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Roma, 30/01/2024

Prot. 000156

Mrs
Declaration of cover insurance coverage
KUPATADZE TAMARA
VIA GUALTIERO SERAFINO 13
ITALY

SUBJECT: Declaration of cover insurance coverage

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

POLICY PERIOD OF COVER: 01/01/2024 - 31/12/2024

POLICY LIMIT FOR YEAR / FAMILY


Hospitalization with or without surgical operation: € 150000.00

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

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