ies during my stay at ... ~.~ .......

visit), which may
7. I shall not do anything while undergo ing the said tour at (place of

bring disreput e to Amity & /)...,.A~ ~~ (Visiting Institutio n for SAP), its officia ls, or

ns.
prejudic e the relation s between Amity and the participa ting institutio

8. I will make the complet e paymen t as laid down by Amity &

1
Av:.. L ~ Vi siting Instituti on

for SAP) for the said Program me.

9. I have taken the necessary Insurance Policy, and Amity & A-""~~ ~~ (Visiting

any mishap / mishapp ening

Inst itution for SAP) has no liability whatsoe ver, to bear, in case

occurs to me.

10. I shall in no case lea ve .. k~ . (place of stay) du rin g my sta y fo r this Study Abroad Program

to ext rem e circum st ances

and would proceed straight back to India post complet ion. In ca se due
 I need to leave .~~[Link]..(Place of st ay)., I understand t hat I would need the written permission
of Director, Amity ...~ .J.('..Y.0.~.~ ......

breal<.ing the ru les

11. I also understand that in case I am found guilty of any unlawful activity or
and Amity &
mention ed above or otherwise, I shall be liable to be deported back to India

....~.~. .l...9.~..... (Visiting Institution for SAP) shall not be liable for any financial
claims/refunds.

12. I am responsible for my visa docume ntation and shall not hold Amity & -M,, ~~
(Visit ing Institutio n for SAP) responsible for Visa Rejection .

me to the lnstitute 's

13. I would make the complete payment towards any loss or damage caused by

properJy or the Arrangements made during my stay at .~ .i..~.~ ·-'· ·· · (Place of stay).

(Signa~ ~~ Student) (Sign at~ ~itness)

Name: ~q\-,¼ ~<'.\~

'1 -~ -fS:&-/ Q, r )..\ 31L\
Address : ~ -Lt - " (Ii. (!2 I.')... l \ '-\ Address:

~\<llo..., i<-\~ ~GV\.t.::(j ~\Jl~-v \<..c_._~~YJ )

No.-.°'" 4 "'j~
1t ~~7 7~ · 9

Date: 6-_ r\\ 0~ \ ).'"\ Date: ~4\o\ \ '1-:\

AMITY
*
Annexure E

Study Abroad/Exchan ge Application Form 2024

In order for your application to be processed, we must have a fully completed Application Form
and all supporting documents.
Supporting documents required are:
Full copy of the passport
Bank Statement
Enrolment letter from current institute
rtudy Programme
Year of entry: ')...O ~

Period of Study

0 Odd Semester (November to December)

D Even Semester (April to May)

D Summer Semester (June)

I Study Programme

NAME {MUST BE AS IN PASSPORT) : jf\RV~ ]° f\ 1. rJ

Last Name: S A;-1.N First Name: I P.,.R.J rJ Middle Name(s): -

E1 Male □ Female

Date of Birth: (Day/Month/Ye ar) 05\01-\ \ 1-oa5

Country of Citizenship (as in passport): 1..N~J'..A- Passport Number: ~ ~ SS '.l_l-l ½3

20
 sport Issue date: (DD/MM/YY) - ')..~ \ ~\ ) '.)...Ol--~
assport Expiry Date : (DD/MM/YY) \ \
- )..~ ()\ ).0)~

Permanent/ Home Mailing Address:

Home number/Street: 2, -1.j - ~s t /t 1s~,I 'l. 1l,'1 1 stc..Qf>...,, ~e...\~Je"'t] Town/City: J+[Link]\l..ct~
State/Province : l c,\ l¼-\~"'-4r-- Postal/Zip Code: Country: J_vJJ b..

Telephone {Inc country code): t-9 1-.

