INSURANCE AND ASSISTANCE CERTIFICATE

This certificate can be used and presented in case of visa application in a foreign consulate.
INSURED DATAS
Name: YOUSSOUFA Area of coverage: Schengen Zone
Given Name : BOUBA Destination: Italy
Date of birth : 07/12/2001
Passport n° : AA098900
DATES REFERENCES
Beginning of validity : 02/02/2023 Certificate n° : ACTCAM000006242
End of validity : 07/02/2023

MAIN BENEFITS mentioned in the General Conditions of the Agreement n° 0801635

- Medical Emergency Assistance: in case of sudden and unpredictable changes of health
- Medical Transportation: current expenses
- Payment of medical expenses: 30.000 Euros with a 50 Euros deductible
- Payment of emergency dental expenses: 160 Euros with a deductible of 50 Euros
- Repatriation in case of death: current expenses
- Loss of registered luggage
- Bail bond up to 2.000 Euros and Layer expenses up to 400 Euros

As an exception to the General Exclusions related to epidemics and/or pandemics declared by the World Health
Organisation, the Beneficiary is covered under the same terms if He/She falls ill during the trip with an infectious disease
including Covid-19. It applies for Medical transportation, Medical expenses, Body repatriation & mortal remains. Please
refer to Terms & Conditions

SPECIAL PROVISION
The insured recognizes and declares that he read and/or have been informed and understood the General Conditions as well
as the Benefits and the Exclusions under the policy.
This certificate can not be used as a letter of guaranty for payment into public or private medical organization.
The insured declares to have not scheduled any travel for therapeutic treatment.
Issued in triplicate, in Cameroon on the : 16/01/2023
For the company: Signature of the insured:

This certificate may be cancelled before the effective date of cover, only when the visa will be denied, the reimbursement will be
done deducting the administrative fees after presenting the original documents as follows : passport, general conditions, certificate.
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Please tear and keep this card always
24hours / 7 days
FOR ANY TRAVEL CLAIIM
URGENTLY CALL THE
FOLLOWING NUMBER IN
FRANCE:
PARIS + 33 1 55 92 13 68
IMPORTANT In case of claim, prior to any action, the insured
or any person acting on his/her behalf must contact IPA at
the phone number hereunder with the following
information:
- Agreement N° : 0801635 - Certificate n°ACTCAM000006242
- Surname: : YOUSSOUFA
- First Name : BOUBA
- Validity dates: as from 02/02/2023 to 07/02/2023
 INSURANCE AND ASSISTANCE CERTIFICATE
This certificate can be used and presented in case of visa application in a foreign consulate.
INSURED DATAS
Name: YOUSSOUFA Area of coverage: Schengen Zone
Given Name : BOUBA Destination: Italy
Date of birth : 07/12/2001
Passport n° : AA098900
DATES REFERENCES
Beginning of validity : 02/02/2023 Certificate n° : ACTCAM000006242
End of validity : 07/02/2023

MAIN BENEFITS mentioned in the General Conditions of the Agreement n° 0801635

- Medical Emergency Assistance: in case of sudden and unpredictable changes of health
- Medical Transportation: current expenses
- Payment of medical expenses: 30.000 Euros with a 50 Euros deductible
- Payment of emergency dental expenses: 160 Euros with a deductible of 50 Euros
- Repatriation in case of death: current expenses
- Loss of registered luggage
- Bail bond up to 2.000 Euros and Layer expenses up to 400 Euros

As an exception to the General Exclusions related to epidemics and/or pandemics declared by the World Health
Organisation, the Beneficiary is covered under the same terms if He/She falls ill during the trip with an infectious disease
including Covid-19. It applies for Medical transportation, Medical expenses, Body repatriation & mortal remains. Please
refer to Terms & Conditions

SPECIAL PROVISION
The insured recognizes and declares that he read and/or have been informed and understood the General Conditions as well
as the Benefits and the Exclusions under the policy.
This certificate can not be used as a letter of guaranty for payment into public or private medical organization.
The insured declares to have not scheduled any travel for therapeutic treatment.
Issued in triplicate, in Cameroon on the : 16/01/2023
For the company: Signature of the insured:
 INSURANCE AND ASSISTANCE CERTIFICATE
This certificate can be used and presented in case of visa application in a foreign consulate.
INSURED DATAS
Name: YOUSSOUFA Area of coverage: Schengen Zone
Given Name : BOUBA Destination: Italy
Date of birth : 07/12/2001
Passport n° : AA098900
DATES REFERENCES
Beginning of validity : 02/02/2023 Certificate n° : ACTCAM000006242
End of validity : 07/02/2023

MAIN BENEFITS mentioned in the General Conditions of the Agreement n° 0801635

- Medical Emergency Assistance: in case of sudden and unpredictable changes of health
- Medical Transportation: current expenses
- Payment of medical expenses: 30.000 Euros with a 50 Euros deductible
- Payment of emergency dental expenses: 160 Euros with a deductible of 50 Euros
- Repatriation in case of death: current expenses
- Loss of registered luggage
- Bail bond up to 2.000 Euros and Layer expenses up to 400 Euros

As an exception to the General Exclusions related to epidemics and/or pandemics declared by the World Health
Organisation, the Beneficiary is covered under the same terms if He/She falls ill during the trip with an infectious disease
including Covid-19. It applies for Medical transportation, Medical expenses, Body repatriation & mortal remains. Please
refer to Terms & Conditions

SPECIAL PROVISION
The insured recognizes and declares that he read and/or have been informed and understood the General Conditions as well
as the Benefits and the Exclusions under the policy.
This certificate can not be used as a letter of guaranty for payment into public or private medical organization.
The insured declares to have not scheduled any travel for therapeutic treatment.
Issued in triplicate, in Cameroon on the : 16/01/2023
For the company: Signature of the insured: