KONFIRMASI JAMINAN ASURANSI PERTANGGUNGAN

PESERTA KUMPULAN
GROUP INSURANCE COVER NOTE
MEGA TRAVEL INSURANCE SYARIAH

PT Asuransi Umum Mega Unit Syariah dengan ini mencatat dan menyetujui untuk menanggung
sesuai syarat dan ketentuan yang tercantum dalam Polis Mega Travel Care Syariah dengan Klausul
Akad Wakalah bil Ujrah.

PT Asuransi Umum Mega - Syariah Division hereby noted and agreed to guarantee in accordance
and comply with the terms and conditions stated in the Mega Travel Care Syariah Policy include
Wakalah bil Ujrah Clause

1. No Polis : FP.61.14.23.000410 | AGE MAX 70 | 100% BENEFIT

Policy No FP.61.14.23.000411 | AGE 71-85 | 75% BENEFIT
Program Benefit : NEW SILVER EXCLUDE COVID

2. Nama Pemegang Polis : PT AZAM ANGKASA JAYA | ID M61PA00038

Name of Policy Holder

3. Periode Pertanggungan Polis:

Policy Cover Period
a. Tanggal Dimulai : January 31st 2023 | After Checked In at
Starting Date International Departure Terminal SUB
JUANDA, International Airport Surabaya

b. Tanggal Berakhir : February 12th 2023 | After Leaved Out from Customs at
Expiry Date International Arrival Terminal SUB
JUANDA, International Airport Surabaya

c. Lama Pertanggungan : 13 Calendar Days

Duration of Cover

d. Extra Cover Perawatan Lanjutan di DN : February 14th to 16th 2023

Extra Cover Domestic Medical Care | 5 Days Since Arrival Date

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4. Itenerary:
a. Asal Berangkat : SUB | International Departure Terminal
Origin JUANDA, International Airport Surabaya
b. Tujuan : JEDDAH, MEDINA AND MECCA SAUDI ARABIA | UMRAH
Destination
c. Kembali : SUB | International Arrival Terminal
Returned JUANDA, International Airport Surabaya

5. Tertanggung | Insured :
Manifest Declaration
CR31012023-34 | 34 Insured Pax | Age Max 70 Years Old
CR31012023-2 | 2 Insured Pax | Age 71-85 Years Old

As Attached

• Travel Asal Jamaah / Source of Travel: AZAM ANGKASA JAYA

• All Guests are healthy and in good condition to go to JEDDAH, MEDINA AND MECCA
SAUDI ARABIA | UMRAH
• They have been vaccinated twice even for few of them already got booster.

6. Klaim Kedaruratan, Medis dan Ketidaknyamanan Perjalanan, diproses dengan mekanisme

Call Center 24/7 System melalui
Any Emergency, Medical and Inconvinience Claims are processed by Call Center System
24/7 with

• Halo MIA 1500 119

• WA CHAT Halomia 08111- 1500119
• Email Halomia | halomia@megainsurance.co.id

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 7. Dokumen Utama untuk memproses Ajuan Klaim | dapat dikirim ke WA Chat Halomia
a. Scan Passpor dan Visa
b. Scan Tiket dan Boarding Pass
c. Scan ID Siskopatuh
d. Scan ID KTP

8. Penanggung: PT Asuransi Umum Mega Unit Syariah – 100%

Security: PT Asuransi Umum Mega Unit Syariah – 100%

Wassalam,
Sincerely,
Jakarta, January 30th 2023
Penanggung | Security,
PT Asuransi Umum Mega – Syariah Division

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