Mobile: isss-a~+~~..1-
Email: tO...'Y1.-1v.1C\.~1A.Q~ O•~@'\""'-C\·n ,u:>M
Alternative email: jl\l~. ~ o\l\[Link]-clv-. G: 1~ l.t,.Q'w\
Home Universit y: -A:,w'½,. -k,ac::vl\.\..a...~
Current Year of Study: t%~ _ 3 "'f!l,e,o. Y

IContact Details of your Next of Kin-

- - - - - - - - - - - - -- - - -
Title: Full Name:
Email:
Address:
Home number/Street: Town/City:
State/Province: Postal/Zip Code: Country:
Telephone (Inc country code):

I Disability/learning Difference Information

Amity University [In] London welcomes students with disabilities and strongly encourages you to disclose
any disability or medical condition which may impact your studies . Declaring disability will not affect the
academic decision about your application but will help us put any individual arrangements or facil ities in
place for the start of your study abroad programme.

Please tick at least one of the following:

g No known disabilities

□
Specific Learning disability e.g. Dyslexia

□
Blind/partially sighted

□ Deaf/hea ring impairment

□ Wheelchair user/mobility difficulty

□ M ental hea lth difficulties

□ Unsee n disa bility e.g. Diabet es, Epilepsy, Asthm a

21
0 Autistic spectrum disorder/ Asperger's Syndrome

D Disability not otherwise listed, please explain below

Please indicate any additional support you may require

Competence in English Language

Is English your first language Y[Link]'.] 0No

Are you currently being taught in English? 0'es CJ

Personal Statement

Please tell us a bit about yourself, including your reasons for choosing to study abroad at
Amity University [In] London permission (please limit to 300 words):

c\\.-t__ ",""~8"' tr..r Moe, 1 °'~ ~ ~ wlev-- ~ Cl.)) ~

jd-. ~ Jl~..- .\ , . _ o_c_o) CM,U v\ C\. ~ J~ Q (:_ ~ Po\'-'"'-e.. ~ 0-.

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r\'..,,__ ~1"1i .,.Jc,.,,,_&,,..__ sW7 e,,,~o«J t,,,JJ ~ I
\0 1..:l .\co "- ~~ J ,ev,. I

22
 Have you ever studied in the UK before? If yes, where did you study, how long did you
study for and what programme did you study? What type of visa did you have for your studies?

eclarations

I give Amity University [In] London permission to contact 3rd parties

(e.g. parents, guardians or home institution).

0 ves, I give consent to contact 3,d parties

D No, I do not give consent to contact 3;d parties

Do you have any criminal convictions?

{If yes, you will be contacted confidentially for further information and to determine
your eligibility to attend Amity University [In] London permission .)

I undertake that I will return to my home country with ODD days of the end of the course at
Amity specified in my invitation letter.

I agree to provide a copy of my exit stamp obtained when leaving the UK to Amity within
even days of returning home. I understand that my certificate and tran~cript will not be
provided until I send the exit stamp to Amity University [IN] London.

I confirm that the above information is correct and complete and all supporting documents
are correct and authentic. If you are submitting this form electronically, please type your
name or enter your electronic signature below. In doing so, you confirm that the above
statement is correct, as if the document has been signed and dated by hand.

SIGNED: _ A_ ~~ - - -- - - -- - -

DATE:

I
 ANNEXURE H:

BANK LETTER FORMAT (To be issued in lnstitute's letterhead and signed by Hol/HoD)

SPONSOR LETTER

I, ?.(:jQ~~~ J \>i_o.J .certify 1w.~..

'f~ that my ward .:t~:.':l'!\... studying in f ~ ~ ---··, Enrollment No
.li<30C:.9.i .~1k.~g,!:-from Institution Name Amity University Uttar Pradesh is going for Study Abroad
Programme for 5 weeks from 11th November 2024- 13th December 2024to Amity University [In]

London .

I certify that h"e/ She is ready to go abroad from Amity University Uttar Pradesh. I have funded all
t he expenses and tuition fees from our own account and will bear all the expenses during his/her
stay in London . He/ she will not be involved in any illegal activity over there.

Date : ~'-\\Q ~ \ l..'-\

Place: ~•-l~~ ~\. J .

