I hereby declare and affirm that the information provided in the Application From is true to the best of my knowledge and I am in sound health. I am neither traveling against the advice of my medical practitioner nor am I traveling with purpose of making a claim under this policy. All terms & conditions and as well as the exclusions are available at the Crescent Star Insurance Limited s website: http://travel.cstarinsurance.com Insured s Signature

Individual

Schengen Countries

Geographical Coverage

In case of emergency, insured shall immediately contact the Help Line stating the necessary details. The contact details of the Help Line are: Schengen Countries

CRESCENT STAR INSURANCE LIMITED

2nd floor Nadir House I.I Chundrigar Road Karachi

UAN: +92-21-111-***-*** PABX: +92 21 32415471-2 Ext: 319 www.cstarinsurance.com

ac7ils@r.postjobfree.com

Plan Type Trip Type Single Premium Rs.

Issue Date

Insured Name

Passport No

CNIC

Date of Birth

Phone No

Destination

Tenure

Purpose

Issuing City

Jurisdiction

Sub Agent

Agent Contact

Agent

Effective Date

ac7ils@r.postjobfree.com

030*-*******

Address

Visit

Declaration

I have read and accepted the policy wording.

24 x 7 Helpline

The Policy shall be null and void and no benefits shall be payable in the event of untrue of incorrect statements, misrepresentation, mis-disclosure of any material particular in the application/proposal form, personal statement declaration and/ or any other connected documents. Beneficiary Name Muhammad Farooq Hafeez Relation Myself Percentage % 100 COMFORT

10-09-2017 Multan

Pakistan

Emergency Medical Expenses Cover

Medical Expenses & Hospitalization Abroad (Deductible $ 100 eel*) 50,000 Medical Referral Included

Repatriation of Mortal Remains Included

Repatriation in case of illness or accident Included Personal Accidental (Injury & Death) PTD*

Accidental death (during travel using recongnized means of transport, planes, public buses, taxies, etc. Deductible $ 100 eel*) 10,000 Multan Branch

Danish Nadeem

danish.nadeem

MUX/TC/384/09742

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