SmartTraveller df our trip is more memorable because insurance protects us ry GENERAL bY) ce -0],0] 00 redefining / insuranceTABLE OF BENEFIT WORLDWIDE SECTION DESCRIPTION PLATINUM GOLD SPECIAL ASIA PERSONAL ACCIDENT 1. | Personal Accident This lump sum benefit is payable on the accidental death, loss of limb(s), eye (s) or permanent USD 100,000 USD 35,000 USD 25,000 disablement from any occupation, which occurs whilist you are travelling. 2. Double in - Flight Coverage The lump sum Benefit for Personal Accident is doubled if the accident occurs while travelling on a USD 200,000 USD 70,000 USD 50,000 regular scheduled flight. MEDICAL, DENTAL & EMERGENCY MEDICAL ASSISTANCE 3. Medical, Dental & Other expenses Becoming ill or being accidentally injured whilst travelling away from your home country can be very expensive. SmartTraveller will reimburse you for medical, emergency dental, hospital, surgical and USD 100,000 USD 35,000 USD 25,000 nursing home expenses, including traditional treatment incurred whilst travelling. Deductible USD25 Medical Expenses in Indonesia We will reimbursed medical expenses in Indonesia for a maximum period of 3 months medical USD1,250 USD1,250 USD1,250 treatment. 4, Repatriation of Mortal Remains The cost of transporting the mortal remains back to Indonesia is paid under SmartrTraveller. UsD 7,500 USD 3,500 USD 2,500 5. Childcare and Compassionate Benefit This pays for one relative or friend if required on medical advice to remain behind with or travel to or with you following your hospitalisation overseas. It also pays for one relative or friend to accompany USD 3,000 USD 3,000 USD 3,000 your children back to Indonesia following your hospitalisation overseas. 6. Hospital Cash Allowance This is a daily cash allowance for any Insured Person who is admitted to the hospital for more than 24 hours. Cover is for the ‘inconvenience suffered’ and is available for you to spend in any way you USD 500 USD 500 USD 500 wish. Maximum USD 25/day Deductible USD25 7. Emergency Medical Evacuation and Repatriation SmartTraveller has arranged with Global Assistance & Healthcare to provide you with its 24-hour worlwide emergency assistance service. The services provided by Global Assistance & Healthcare USD 40,000 USD 40,000 USD 40,000 include medical advice, hospital admission and arrangement of compassionate visits, also monitoring | Femy¥SP 50.000 | Family USD 50,000 Fe of medical condition and medical expense guarantee, refferal to doctors, hospitals, embassies, lawyers and interpreters. In addition SmartTraveller will reimburse you up to the selected amount for emergency medical evacuation and repatriation arrangements. TRAVEL INCONVENIENCE 8. | Baggage and Personal Effects : , ; ; ; USD 1,500 USD 1,500 USD 1,500 it Loss of or damage to your personal luggage including contents and articles worn or carried during Maximum USD 300 Maximum USD 300 Maximum USD 300 any one item/set any one item/set any one item/set your journey are covered up to the limit shown in the policy certificate. Maximum USD 500 Marmum USD 500 Nanimum USD 500 Deductible USD25 for Laptop for Laptop for Laptop 9. | Travel Documents it This is a reimbursement for the cost of obtaining replacemnt passports, travel tickets and other relevant travel documents up to USD 150. USD 300 USD 300 USD 300 Deductible USD25 10. | TRAVEL INCONVINIENCE Baggage Delay If your baggage is delayed for more than 12 hours due to mishandling by the airlines or hijack, USD 500 USD 500 USD 500 SmartTraveller will reimburse expenses incurred for emergency items such as clothing or toiletries.as TABLE OF BENEFIT (continue) This section will cover claim of section 1 - 19 due to terrorism act during your trip. WORLDWIDE SECTION DESCRIPTION PLATINUM GOLD SPECIAL ASIA 11. | Personal Liability SmartTraveler cover you against personal Legal Liability to Third Parties for bodily injury or property damage together with associated legal costs and expenses, due to your negligence arising during your USD 150,000 USD 135,000 USD 125,000 journey. 12. | Travel Delay You may claim the cash benefit amount shown in the policy certificate for each 12 hour period that Usb 500 USD 500 UsD 500 the aircraft, train or sea vessel on which you have arranged to travel is delayed due to events beyond | (USD 50/12hours) (USD 50 /12 hours) (USD 50 /12 hours) your control. Should you choose to re-route, your cost of cancellation charges and any additional cost including accommodation will be reimbursed Cancellation due to trip delay. USD 2,000 USD 2,000 USD 2,000 Deductible USD25 13. | Loss of Deposits This is the reimbursement of any irrecoverable prepaid deposit if it is necessary and unavoidable for you to cancel your trip within 30 days prior to your trip. USD 3,000 USD 3,000 USD 3,000 Deductible USD25 14, | Trip Curtailment You will be reimbursed for the prepaid and unused part of your journey if you have to curtail your trip USD 2,500 USD 2,500 USD 2,500 due to reasons beyond your control up to the limit stated in policy schedule. Deductible USD25 15. | Flight Misconnection This is to reimburse any expenses incurred for additional accomodation, meals or refreshment incurred USD 200 USD 200 USD 200 due to flight misconnection. 