Policy 10525387V-A, — 7 Policy Page 1 of 3 Number 10525387V-A Visitor To Canada Plan #4 21ST CENTURY POLICY CONFIRMATION ** TCavereS? promjum Deauelible Named Insureds ‘imi ‘Amount _Totat 1. PETROVIG, Paula (Hor-i4-1991 123 ws) Emergency Meeica Coverage - SCCA 4$50,000.00__$128.96__ $50.00 _ $128.96 Premium $128. $0.00 $128.96 ‘TOTAL POLICY CHARGES 30.00 $128.96 BALANCE OWING $0.00 rir Pay ‘eave Dotedun-26-2034 cenatian Phone780-435-4550 Expiry Oateaug-16-2018 ‘canadian Aaaress269 tiverpoint Issue Dateduneo2-2014 ‘Eémonton, AB TSA 4Z3 Durations Days sSonsor Nomestan Jokte country OF Orinserbie. | Vitor Type Vitor ‘aeney YOWSO0VOwaR Fin Taency Phonesa6-233-3723 ‘ Yor Agency Rep Signature: Ad ote: Line 2 de hey want eo Bpstr be crn as * This Policy Confiemation and Policy Wording version VOG form your insurance contract * tmerguncy Medea! Coverage - SCA esa tat hs Insured under aye 60, hs stated Ye egy requrrent nd SIRE Masi Ses econ nar automat incest Stanie CoROnte CONDTTION ston meh dal pecaratin sured, onsaye sas nes $10,000 Aden! bash & Gomamaerment TIN CIRCUMSTANCES LIKELY TO RESULT IN A CLATM, CALL OUR ASSISTANCE CENTER 24 hrs a day, 7 days a week at 1-877-882-2957 toll-free from the USA and Canada. IF tunable fo use the toll-free number, cal collect to Canada: +1 519-251-7856. To enquire about the status of any existing claim, call 1-866-229-6386 (Canada-Wide ‘Toll Free) between 8 and 4pm ET. If paying by credit card, the name "21st Century Travel Ins" will appear on your statement. 21st Century Travel Insurance Limited has been Canadian owned and operated since 1979, Iine fava 71 steentunsting com /Paees!Onnte/Raciment View sene7inanrintmade=tme 1/0694