DUBAI Your MSH contact

Contact Center +971.4.365.13.32 Rahma LAHIANI

precert@msh-intl.com

January 03, 2024

LETTER OF GUARANTEE N° EU240003350

To BANGKOK HOSPITAL PHUKET

2/1 HONGYOK UTIS ROAD,TALADYAI, MUANG DISTRICT
83000 PHUKET
THAILAND
Tel.: +66-76-254-425 - Fax: +66-76-254-425 - E-mail: bpk.interinsurance@bgh.co.th

Last name: MUNEEKARD Insured Name: SPINELLI PIERRE

Patient First name: PORNWILAI Policy: 11286106
Date of birth: february 12, 1975 Member ID: 11286106

Date of admission January 03, 2024

Expected length of stay 1 Day(s)

Coverage provided if patient is still insured at the actuel time of service.

Based on the quotation received on january 03, 2024 your copayment will be 0 THB
Type of medical service Original Charge Our Payment Copayment
General Dental 15540 THB 15540 THB 0 THB
TOTAL 15540 THB 15540 THB 0 THB

In order to extend the coverage, please contact us and send a medical report describing the plan of treatment and the expected
length of stay to our medical department: medical@msh-intl.com - Fax: Paris+33.1.44.20.82.15 Dubai+971.4.363 7327
Calgary+1.403.265 9425 Shangai+86.21.6187.0153

Please send the original invoices and a medical report to:

providers.mea@msh-intl.com or MSH INTERNATIONAL
Office 1902, Level 19, One by Omniyat, Business Bay PO Box 506537 Dubai - UAE

We thank you for your kind cooperation MSH INTERNATIONAL

Yours sincerely,

PARIS
International case manager
«All invoices and claims documents should be submitted to MSH within a period not exceeding 30 days or as per contractual agreement from the
discharge date of the patient.»
MSH INTERNATIONAL - DIOT-SIACI Group - Insurance or reinsurance broker. Head Office : Season - 39, rue Mstislav Rostropovitch - 75017 Paris - France. Tel.: +33 (0)1 4420 9999 - Fax: +33 (0)1 4420 9500. SAS - Capital: 2 500
000 € - RCS Paris 352 807 549 - APE 6622 Z - VAT No: FR 78 352 807 549. ORIAS No 07 002 751 (orias.fr) - Regulated by the ACPR - 4, Place de Budapest - CS 92459 - 75436 Paris cedex 09 - France. Complaint: MSH International -
Service Réclamations - 23, allées de l’Europe, 92587 Clichy cedex - France.