Wondershare

PDFelement

www.ekta.insure/en info@ekta.insure ekta.insure

MAKE INSURANCE
S I M P L E
VOLUNTARY COMPREHENSIVE INSURANCE POLICY FOR
TRAVELLING ABROAD WITH COVID-19 COVERAGE
POLICY ISSUED ON
POLICY # 346143.432 04.12.2023 12.43

POLICY NUMBER № 346143.432 WORK COVERAGE PLAN GOLDEN

TERMS OF VALIDITY 04/12/2023 04/ 03/ 2024 APPLYING FOR VISA DEDUCTIBLE 25%

COVERAGE TERRITORY UNITED ARAB EMIRATES APPLYING TO EMBASSY INSURED SUM

PLAN PER PERSON
PAYMENT, USD

NAME, SURNAME (INSURANT) WICKRAMAARACHCHI BORDER CROSSING

MEDICAL COVERAGE 50000 USD 13.87
252 USD
SAMEERA CHINTHAKA TRAVELING NOW
ACCIDENT 5000 0
PASSPORT N10383026 REGULAR VACATION
FINANCIAL RISKS 0 0
DATE OF BIRTH 1985.11.04 EXTREME SPORTS

OVERALL INSURANCE TARIFF 0.00028

PHONE +9476 2027840 SPORT

ADDRESS OVERALL INSURANCE PAYMENT 13.87

AMBILIPITIYA ,SRI LANKA 252 USD

OPTIONS

ACCIDENT 5000 ALCOHOL BAGGAGE 500 USD

CANCELLATION OF THE TRIP INSURANCE AMOUNT HOME INSURANCE

CRUISE HOME PETS

INSURED PERSONS

№ NAME, SURNAME (INSURED) DATE OF BIRTH PASSPORT ADDRESS

1 WICKRAMAARACHCHI SAMEERA CHINTHAKA 04.11.1985 N10383026 —

INSURED EVENT

CALL: +1 786 840 07 74 +4 822 390 52 47

+38 067 419 09 96 info@ekta.insure

Insurance company ЕКТА, 5, building 2, Letter B1, Dilova str., Kyiv, Ukraine, 03150

Insurance coverage is provided in accordance with:

European Council Decision 2004 / 17 / EG on travel medical insurance
European Council Decision 2004 / 17 / EC on travel medical insurance
European Council Decision 2004 / 12 / WE on travel medical insurance
The insurance meets all requirements of the regulation (EC) 810 / 2009 of the European Parliament and the council of 13th July 2009

This Agreement is concluded on the basis of the Law of Ukraine ""On Insurance"", the Law of Ukraine ""On Financial Services and State Regulation of Financial Services Markets"", other regulations of Ukraine in
the field of insurance.
• license issued by NCFSMR of Ukraine to conduct business activities for the provision of financial services (except for professional activities in the securities market) in the part of voluntary health insurance
(continuous health insurance) and the Rules of voluntary health insurance (continuous health insurance), orders NCFSMR of Ukraine № 517 dated April 2, 2019.
• license issued by NCFSMR of Ukraine to conduct business activities for the provision of financial services (except for professional activities in the securities market) in the part of voluntary medical costs
insurance and ""Rules of voluntary medical insurance"", order NCFSMR of Ukraine №521 from April 4, 2019.
• license issued by NCFSMR of Ukraine to conduct business activities for the provision of financial services (except for professional activities in the securities market) in terms of voluntary insurance against
accidents and ""Rules of voluntary insurance against accidents"", order NCFSMR of Ukraine №521 from April 4, 2019.
• license issued by NCFSMR of Ukraine to conduct business activities for the provision of financial services (except for professional activities in the securities market) in the part of voluntary financial risk
insurance and the Rules of voluntary financial risk insurance, order NCFSMR of Ukraine №427 from March 21, 2019.
• license issued by NCFSMR of Ukraine to conduct business activities for the provision of financial services (except for professional activities in the securities market) in the part of voluntary liability insurance to
third parties (other than provided for in paragraphs 12-14 of Article 6 of the Law of Ukraine ""On Insurance"") and Rules of voluntary liability insurance to third parties (other than provided for in paragraphs 12-14 of
Article 6 of the Law of Ukraine ""On Insurance""), the order of NCFSMR of Ukraine № 427 from 21.03.2019

I HAVE READ AND ACCEPTED TERMS AND CONDITIONS OF THIS CONTRACT. I HAVE RECEIVED CONTRACT AND POLICY

INSURANT SIGNATURE INSURER SIGNATURE