CERTIFICATE OF INSURANCE

Being part of the Policy for Travel and Study in New Zealand

Scholar Guide Company Ltd Product: NZ Student Plan - Sept 2021

1467/4 Sukhumwit 65/1 Rd Policy: 20186 / UNI155430
Prakhanong-Nua, Wattana Education Provider: Hillcrest High School
Bangkok 10110, Thailand

Applicant Name/S Date of Birth Student ID/s

Ms Tamtawan Boonprakob 9/11/2005

Policy Note/s

Date Issued 18/10/2022

Policy Start Date 16/12/2022
Policy Expiry Date 20/12/2023
Period of Insurance 369 days

Schedule Premium $597.23

Govt Levies $14.79
Document Fee $20.00
Total Premium $632.02

SCHEDULE OF BENEFITS IN NZ$ NZ STUDENT PLAN

The following is a list of the maximum limits for each Section, and sub-limits that apply to benefits under some
Sections. They apply per Insured Person and are based on a maximum period of insurance of 365 days from
the Policy Start Date. They apply to Your Policy regardless of:

• Whether Your Period of Insurance stated above is a different period, and

• the number of Policies You arrange with Us over those 365 days.

The above terms apply wherever these maximum limits and sub-limits are started throughout the Policy.

Section 1 Medical & Related Expenses (including Evacuation, Repatriation & Cancellation) Unlimited
Subject to the following sub limits:
- Alternative Medical Treatment $500
- Optical cover (only applicable to policies issued for 6 months or longer) $300
- Treatment of Mental Illness & Counselling $20,000
- Sexual Health Consultation $250
- Medical Expenses for temporary return to Country of Origin $200,000
- Continuing Treatment in Country of Origin $20,000
- Loss of Deposits $100,000
- Repatriation due to Mental Illness, Suicide & Drugs/Alcohol $10,000
- Resumption of Travel $30,000
- Accompanying Relatives $100,000
- In Hospital Personal Cash (up to $100 per day) $10,000
- Funeral Expenses $100,000
- False Arrest $10,000
- Hijack Cash (up to $100 per day) $10,000
- Rental Vehicle Return $1,000
- Travel Delay $10,000
- Search & Rescue $10,000
- Denial of boarding due to suspicion of contracting Covid-19 ($200 per day) $1,400
 SCHEDULE OF BENEFITS IN NZ$ NZ STUDENT PLAN

Section 2 Luggage & Personal Effects $15,000

Subject to the following sub limits:

- Deprivation of Luggage $1,000

- Replacement of Travel Documents $3,000
- Unauthorised use of Travel Documents $5,000
- Money lost or stolen $1,000
- Fire Damage $12,000
- Maximum Individual Item Value (unless specified and additional premium paid) $2,500

Section 3 Missed Transport Connection $25,000

Section 4 Death or Disablement by Injury $50,000

- Death for under 16 years of age $10,000

Section 5 Personal Liability $2,500,000

Section 6 Kidnap & Ransom $250,000

Section 7 Rental Vehicle Excess $5,000

For family policies, the maximum limits available are two times the limit shown in this table (unless something
else is provided in the remainder of this Policy or your Certificate of Insurance) and the limits are shared
between all family members on a Policy.

CLAIM & EMERGENCY ASSISTANCE CONTACTS

Toll free in New Zealand: 0800 864 227 (0800 UNICARE) Claims email: claims@crombie.co.nz
Toll free in Australia: 1800 864 227 (1800 UNICARE) Assistance email: assist@nibtravel.com.au
Outside NZ & Australia call collect: +64-4-381-8166 Claim forms are available at: http://www.uni-care.org

For Uni-Care on behalf of nib nz limited

Serial# 9B0588F5-001