26
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[Link]: 2408161224 14560748 MIR ARFATH ALI
DS\e: 16AUG 2024, 12:25 PM LICENSED STAMP VENDOR
Purcb:ucd B y: Lie. No. I 6-04-026/20 17
T~UNJAIN [Link]. 16-04-0 19/2023
Sid POONAM CHAND PAIN! 8-2-603/A/3 4/ l , ZEHRA
Rio HYDERABAD NAGAR, ROAD NO. I 0,
For Whom BANJARA HILLS,
• <;$ELF •• HYDERAB AD-.2Q0034
Ann~ n,1U6

INDEM NITY BOND

I am the father of Mr. TARUN JAIN, R/o 3-4-55 8/B, 596/2 , 3, 4, Stellar
Reside ncy, Naraya naguda , Metro Pillar No.115 4, Kachig uda,
Stn
Kachig uda, Hyder abad-5 00027, Telang ana State, India, aged about
19
years, who Is studyin g at AMITY GLOBA L BUSIN ESS SCHOO
L,
t HYDER ABAD in its AUTUM N Progra mme bearin g enrolm ent • no .
A3060 642209 2, Is now procee ding to as a part of Study Abroad Progra
mme
=(SAP) 2024. I have unders tood that Amity and · Amity Londo n Busine
ss
School, have made the necess ary arrang emen_t for the conduct of
said
program .

I have gone throug h the rules and regulat ions prescri bed by the Amity
and
! Amity London Busine ss School to be followe d by the studen ts, while
on an
outstat ion tour, which I have found very approp riate, and the same has
also
Jbeen rea~ and unders tood by my son/da ughter who has also execut ed an
undert aking for the same. I have fully vnders tood that my son is
going
J entirely at his own accord and Am~iy- an<:1 Amity Londo n Busine ss
School
shall not respon sible for his/he r -~ ~ -L•~ l;llld deeds during their stay in
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e of los s(s) or dam age (s) wh ich ma y ari se ou t from the act
every typ o from any cla im
ctio n of my son / dau ght er, dur ing the sai d tou rs, an d als
ina
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arising from tho se act ion or ina
ess the Amity
rth er, I als o her eby pro mi se to kee p indemnified and har ml
Fu ion s tha t my
/ officials from any com pli cat
University and its Employees ues /
ter fac e me dic ally / hea lth &travel-wise an d any oth er iss
son /da ugh ic.
atio ns tha t ma y ari se du e to the ongoing COVID-19 pan dem
complic

Signat ure of the Indemnifier:

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Name of the Ind emnifier: ~0 \-\
GM e~d ?o±V\~

1. Sig nat ure of Witne ss :

e .M 2. Sig nat ure of Witness: V< r11.o...l,_;

Da te: 2-0 -o g - l..':f:

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LICENSED STAMP VENDOR
DJtc: 16 AUG 2024. 12:25 PM Lie. No. 16-04-026/20 17
Pun:hatir<l By: [Link]. 16-04-019/2023
TARV"'flAIN 8-2-603/N34/I, ZEBRA
S/o l'OONAM CHAND PATNI
A .NAQAl?.[Link] .1 0,
Rio HYDERABAD .ruu~.t,.'fm [Link],
For W hom
HYDERABAD-500034
•• SE~ " Ph 9393277086
UNDERTAKING

I, Mr. TARUN JAIN, S/ o Mr. POONA141·cHAND PATNI, R/o 3-4-558/B,

596/2, 3 , 4 , Stellar Residency, Narayanaguda, Metro Pillar No.1154,
Ka·c higuda, Stn Kachiguda, Hyderabad-500027, Telangana State, India,
aged abou t 19 years, who is studying at AMITY GLOBAL BUSINESS
SCHOOL HYDERABAD in its AUTUMN Programme bearing enrolment no.
A30606422092, and now proceeding to Amity London Business School, for
'Study Abroad Programme (SAP) 2024. From 11 th November 2024 till 13th
December 2024 I h ave the necessary permission/ concurrence from my
Parents/Gu ardian, for my travel to this study abroad programme .
I hereby undertake that

1. I shall follow the rules and regulations as laid by Amity & Amity
Landon Business School for the Study Abroad Programme (SAP) 2024
which have been clearly read and understood by me

2. I shall not br,eak any of the rules & regula tions and also the laws or
the country where I am proceedin g.
3. I shall not indulge in any unla · ·1r.' t9-J1d any activity other than
my duties & obligations. · '\
\
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Contd ... 2
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,

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4. I shall not do anythi ng which may cause any injury or damag e to me

or to any other person .

5. I shall keep my visa papers with full securit y & always ready.

6. I. spit observ e strict discipl ine and follow the instruc tions of my
Teache rs/Prof essors / Attend ants and other author ities during my stay
at London .
I shall not do anythi ng while underg oing the said tour at (place
of
7.
visit) which may bring disrepu te to Amity & Amity Londo n Busine ss
School, its officials, or prejud ice the relatio ns betwee n Amity and the
partici pating institu tions.
8. I \vill make the comple te payme nt as laid down by Amity & Amity
London Busine ss School for the said Progra mme.
9. I have taken the necess ary Insura nce Policy, and Amity & Amity
London Busine ss School has no liabilit y whatso ever, to bear, In case
a ny mishap / mishap pening occurs to me.
10. I shall in no case leave London (place of stay) during my stay for this
study aboard progra m and would preced e straigh t back to India post
comple tion. In case due to entran ce circum stance s I need to leave
London (place of stay) I unders tand that I would need the written
permis sion of Directo r, minty London Busine ss School .
I also unders tand that in case I am found guilty of any unlawf
ul
11.
activity or breaki ng the rules mentio ned above or otherw ise, I shall be
liable to be deport ed back to India and Amity & financi al
claims / refund s.

12. I am respon sible for my visa docum entatio n and shall not hold Amity
& Amity Londo n Busine ss School respon sible for Visa rejectio n.

13. I would make the comple te payme nt toward s any loss or damag e
caused by me o the institu te's proper ty or the Arrang ements made
during my stay at London (place of stay) .
.
A~ -
(Signat ure of the Studen t)
~t
(Signa ture of t~ itness)

Name:
-
lo..'tu.V\
- ,,
iQ.'"'

1"'6 AUG2024
 I

4560~-8..,
;: U R111 ldl '°816122'1 112:25 TELANGANA LICENSED STAMP VENDOR
Date: 16 AUG 2024, PIii
Lie. No. J6-04-026/2017
Purc basro 81·: [Link]. J6-04-0 J9/2023
TARU!\ JAIN 8-2-603/A/34/J, ZEHRA
S!o POONAM CHAND PATNI NAGAR, ROAD NO. I 0,
Rio HYDERABAD BANJARA HILLS,
For Why , HYDERABAD-500034
•• SEL F!• Ph 9393277086

AFFIDAVIT
D PATNI,
I S/o LATE PRAKASH CHAN
I, Mr. POONAM CHAND PATN gud a,
at 3-4 -55 8/B , 59 6/2 , 3, 4, Ste lla r Re sid enc y, Na ray ana
Re sid ent 7,
No .11 54, Ka chi gud a, Stn Ka chi gud a, Hy der ab ad -50 002
Metro Pil lar as un der :
eby sol em nly aff irm and on oat h
Tel ang ana Sta te, Ind ia, do her
1. Th at I am a Cit ize n of Ind ia. Glo bal Bu sin ess
N JAIN is a stu den t of Am ity
,, ..-. "')_ - Th at my So n TARU
sui ng 3 rd yea r BBA pro gra mm e.
· School, Hy der aba d, and pur roa d
t my Son TA RU N JA IN, trav elli ng to Lo ndo n for Stu dy Ab
a
,RI!!~ .,,,...... '!l ·g h_
edu cat ion and livi ng dur ing the
1~ am me and I am spo nso rin g his
d of his stay In Lon don .
our ces to spo nso r my So n's
I hav e ade qua te fin anc ial res &
elin g, stu dy ma ter ial exp ens es
cat ion viz; Tu itio n boa rdi ng, trav
die s at yo ur Un ive rsit y.
er livi ng exp enses dur ing his stu ble ms
will not fac e any fin anc ial pro
Th at I ass ure you tha t my Son fac ts
his stu die s will not be int err upt ed. He nce the abo ve sta ted
and
t of my kno wle dge and bel ief. ~
_.are tru e and cor rec t to the bes
Sworn and sign ed before me ~~ ·
On thi s the 16 day of Au gus t,
th 202 4 /1 Al;JESJ(t)
D6 6r iE NT
At fiyder aba d, T.G ., Ind ia.

