Certificate of Insurance

Outbound Travel

Policy Number: LTL/203122/AE2022 Policy Issue Date: 09/12/2022

Plan Type: Standard Traveler Cover Dates: 10/12/2022 - 18/12/2022
Destination: Worldwide ex USA/Canada Date of Birth: 17/10/1998
Policy Holder: Mr MUHAMMAD AFSAL PALLIVALAPPIL Passport No: P4941828
Email: [email protected] Mobile: 585028006
Address: VELIKOTH HOUSE, NILESHWAR

Cover Limit (up to) Excess Cover Limit (up to) Excess

Trip Cancellation / Curtailment Not Covered Personal Possessions Not Covered

Emergency Medical and Other Expenses $100,000 $100/$250 Valuables (including Laptop) Not Covered
*

Transportation & Accommodation Expenses Not Covered Single Item, Pair or Set Not Covered

Emergency Family Travel Not Covered Tobacco, Alcohol & Fragrances Not Covered

Repatriation of the Deceased $7,000 $100 Baggage Delay Not Covered

Funeral Expenses $500 $100 Personal Money $1,000 ($200 cash limit) $100

Dental Expenses $200 per tooth (max $500) $100 Loss of Passport / Travel Documents Not Covered

Personal Accident Travel Visa Rejection Not Covered

Accidental Death or Dismemberment Not Covered Personal Liability Not Covered

Accidental Death (Common Carrier) $50,000 Legal Expenses Not Covered

Permanent Total Disablement Not Covered Bail Bond Not Covered

Missed Departure Not Covered Credit Card Fraud Not Covered

Travel Delay Not Covered Mugging Not Covered

* $250 excess for the 92 days policies duration.

Important

The certificate contains only a Summary of Cover. Please refer to applicable Terms and Conditions of the Policy Document for full details. The insured person must be a resident of the GCC. All plans are
Schengen Visa Compliant.
Emergency Medical Expenses, compensation to the insured person aged between sixty-six (66) and seventy-five (75) years being limited to 10% of the sum insured and up to a maximum of $100,000
Please contact us if any of your personal details shown within this Certificate of Travel Insurance are incorrect.
Always contact our 24- hour emergency medical service when you are hospitalized, require repatriation or where your medical fees are likely to exceed US$ 250.

Section B, Emergency Medical and Other Expenses, provides coverage for COVID-19 if the insured person contracts the virus during the period of insurance subject to the cover, terms and conditions more fully
described in the Policy Document.

For 24 hour Medical Assistance Call International: +971 4 4365653

Mail: [email protected]

For Claims: Call UAE: 800 035702831

Telephone for Europe: +353 91 560621
Mail: [email protected]

The Travel Insurance is underwritten by Alliance Insurance PSC, with services provided by MAPFRE ASISTENCIA. It is very important that you read the policy wording carefully before you travel and make sure you
understand exactly what is covered and what is not covered and what to do if you need to claim.

Mr. K. Nadarajan
Assistant General Manager
General Insurance Underwriting – Non motor
Warba Centre, P.O. Box 5501, Dubai,
United Arab Emirates
Phone: +971 4605 1111

Page 1 of 2
Alliance Insurance PSC

Alliance Insurance Company PSC 09/12/2022

2nd Floor, Al Warba Center, Abu Bakker Al
Siddique Road, PO BOX 5501, Dubai, UAE To: The Embassy / Consulate
RE: Travel Insurance - International Travel Protection

To Whom it May Concern,

This letter serves to confirm that traveller/s named below is/are adequately covered for International travel Insurance and Schengen Countries, whilst
travelling on journey during the period detailed below:

Reference of the Policy:

Policy Number: LTL/203122/AE2022 Policy Start Date 10/12/2022

Date Of Subscription: 09/12/2022 Policy End Date 18/12/2022

Duration of Cover: 9 day(s)

Territory covered Worldwide ex USA/Canada

First Name Last Name DOB Passport No.

MUHAMMAD AFSAL PALLIVALAPPIL 17/10/1998 P4941828

We confirm that the insurance coverage meets all the requirements of the Regulation (EC) No 810/2009 of the European Parliament and the council of 13th July 2009

To this end we record the pertinent benefits as follow:

1a. Emergency Medical Expenses $100,000

1b. Medical Evacuation, repatriation or Transportation Included above

Yours faithfully

Mr. K. Nadarajan
Assistant General Manager
General Insurance Underwriting – Non motor
Warba Centre, P.O. Box 5501, Dubai,
United Arab Emirates
Phone: +971 4605 1111

24 Hour Emergency Medical Assistance Helpline: International: +971 4 4365653

This Travel Insurance is underwritten by Alliance Insurance PSC, with service provided by MAPFRE ASISTENCIA