U3674-GB47KE56

International Insurance
DER PASS

ASLONOV JALOL 01.10.1987 401356952 TAJIKISTAN

№ LIST OF INSURED BIRTH DATE NATIONALITY OPERATION AREA Great Britain

PERSONS
TRAVEL F 10.11.2023 T 10.11.2024 D 3
ASLONOV JALOL 01.10.1987 TAJIKISTAN R O A 6
1 DATA O Y
5
M S

INSURANCE PROGRAM Standard-Plus

RISKS INSURED INSURANCE AMOUNT FOR
17.10.2023 – 09:35
EVERY INSURED
DATE AND TIME OF ISSUE
TOTAL 90 (USD)
MEDICAL 30 000 (USD)
EXPENSES
TRIP CANCELLATION Not included

Insurance periods:
According to the Standard Plus program (Chapter 16 of Rules #1
or Rules #2), the duration of insurance coincides with the
duration of the trip.
This policy confirms the conclusion of an insurance contract between the
branch of Aetna International Travel Insurance and the policy holder for
the conditions of insurance of property interests of citizens traveling outside
their permanent place of residence within the Standard, Standard Plus,
Cancellation programs, valid from 22.04.2022 (hereinafter rule 1), and/or

COVID-19 is covered as per the T&Cs
Rules for insuring the property interests of citizens traveling outside their
permanent place of residence (under the Optimum programs) and insurance
for expenses related to a forced cancellation of a trip or a change in the time
of travel (Trip Cancellation Plus program), approved with Ordinance 02-
2204/2022 of 04/22/2022, valid from 04/22/2022 (hereinafter referred to as
Rule 2) • depending on the selected insurance program.

In the event of an insurance claim, contact the Service
Center: 50 Cannon St, London EC4N 6JJ, UK
If medical assistance is needed during the trip:
+44 870442 4386 (24/7)
In the event of cancellation, loss of luggage and other
insured events.
Under the Insurance Contract, due notification of the Contracting Parties shall
be made in accordance with the methods set out in Section 2.24 (Sections 1 to
4) of Rules 1 and 2. Upon the occurrence of an insured event, the application
and documents will be made available to the insurer in accordance with
Clause 11.7.1. - 11.7.4. Rule 1 or Rule 2.
Based on art. 435, 438 of the Civil Code of the Kingdom, the consent of the
insured to take out this policy (offer) on the terms proposed by the insurer
(acceptance) shall be deemed payment of the full insurance premium no later
than the date of commencement of the period of validity (duration of travel)
of this policy. The insurance premium is paid out as a lump sum.

By paying for this policy, I confirm that I am aware of Rules 1 and 2 and the
Special Conditions of Insurance and that they form part of this insurance
contract.
I agree to the insurer's policy on the processing and storage of personal data
© 2023 Aetna International in accordance with Art. 6.6. Rule 1 or Rule 2.
50 Cannon St
Applications that are part of this insurance contract:
London EC4N 6JJ 1. Special insurance conditions;
+44 870 442 4386 2. Rule 1 or Rule 2;
3. Excerpts from Rule 1 or Rule 2;
4. Key information document (KID) and insurance brochure.

Guided by part 2 of art. I confirm the agreement of the

parties on the permissibility of using facsimile
reproduction of signatures and seal impressions with
copying tools.