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Address:.(:{p! PQonem Cheod Patnl.

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:f11' / Name TARUN JAIN

POONAM CHAND PATNI

05/04/2005

ra'1 I Gender Male

Signature Not
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[Link]~bJ
Income Tax .
Date: 2024.~ :43 1ST

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~ I Date of Birth ~/Sex .,,
05/04/2 00'5 M .·
ilr-'t~/Placcio fBirth ..
HYDERABAD,TEtANGANA
~ m ~)'~ I,Pface of Issue
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u1Rt ffi ;Cr~/ Data of Issue / Oat\of Expiry

L 24/01/2 024 23101 /2034

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BABITA PATNI
~ 'Q'J q;;fi ~ --fl'i / Name of ~

(@I / Address
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3-4-558/8,59 6/2,3,4,STEL LAR RESID~NCY
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NARAYAkGU~A~HY~ERABAD
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PIN:500~27,T ELANGANA ,INOIA . ...
~ qm,nt i15l ~- 3lR ~~JR~ M ~ ~ / Old P•nport No. with Date o1nd P1ace of lnue
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~ ;:i / File No. . .. . .
HY107618665 2124 / /

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3. TATED/ SIDOHARTH JAIN MR
05NOV E EK/GTYHDW
4 EK 525 L 05NOV 2&HYOOXB HK3 0410 0640
1350 05NOV E EK/ GTYHDW
5 EK 029 L 0SNOV 2•oxBLHR HK3 0940
6 EK 016 U 14DEC 6*LG""1>X6 HK3 1 335 0040 15OEC E EK/ GTYHDW
7 EK 526 U tSOEC 7*DXBHYD HK3 0330 0825 15DEC E EK/GTYHOW

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9 TK TL24AUG/ HYOVS3639

PASSENGER PTC NP FARE<INR> TAX/ FEE PER PSGR

01 AGARWAL/TANAY* AOT l 59125 42654 101779
02 JAIN/ TARUN• ADT 1 59125 42654 101779
03 TATEO/SIOOH• AOT 1 59125 42654 101779

TOTALS 3 177375 127962 305337

 ~ ICICl~Lombard
9, Nibhaye Vaade - - - -

Risk Assumption Letter

Ref. No.: W343561246

23-Aug-2024
Oe·ar Customer,

We value your relationship with ICICI Lombard General Insurance Company Limited and thank you for choosing us as
your preferred service partner.

Please find enclosed herewith your policy having policy number 4129/357093609/00/000 which has been issued based
on the details furnished to us by the insured:-

Insured Name TARUN JAIN Policy No. 4129/357093609/00/000

Mailing Address
3-4-558/B,596/2,3.4, Stellar Residency Period of lnsura!lce / From : 05-Nov-2024
Narayanguda Trip Particulars To : 17-Dec-2024 ,
Hyderabad! II HYDERABAD,HYDERABA Days : 43
D,TELANGANA,INDIA- 500027
Contact Number 98....... 72 Gec)araphleal Scooa EXCLUSCANADA
EmaiJ Id ch ........ °"..@[Link] Plan Type PLATINUM_X 50
Nominee Name POONAM CHAND PATNI Visa T11oe Non lmmiorant
Insured Age 19.0 Alternative Polley No. 4129/1-106480900/00/000
Product Code I 4129 - lntemationaltravel UIN No. ICITIOP22093V032122
Product Name
DOB 05-Apr-2005 Pass~rt No 89551443
IPolitically Exposed Person (PEP)lclose relative of PEP: !No
Note:
Medical expense• due to Covid-19 la covered if contracted during the travel period as per policy terms and
conditions

This policy does not cover any injury/illness and complications arising out of pre-existing condition whether declared or
undeclared.

