Mrs Nicole Andres

12 Kirkland Way

Parmelia

WA6167

21/08/2014
Policy Number: 18512379

Mrs Nicole Andres,

Thank you for choosing Medibank Travel Insurance.

Please find attached your Certificate of Insurance containing details of your policy and Product Disclosure Statement (PDS).
Please read them carefully. We want to make sure you understand all the details of your insurance cover. We also suggest
you keep these documents with you in a safe place on your trip as a point of reference in case you need to make a claim.
If any of the information on the Certificate of Insurance is incorrect and requires changing, please contact us so we can
change it for you.
Need help whilst you're away?
Whilst we hope you have a fantastic trip, if you need assistance whilst you are away, we are here to help.
Our emergency assistance team is available to help 24 hours a day, seven days a week. Their contact details can be found
on your Certificate of Insurance, in the PDS or online at medibank.com.au/travel.
Useful pre-travel information
Before you travel, we recommend you familiarise yourself with information (such as recommended vaccinations for your
destination) relevant to your itinerary. Our website medibank.com.au/travel (click on "Travel Tips") has loads of handy tips for
you to benefit.
Need to make a claim?
Information about how to make a claim can be found on medibank.com.au/travel.
For all other enquiries, please call us on 1300 362 544 or email us at medibank@travelinsurancepartners.com.au.
Safe travel,

Medibank Travel Insurance

Medibank Private Limited ABN 47 080 890 259, an Authorised Representative, AR 286089 of Travel Insurance Partners Pty Limited ABN 73
144 049 230, AFSL 360138, issues the insurance on behalf of the insurer Great Lakes Reinsurance (UK) PLC, ARBN 127 740 532, ABN 18
964 580 576, AFSL 318603, trading as Great Lakes Australia.

Policy Number: 18512379

Page 1 of 4

Your Certificate of Insurance and Tax Invoice

Mrs Nicole Andres

Policy Number:

18512379

12 Kirkland Way

Policy Type:

Medical Only Single Trip

Parmelia

Issue Date:

21/08/2014

WA6167

Plan:

Medical Only

your details
Existing Medical Conditions/Pregnancy Cover

Adult Traveller(s)

Date of Birth

Conditions declared,
approved by us and payment
received

Mrs Nicole Andres

17/02/1977

No

Mr Dhaval Bapat

13/05/1982

No
Existing Medical Conditions/Pregnancy Cover

Child Traveller(s)

Ms Aamani Bapat

Date of Birth

Conditions declared,
approved by us and payment
received

21/09/2012

Phone (Daytime): 0420665886

No

Mobile:

Email: andresnic@gmail.com

This policy has been issued on the basis that if travelling to the Americas or Africa, and you have ever been
diagnosed with a heart condition, a lung condition (other than Asthma if you are under 60 years) or reduced
immunity, you have gone through our medical assessment process and we have agreed to provide a policy.

travel details
Area of Travel:

Europe, Asia and the Middle East

Country Most Time Spent in:

Germany

Travel Start Date:

23/08/2014

Travel End Date:

13/09/2014

cover details
Excess Chosen:

$100.00

Specified Luggage

Not applicable

Increase Rental Car Insurance Excess By:

Not applicable

Motorcycle / Moped Riding Cover*:

No

Snow Skiing, Snowboarding and Snowmobiling Cover: No

* If covered, conditions apply e.g. the engine capacity must be 200cc or less and you must be wearing a helmet.

Policy Number: 18512379

Page 2 of 4

amount paid
Base Premium:

$140.40

Existing Medical / Pregnancy Cover

$0.00

Specified Luggage:

$0.00

Increase Rental Car Insurance Excess Cover:

$0.00

Motorcycle / Moped Riding Cover:

$0.00

Snow Skiing, Snowboarding and Snowmobiling Cover: $0.00

Total Amount Paid:

$140.40

Total GST Included:

$0.00

Total Stamp Duty Included:

$1.38

Receipt Number:

83J21752VN25

Transaction Reference Number:

83J21752VN25

emergency assistance
When calling for emergency assistance, please have a contact number we can call you back on.
USA / Canada: 1855 802 3392

NZ: 0800 284 346

UK: 0800 096 8821

Other countries: Call Australia on +61 (2) 8907 5672.

Policy Number: 18512379

Page 3 of 4

important information
This policy has been issued on the basis that you have provided accurate and complete answers to the
application questions and have agreed to receive travel advice. A Combined Financial Services Guide and
Product Disclosure Statement was provided on 21/08/2014. Please check the information contained in this
certificate is correct. If this is not the case the policy may be invalid, please contact Medibank Travel Insurance
immediately to update the information. When you receive this document please refer to medibank.com.au/travel
for important notices and travel advice that may affect your policy.
Please note that this policy has some limitations and exclusions. Please refer to the Product Disclosure
Statement for full details of what the policy does and does not cover. Some of the exclusions include:
l
l
l
l

l
l

There is no cover for motorcycling/moped riding unless the additional premium is paid.
There is no cover for skiing, snowboarding or snowmobiling unless the additional premium is paid.
There is no cover for luggage or personal effects left unattended in a public place.
This policy does not automatically cover claims directly or indirectly arising from, or exacerbated by all existing
medical conditions or pregnancy. Please refer to the Product Disclosure Statement for more information about
what the policy covers.
Cover is only provided for unexpected serious pregnancy complications which occur before the 26th week of
pregnancy.
There is no cover for claims arising from childbirth or the health of a newborn child, irrespective of the stage of
pregnancy at which the child is born.

You have the right to cancel the policy by notifying Medibank Travel Insurance in writing within 15 working days.
Please either contact us, or refer to the Product Disclosure Statement for more information.
Medibank Private Limited ABN 47 080 890 259, AR 286089, and Salesforce Australia Pty. Ltd. ABN:30 006 688
955 AR 298945 are Authorised Representatives of Travel Insurance Partners Pty Limited ABN 73 144 049 230,
AFSL 360138, and issue the insurance on behalf of the insurer Great Lakes Reinsurance (UK) PLC, ARBN 127
740 532, ABN 18 964 580 576, AFSL 318603, trading as Great Lakes Australia. We do not provide any advice
based on any consideration to your objectives, financial situation or needs. Please review your own needs and
the Product Disclosure Statement and Financial Services Guide before deciding to buy this insurance. Download
a copy of the combined FSG/PDS here or contact us on 1300 362 544 or email
medibank@travelinsurancepartners.com.au. All prices listed are quoted in Australian dollars $AUD.
For GST purposes, the taxable supply being made to you is the domestic component of your travel insurance. If
you are registered for GST purposes your input tax credit entitlement is based on the GST amount shown in
accordance with the GST law relating to insurance premiums, the GST amount may be less than 1/11 of the total
amount payable.

Policy Number: 18512379

Page 4 of 4