United Nations Population Fund

Certification of Insurance Coverage

I understand that a requirement for being contracted by the United Nations Population
Fund (UNFPA) as an individual consultant is that I have adequate medical, health and
accident insurance coverage in force during the entire period of my consult services with
UNFPA. I understand that such coverage must be procured privately. I understand that
UNFPA does not offer any medical/health/accident insurance plan for individual
consultants.

I understand and agree that any medical or dental expenses incurred during the contract
period with UNFPA as an individual consultant are my sole responsibility and not the
responsibility of UNFPA.

I have reviewed my medical/health/accident insurance plan and give assurance, by

signing below, that I retain or have retained valid and adequate insurance coverage for
medical/health/accident, and medical evacuation if applicable, for the entire period of my
retention by UNFPA as an individual consultant.

Print name: TUDIONO

Signature:

Date: