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DECLARATION OF MEDICAL INSURANCE PPLIB2STONTT Certificate Types ro Pariot Platinum InteratonsliSM) Prema: 7.37 USD. O2Aug2019 ‘Adventure Sports: Ne 25-Aug-2019 380.0080. $.000.00000 USD applemcntal Accidental Death: 040 USD arenas ll at all ns be subject We fal ern condition detninons and exclusions contained the cova Person(s) Tnvured 1D Date of Birth (O10, BEDAA, AS14009 25.808 98S jsidence Addrenss SUIT STREET —lobannesbarg — 200] -SOUTHAFRICA cred By: INTERNATIONAL MEDICAL GROUP, INC. as apeat for Ue Tasarer er ‘SlrbesLnternatlonal Inverance Corporation (publ) ‘witness whereof this certificate been sgpod, as authorized by the inser by ‘lest review thi information for accurey. Ifyou fin any discrepancies, please coat! Intestinal Medica! Group a5 sora possible, Please reference your cerficate umber aot below when comacting IMIG at se FULFILLMENT DOCUMENTS AVAILABLE FOR DOWNLOAD: {Cick on ay of the dacaments Belew to open i ina new browser ladon ‘Gover Lest Cis. Wong, & Nn AIRX Bascal Co amicable) Bias lis Precerifiction eochune q iM.Cond Other Important Links: Ibsrnatrat Matil Group = F030 ‘Ba § Maran 8 dpi IN 86208 Phone: 186 3857241317880 Fee irhastasos 2900 Norn Mean Sex Inanapts, 1 4004-4718 Unie State f America Tekpime 1.317485 8500 mai nora. ‘Webateeo-amglofal cn

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