TRAVEL INSURANCE CERTIFICATE

REFERENCE: GHA-24-0000091 ISSUING DATE: 18/01/2024 PLAN: Silver AGENT: Unique Insurance Company
DESTINATION FROM TO COUNTRY OF RESIDENCE TELEPHONE NUMBER
Mauritius 21-01-2024 19-02-2024 Ghana 0274455906,+2330555785978

FULL NAME DATE OF BIRTH PASSPORT NUMBER

BERNARD ELORM ADEM 06/10/1993 G2738212

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

Emergency Medical expenses Up to $ 75,000 $ 30
Emergency Medical Evacuation & Repatriation in case of serious illness or accident Real Cost 0
Repatriation of Mortal remains Up to $ 30,000 0
Emergency Dental coverage Up to $ 250 0
Trip Cancelation & Curtailment Up to $ 1,000 0
Delayed departure abroad Up to $ 750 / per hour $ 30 6 hours
Loss of Baggage Up to $ 600 / per bag $ 150 & per item $ 50 0
Delay of Baggage Up to $ 750 / per hour $ 30 6 hours
Personal Liability Up to $ 100,000 0
Loss of Passport, Driving License, National I.D. abroad Up to $ 100 0
Loss of Credit Card Up to $ 500 0
Personal Accident due to Death – Common Carrier Up to $ 15,000 0

Above sums insured are per person & per period of cover.
Important Notes:

-This policy only covers sudden illness and accidents. All treatments related to or resulting from pre-existing medical conditions are excluded from cover (Please carefully read the general conditions)

Confirmation Code FOR UNIQUE INSURANCE CO. LTD

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

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