16. | Hijacking Z A i z Hl z USD 1,000 USD 1,000 USD 1,000 If your conveyance is hijacked, SmartTraveller will pay a daily cash benefit for delay or interruption to (USD 50/24 hours) (USD 50 /24 hours) (USD 50 /24 hours) your journey 17. | Household cover gt We will reimburse by payment or at its option by reinstatement or repair against physical loss or damage to the contents based within the residence of the Insured in Indonesia that was left vacant USD 5,000 NO NO because of the Insured person trip, caused by fire during the period of insurance, but only after the Insured Person has legally left Indonesia 18. | Own Risk of Rental Vehicle it We will reimburse the Insured person for any or deductible which Insured person becomes legally Usp 250 NO NO liableto pay in respect of loss or damage caused by an Accident to the rented. The Insured person must be either as a named driver or passenger of the rental vehicle. 19. | Golfing Equipment Cover peta This section will cover a. Loss of or damage to your golf equipments USD 250 NG nO b. Entertainment cost if the insured win the hole-in- one competition USD 200 20. | Terrorism a Yes Yes YesIndividual | Family | Individual} Family | Individual | Family 1-4 days ee | 18 2 15 4 10 5-6 days 24 a3 15: 24 ifs 20 7-8 days 32 48 24 36 12 30 9-10 days 39 9 29 45 18 Bo) 11-15 days 43 | 68 37 57 23 50 16-20 days 55 84 40 60 30 58 21-25 days 63 95: 43 65 35 63 26-31 days 70 105 46 ca 38 69 Each additional 10 20 8 12 6 10 week | Annual Policy 135 185 NA NA NA NA Special Asia : Brunei, China, Hongkong, Kamboja, Laos, Macao, Malaysia, Myanmar, Philipina, Singapura, Taiwan, Thailand, Vietnam, Timor Leste. Single Trip = maximum for any one trip is 180 days Annual Policy = maximum for any one trip is 60 days. Main Exclusions The following is a summary of the main exclusions in the Policy. Please refer to your certificate of insurance for further details. War, revolution, goverment acts, terrorism and sabotage (this Exclusion does not apply to passive risks). Passive risk shall be deemed to mean Insureds being killed or injured because they were accidentally in a place when an act of terrorism or strike, riot and civil commotions occurred. Nuclear hazard Self-inflicted injury or illness. Venereal disease, AIDS or AIDS related disease. Alcoholism or drug abuse. Any pre-existing conditions. Racing, motor sport, mountaineering, pot-holing, underwater activities or other hazardous pursuits and flying as a pilot or crew member, winter sports. Important Information At the time of effecting this insurance you must be fit to travel and not be aware of any circumstances which could lead to cancellation or disruption of your planned journey. Coverage is available to adults up to the attainment of 70 years of age on the date of departure. A family means the Insured, spouse and dependant children over 1 years of age up to 19 years of age or if full-time students up to a maximum of 25 years old. No refund premium will be allowed once coverage under any section of the policy has become operative. The maximum period of insurance for a single trip is 180 days and for annual Policy is 60 days per trip. This policy applies if the trip starts from Indonesia and return to Indonesia. This policy can only be bought by Indonesia citizens or expatriates who have permanent resident permits or KITAS to stay in Indonesia.Medical Assistance and Advice Services As acustomer of SmartTraveller, you automatically become a member of the Global Assistance & Healthcare during your travelling. As a Medical Assistance provider who is experienced in providing health services and assistance, Global Assistance & Healthcare have a representative in more than 70 countries in the world. Global Assistance & Healthcare has a medical team that dedicated to provide emergency medical assistance or consultation services. Global Assistance & Healthcare is very easy to be contacted. Any time and any where you need help, assistance is provided quickly and professionally. In addition, 24 hours per day - 365 days per year service assistance has been dedicated to serving SmartTraveller customers. When you are abroad and there are EMERGENCY health problems that are covered in SmartTraveller policy, please contact the 24-hour Alarm Center to obtain service medical advice and assistance. Do not forget to mention your certificate number, full name, and travel agent 24-Hours Alarm Centre | (62-21) 299 78 999 (collect call) Other telephone numbers : Australia : 1800-352028 France : 0800-909825 Hong Kong =: 800-901536 Singapore : 800-6211105 United States : 888-6564234 30 minutes policy issuance on line claim report through AXA website 24 hours service assistance passive risk due to terrorism & sabotage is covered This brochure is not a contract of insurance. The precise terms and conditions are specified in the insurance policy.Question & Answer 1.Q: In the event of transportation delay or sick beyond my control and | cannot return to Indonesia before the expiry date, would | still be covered? A: Yes. You are automatically covered without additional premium up to 72 hours where reasonably necessary for the completion of your jJoumey. 