E-Policy No.

IGI100461SMT

Policy Certificate
Insurance for Schengen states & rest of the world E-Policy No IGI100461SMT

Issued At: Pak Reliance Travels-FSD Amount (PKR) 4,733.00

Amount is inc. of all applicable Taxes

POLICY INFORMATION

Policy Type: Single / Family Plan: NO ICING Term: 1 Month

Issue Date: 15-3-2017 Effective Date: 1-6-2017

INSURED INFORMATION

Name: RUKHSANA HAFEEZ Passport No: AH6516822 Scan the QR Code to

verify your policy
CNIC # 33201-0588682-6 Phone # +92 332 7379046 DOB: 30-6-1979
Address: MOHALLAH BASHIRABAD, CHENAB NAGAR, TESHIIL: LALIAN, DISTRICT: CHINIOT-PAKISTAN

BENEFICIARY INFORMATION

Beneficiary Name: RANA HAFEEZ AHMAD Relationship: HUSBAND

Address: SAME AS ABOVE

FAMILY INFORMATION

Spouse Name: Gender: DOB:

Child 1: RANA HASEEB AHMAD DOB: 12-12-08 Child 2: DOB:
Child 3: DOB: Child 4: DOB:
The insurance offered is only with respect to the benefits as This is a computer generated
specifically indicated in the schedule of benefits subject to the policy E-Policy and does not require a
terms and in consideration of the premium paid as plan selected. Signature.

NOTE:
For Consulates / Embassies: you may verify the authenticity of this policy through the website: www.mytravelinsurance.com.pk
Using the E-Policy No. and Passport Number of the insured.

Declaration:
I am not traveling to receive medical treatment, diagnosis or consultations.
I am now in good health and have never been treated for or advised that I have
heart disease, abnormal blood pressure, kidney disease, cancer or diabetes
Medical History, If any.
Other Accident Insurance carried or applied for. Signature of Applicant Date

Coverage is automatically excluded for any pre-existing* conditions, whether declared above or otherwise.
In such a case, Coverage can only be effected through a specific endorsement issued by the Company.
Claims pertaining to Non-Schengen States will be settled in Pakistan in Pak Rupees.
*Pre-Existing condition - Any Medical condition for which treatment or medical advice was sought in the last 24 Months.

Thank you for choosing IGI Travel sure, for policy terms and conditions or detailed benefits, please visit www.mytravelinsurance.com.pk
or ask your travel agent for a copy of policy document or contact us on 111-308-308.
For other information, including claims and queries, please visit www.igiinsurance.com.pk.
In case of emergency, please contact our International Health care service providers, International SOS on Call Collect Number: 00-9714-601 8824.

Issued in Pakistan

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 E-Policy No. IGI100461SMT

SCHEDULE OF BENEFITS (US $) NO ICING

Benefits Benefits
Medical Expenses Accidental & Sickness Hospitalization Deductible US$100 EEL
50000 Death Repatriation 5000

Assistance Services Free Accidental Death & PTD 10000

The Policy shall be deemed to be issued as an electronic document. Any print out of same is for the purposes of record and reference only.

All terms, Conditions and Exclusions as per standard IGI Insurance Ltd Policy wordings and Clauses

The agreement to purchase this insurance coverage is a declaration that I/we have read and understood the terms & conditions stated in the policy
wordings and I/we hereby agree to the terms and conditions stated therein. I/We also declare and affirm that I/We are in good health and fit to travel.
I/We have not been advised against traveling by my/our doctor. I hereby declare that all information stated in this schedule is true and complete and
that I/We have not concealed any material information from IGI Insurance Ltd.

General Policy Exclusions

We will not pay any claim, which results from loss or damage to Property or expense, directly or indirectly caused by:

1. Medical expenses arising out of Pre-existing Conditions.

2. Insured Persons traveling abroad to obtain medical treatment as a consequence of accident, illness or Pre-existing Conditions.
3. Any expenses for medical evacuation or repatriation if the Insured Person is not suffering from a Serious Medical Condition and can be treated locally.
4. Any expenses for medical evacuation or repatriation where the Insured Person can travel without a medical escort.
5. Any treatment or expenses related to childbirth, miscarriage or pregnancy.
6. Any loss sustained while the Insured Person is participating in any professional/extreme sport or engaging in any nonscheduled flight.
7. Any expenses incurred as a result of a self-induced injury, suicide, drug addiction or abuse, alcohol abuse, or sexually transmitted diseases.
8. Any expenses related to the Insured Person engaging in the commission of an unlawful act.

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