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Att Estero 0132492
Att Estero 0132492
Prot. 000156
Mrs
Declaration of cover insurance coverage
KUPATADZE TAMARA
VIA GUALTIERO SERAFINO 13
ITALY
It is hereby certified that Mrs KUPATADZE TAMARA is insured (world - wide cover for medical
expenses) with Divisione Allianz Lloyd Adriatico health policy registered in the name of TECHNIP OPZ.
1 - N. 732957564
Mrs KUPATADZE TAMARA born 24/12/1984 - Resident in ROMA (RM) - cap 00138 - VIA
GUALTIERO SERAFINO 13 - ITALY - Fiscal code: KPTTMR84T64Z154U
Note: This declaration neither affirmatively or negatively amends, extends nor alters the coverage afforded by
the policy numbered on this declaration.
SAS
Ufficio portafoglio
e liquidazioni