2.Q: Are there any differences in coverages between business and leisure Travels? A: No. You are covered for all benefits insured under Smart Traveller. However, you are not covered for any third liability arising from your pursuit of any trade, business or profession when you are on business travel. 3.Q: Does SmartTraveller cover any terrorism act? A: Yes. Terrorism is covered except for losses arising from terrorist acts using chemical / biological substances or where the insured person is participating in terrorist acts. 4.Q: Does SmartTraveller cover scuba diving? A: No. Itis not covered under SmartTraveller. 5.Q: My credit card provides travel insurance cover whenever | charge my fare or travel package to my card. Do | still need to buy SmartTraveller? A: The travel insurance provided by your credit card may not cover Medical Expenses. Our Smart Traveller provides you with many other benefits i.e. Medical Expenses to protect you from overseas high medical cost Many others benefits such as Personal Accident, Baggage, Travel Delay, Travel Document, Personal Liability, Loss of Deposit or Cancellation, Trip Curtailment, Flight Misconnection, and Hijacking are also covered under SmartTraveller. 6.Q: Can any children get SmartTraveller for their travel coverage? A: Yes. They can buy SmartTraveller, if they travel is accompanied by an adult. 7. Q: Does SmartTaveller respond to a claim immediately? A: Yes. As long as client has submitted document of claim completely we can process their claim within reasonable time since AXA has a reputable claims service and fast track system which provides fair and quick advice and settlement. 8.Q: If lam above 70 years old, can | still be covered by SmartTraveller? A: The standard maximum age for our SmartTraveller is 70 years. However you can be covered subject to our approval and we can only provide travel inconvinience coverage (no personal accident & medical cost cover). 14 we can not eliminate fam el aac} , Or ig can insure itCustomer Care Centre AXA Tower It. GF 4, Prof. Dr. Sattio Kav. 18, Kuningan City Jakarta 12940, Indonesia Tel: +62 21 3005 9005, Fax: +62 21 3005 9008 Email : customer@axa-insurance.co.id La GENERAL redefining / insurance Proposal Form SmartTraveller Important Notice = You must disclose in this proposal form, fully and faithfully all the facts, which you know or ought to know otherwise, the cover provided by the policy may be void = If the insured person is part of a group or a family, please provide the below details for each member of the group or the family on a separate piece of paper. Name of Insured Person (s) Address Tel: Date of Birth Occupation Beneficiary Relationship Destination Period days, starting from J+ _ to Jf Insurance days days days -10 days 141-415 days 16-20 days 21-25 days 26-31 days Each additional week Annual Policy Om OoOnaer B Total Premium US$ Warranty The Insured Person warrants that : = he/she is not travelling contrary to the advice of a Medical Practitioner or for the purpose of obtaining medical treatment. ® this policy is issued before he/she commences the journey. Signed by or on behalf of the Insured Person Date PT Acuransi AXA Indonesia Head Office ‘AXA Tower I. 11. I Prot, Or, Satrio Kav. 18, Kuningan City, Jakarta 12940. Indonesia Tel: +82 21 3005 9000 | Fax: +6221 3005 9009 | Email: axaindo@axa-insurance.co.id | Website: www.ax-insurance.co.idAXA : A World Leader in Financial Protection AXA Group in 2011 Present in 57 countries Euro 86.1 billion in consolidated revenues Euro 1,079 billion Euros in assets under management 163,000 employees and distributors worldwide working to deliver the right solutions and top quality service to our customers. = 101 million customers across the globe have placed their trust in AXA to: — insure their property (vehicles, home, equipment and other properties) — provide health and personal protection coverage for their families or employees — manage their personal or corporate assets Standard & Poor's Rating: AA- #1 global insurance brand by Interbrand PT Asuransi AXA Indonesia ™ Has extensive general insurance experience in Indonesia = Has more than 150 professional, well-trained and care employees in giving service to clients ™ Has vary insurance product both for individual or business e at above contact number or her information a \ you can directly contact us at below teley one number Below are our other smart products to complete your insurance needs. SmartHome SmartDrive SmartTraveller SmartTraveller Domestic SmartCare Prime SmartCare Executive Tel : +62 21 3005 9005 www.axa-insurance.co.id W Follow @AXA_General PT Asuransi AXA Indonesia AXA Tower It. 11. Jl, Prof. Br, Satrio Kav. 18, Kuningan City Jakarta 12940, Indonesia Tal": +69 24 3008 9000 GENERAL 1 3005 9009 a indo@axa-insurance.co.id redefining / insurance Fax Email =