Pre-existing Condition shall mean and include any condition, ailment or injury or related condition(s) for which you had
signs or symptoms, and/ or were diagnosed, and/ or received medical advice/ treatment within 48 months prior to the
first policy issued by the insurer.

lmportant:This policy has been issued based on the details furnished by the policyholder. Please review the details
furnished in the policy certificate cum information sheet and confirm that same are in order. In case of any
discrepancy I variation, you are requested to write back to us immediately at customersupport@[Link] or
contact our toll free no. 1800 2666 for necessary changes I rectifications. In the absence of any communication from
you with in period of 15 days of receipt of this document, the policy would be deemed to be in order and issued as per
your proposal.
 t'art 1 of the schedu.l e - International Travel Insurance

Policy No. 4129/357093609/00/000 [Link] Days 43

Period of Insurance From : 05-Nov-2024 Geographical Scope EXCLUSCANADA
To : 17-Dec-2024
GSTIN Number {Cuatomer) . Invoice number 1008242136713

Insured Name TARUN JAIN Date of Birth 05-Aor-2005

MailingAddless 3-4-558/8,596/2,3,4, Stellar Gender Male
Residency Narayanguda
HyderabadllJHYDERA8AD,HYDE
[Link],INDIA • Nominee Nllme POONAM CHAND PATNI
500027
Contact Nutflber 98....... 72 Relationship With Father
Nominee
Email Id ch•"'•••••••••@[Link] Passoort No 89551443
Sum lnaured {USO) 50000 IL IE> 874044028
Medical Treatment History NA [Link] Disease None
Family Doctor Name & 9885172972
Address
Servlclng Branch Hyderabad Servicing Branch Second Floor, Shop No 1-7,
Address 18-20, Lumbill Jewel mall,
Road No02, Banjara Hills.
Hyderabad, Telangana,
500034
ASHA No. .
Please Note: Any claim due to or arising out of pre-existing disease/ailment whether declared or
undeclared is not covered under the olic

The above records details given by the insured pursuant to Clause 8(2) of the IRDA (Protection of policy holder's
interest) Regulations, 2017. If the information shown above is found to be either incomplete or incorrect at the time of
claim, the same shall be construed as non disclosure of material information

Pia, Name : PlATINUM X 50

Benefits Sum Insured Deductibles
Accidental Death (Common Carrier) USO 5000 NA
Bounced Booking - Hotel/Airline US02000 USD250
Burglary Cover for Home Contents INR 100000 NA
Compassionate Visit USO 7500 NA
Daily Allowance irn Case of
USO 50 per day for max 5 days NA
Hosoltalisation
Delay of Checked-In Baoaage USO 100 6 hours
Dental Expenses USO 300 USO 100
Emeraencv Cash Advance USO 1000 NA
Emeraencv Hotel Extension USO 5000 USO 260
Fire Cover for Buildino INR 2000000 NA
Fire Cover for Contents INR 1000000 NA
Hliack Distress Allowance USD 125 per day for max 7 days 12 hours
Loss of Baggage and Personal
US02000 USO 100
Effects
Loss of Passport USO 300 USO 50
Medical Cover(lncludes Medical USS 100 (Total amount applicable for
Evacuation cost, Sublimit applicable Medical Expenses alongwith the
USO 50,000
for age 51 yrs and above. Please applicable extensions under Medical
refer policy wordings for details) Expenses)
Missed Fliaht Connection USO 500 3 hours
Personal Accident USO 15000 NA
Personal Llabilitv USO 100,000 5% of [Link]
Political Risk and c.-tastrophe
Evacuation
USO 7500 NA
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