TRAVEL INSURANCE CERTIFICATE

REFERENCE: SIJ-23-0007034 ISSUING DATE: 06/09/2023

DESTINATION FROM TO COUNTRY OF RESIDENCE TELEPHONE NUMBER

ITALY - Schengen , Europe-Schengen 15-09-2023 13-09-2024 Jordan

FULL NAME DATE OF BIRTH PASSPORT NUMBER

Salsabeel Bazzari 31/12/1999 R990115

Contrary to any stipulations stated in the General Conditions, the Plan subscribed to, under this Letter of Confirmation, covers exclusively the below mentioned Benefits,
Limitations & Excesses shown in the table hereafter.
The General Conditions form an integral part of this Letter of Confirmation.
For more info/modification regarding your policy, kindly do not hesitate to contact your authorized agent or e-mail us on info@siassistance.com

BENEFITS SUM INSURED EXCESS ‫ﻓ ﻮاﺋ ﺪ‬

Emergency Medical Expenses Up to $ 60,000 0 ‫ا ﻟ ﻨ ﻔ ﻘ ﺎ ت ا ﻟ ﻄ ﺒ ﻴ ﺔ ا ﻟ ﻄ ﺎ رﺋ ﺔ‬
72
Emergency Medical expenses due to COVID-19 Up to $ 35 000 COVID-19 ‫اﻟﻨﻔﻘﺎت اﻟﻄﺒﻴﺔ اﻟﻄﺎرﺋﺔ ﻣﻦ ﺟﺮاء ال‬
hours
Emergency Medical Evacuation Real Cost 0 ‫ا ﻻ ﺧ ﻼ ء اﻟ ﻄﺒ ﻲ اﻟ ﻄﺎر ئ‬
72
Hospitalization expenses due to COVID-19. Up to $ 35,000* COVID-19 ‫اﻟﻨﻔﻘﺎت اﻻﺳﺘﺸﻔﺎﺋﻴﺔ ﻣﻦ ﺟﺮاء ال‬
hours
Repatriation to the Country of Residence Up to $ 60,000 0 ‫ا ﻹ ﻋﺎ د ة إﻟ ﻰ ﺑ ﻠ ﺪ ا ﻹ ﻗﺎ ﻣ ﺔ‬
Repatriation of Mortal Remains Real Cost 0 ‫إ ﻋﺎ د ة اﻟ ﺮ ﻓﺎ ت‬
Emergency Dental Coverage Up to $ 500 $ 50 ‫ا ﻟ ﻌ ﻨ ﺎﻳ ﺔ ا ﻟ ﻄ ﺎ رﺋ ﺔ ﺑ ﺎ ﻹ ﺳ ﻨ ﺎ ن‬
24
Delay of checked baggage Up to $ 300 ‫ﺗ ﺄ ﺧ ﻴ ﺮ و ﺻ ﻮ ل ﺣ ﻘ ﺎﺋ ﺐ ا ﻟ ﺴ ﻔ ﺮ‬
hours
Loss of baggage Up to $ 800 $ 25 ‫ﻓ ﻘ ﺪا ن ﺣ ﻘ ﺎﺋ ﺐ ا ﻟ ﺴ ﻔ ﺮ‬
Sea & Mountain search & Rescue Up to $ 10,000 0 ‫ﻋ ﻤ ﻠ ﻴ ﺎ ت ا ﻟ ﺒ ﺤ ﺚ وا ﻹﻧ ﻘ ﺎ ذ ﻓ ﻲ ا ﻟ ﺠ ﺒ ﻞ وا ﻟ ﺒ ﺤ ﺮ‬
Trip cancelation (agg. up to $2,500) (Up to 70 70 ‫ دوﻻر أﻣﻴﺮﻳﻜﻲ()ﻟﻐﺎﻳﺔ‬2,500 ‫اﻟﻐﺎء اﻟﺮﺣﻠﺔ )ﻣﻊ ﺣﺪ ﺗﺮاﻛﻤﻲ ﻟﻜﻞ ﻣﻄﺎﻟﺒﺔ ﺣﺘﻰ‬
Up to $ 1,500 $ 75
years) ‫)ﺳﻨﺔ‬
Trip curtailment following death only Up to $ 500 $ 75 ‫ﺗ ﻘ ﻠﻴ ﺺ ﻓﺘ ﺮ ة اﻟ ﺮ ﺣ ﻠ ﺔ ﻧﺘﻴ ﺠ ﺔ اﻟ ﻮ ﻓﺎ ة ﻓ ﻘ ﻂ‬
Legal Expenses Up to $ 2,500 0 ‫ا ﻟ ﻨ ﻔ ﻘ ﺎ ت ا ﻟ ﻘ ﺎﻧ ﻮﻧ ﻴ ﺔ‬

Advance of bail bond Up to $ 5,000 0 ‫ﺗ ﺴ ﻠﻴ ﻒ ﺳﻨ ﺪ ﻛ ﻔﺎﻟ ﺔ‬

Loss of passport Up to $ 300 0 ‫ﻓ ﻘ ﺪا ن ﺟ ﻮا ز ا ﻟ ﺴ ﻔ ﺮ‬
Up to 14 days and a maximum limit of $70 per
Quarantine Expenses 0 ‫ﻧ ﻔ ﻘﺎ ت اﻟ ﺤ ﺠ ﺮ اﻟ ﺼ ﺤ ﻲ‬
day
Above sums insured are per person & per period of cover.
Confirmation Code FOR SWAN INTERNATIONAL ASSISTANCE S.A.L

For official use, scan the above code to validate this confirmation letter.

PLEASE KEEP THIS LETTER OF CONFIRMATION WITH YOU In case of emergency or request of assistance, call us on:
AT ALL TIMES. +33 9 70 73 22 47 or +961 9 211 662 or
1-514-448-4417 or send an email to:
Claims must be reported within 48 hours from occurrence of the event and request@swanassistance.com
all related original documents must be submitted to the Company by the You will be asked to provide the reference of this letter and/or show this
beneficiary within four (4) months maximum. document. This purchase is non-refundable. Please refer to your receipt. Page 1 / 1