Confirmation of Cover

Insurance Company of North America – Philippine Branch (a Chubb Company) hereinafter called the “Company” hereby
insures the Insured/(s) named in the Confirmation of Cover under the Group Policy subject to the terms, conditions and
exclusions contained herein.

Confirmation Number : AGDPHAA0019069

Named of Insured Person(s) Date of Birth

__________________________________________________________________________________________________
Ruby Cadivida Seit 26 JUN 1969
__________________________________________________________________________________________________
Total Premium Payable : PHP 249.25
__________________________________________________________________________________________________
Period of Insurance : From 28 Oct 2023 To 28 Oct 2023
__________________________________________________________________________________________________
Plan Type : ONE WAY
__________________________________________________________________________________________________
Plan Category: DOMESTIC
__________________________________________________________________________________________________
Group Policy Number: AGDPD00001

This policy covers individual up to 75 years old only.

Please retain or print a copy of the Confirmation of Cover.

Customer Service Hotline: +63 2 8 849 6000

(Mondays – Fridays, 8.30am to 5.30pm)
E: Travel.PH@chubb.com

IN WITNESS WHEREOF the Company has caused this Group Policy to be executed and/or and to commence from the Period
of Insurance as stated in the Confirmation of Cover, provided that this individual insurance shall not be binding on the
Company unless the Confirmation of Cover is signed by an authorized representative of the Company.

Signed on behalf of the Company

_________________
Peter van Ratingen
Country President
Date of issue : 24 Oct 2023

© 2020 Chubb Group. Coverages underwritten by one or more companies of the Chubb Group. Not all coverages available in all jurisdictions. Chubb®, Chubb logo®, and Chubb
insured® are trademarks of Chubb Limited.
 Confirmation of Cover
Chubb Travel Insurance is designed to provide you with peace of mind on your travels. Be assured knowing that help
is readily available with our 24/7 worldwide assistance hotline - Chubb Assistance.

For ease of reference, keep a copy of the Chubb Assistance Card below with you at all times. You can either print a
copy of the card or keep the softcopy version and view the file on your mobile device.

Visit https://www.chubbtravelinsurance.com.ph/en/help/chubb-assistance for more information on Chubb Assistance.

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This 24-hour emergency hotline number gives you

immediate worldwide assistance:
+63 2 8 864 0865
Name: burr alma
Policy Number: AGDPHAA0019069
Effective from: 28 Oct 2023

© 2020 Chubb Group. Coverages underwritten by one or more companies of the Chubb Group. Not all coverages available in all jurisdictions. Chubb®, Chubb logo®, and Chubb
insured® are trademarks of Chubb Limited.