\)\ 096132621t1

.q PRIillE INSI"JRANCE CO}IPAN}' LINT ITED

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Head office: Unique Heights (9th

Froor), 117, KaziNazrur rsram .'-,
Dhaka_1000. phone: (+Ati_OZ) bstesOsz_OZ --...Avenue,
email ; info@prime-insurance.net
website: www. prime-insurance. net

BIN : 000'162206-0208

MONEY RECEIPT
MUSHAK:6.3
lssuing Office Purana Paltan Branch
Money Receipt No PRP-2023_2327
Class of lnsurance Miscellaneous
Date : 30-10-2023
Received with thanks from ABU KHALTD MOHAMMED BARKA
TULLAH, BAITUL ABED, 53, PURANA
DHAKA GPO, PALTAN, DHAKA PALTAN ,
The sum of
Tk. 8,a16.00 (Eight Thousand Four
Hundred Sixteen taka)
Mode of payment Cheque; 224457

Drawn on Dated 30-10-2023

lssued against PICL/PRP/MISCiOMP-0456/1

0/2023(B&H )

Premium BDT 7,318.00

VAT BDT

BDT
1,098.00

8;4j0.00
r I
r
F I

rt T

This RECEIpT is computer generated,

authorized signature is not required.

* Note:
lf have any complain about lnsurance,
call 16130

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elE=r@ffiffi
{3 PRJI\/IE, INSURANCE C OI\/IPAN\' LTN/IITEf)
Unique Heights
Fox:
19rh Floor) 1 17, Kozi Nozrul lslom Avenue, Dhoko-1000, Bonglodesh.Phone:(+BB-02) 09613262100,09613262188,55138659.62
(+BB-02) 55-I38658, E-moil:info@prime-insuronce.net, wwwprime-insuronce.net

"t
ovERS EAS MED| CLA| M r DENTT F I CATI ON (B & H) SCH EDUL E
,,4'
Plan : NON.SCHENGEN COUNTRIES AND WORLDWIDE EXCLUDING USA & CANADA

This Overseas Mediclaim lnsurance is only available to Bangladeshi Citizens between 6 months and 79 years of age who are
undertaking bonafide trips outside Bangladesh which will not involve any form of manual work and d q."not exceed 180 days in
d u ration unless specif ically extended

Policy No. PICL/PRP/MISC/OMP-0456/10/2023( B&H ) Plan "A" Date'3011012023

01. NanB of tre lnsured (as indicated on passporg : ngU XHRLTO MOHAMMED BARKATULLAH

)
02. Age (ln mmplebd years : 70 Years Dab of birtr : 16101119s4

03, Residence Address . BATTUL ABED, 53, PURANA PALTAN , DHAKA GpO, PALTAN DHAKA

(Speciff)
04. Insured's Occupalion , BUSTNESS
05 Residence Telephone No. /Mobile No. ',01122589570

06. PassportNo. : EA 0662786

07. NanB and Address oftre Usual Physician : ------
Telephone No. ffice / Honre

08. PIAN TYPC : PAN ''A'' : NON.SCHENGEN COUNTRIES AND WORLDWIDE EXCLUDING USA &
09. Limitof Cover See (Condition-12) CANADA

For Non-Schengen Countries :(Both lllness & Accident) : US$ 50,000

10. Deductible : For

\A/orld Wde (Excluding Schengen Counfies)
US$ 100, Energency Dental Care: US$ 50/=

11. Amount of Premium (BDT) NetPremium : 7,318.00

Vat 15% : 1,098.00

Total : 8,416.00

lssue
12. Date of : 3011012023

13. No. ofDaysCovered : days (From:

14 3011012023 To 1211112023 )

14.Counfy : INDoNESIA purpose of visit :ToURlsT

1 5. First day of lnsurance (Dats & Tinr Comnencing {rom 30-OCT-23
he tjne of boarding tre aircraftor oher npde of ffansport
from Bangladesh
16. Addressof lssuing Offce : Purana Palbn Branch,60/2 Purana paltan (5tr Floor), Dhaka.-1000
No.
Telephone :

E-nnil info@prine-insurance.net
warranted thatif any alteration/Modification /Cancellation of this Policy is needed the insured must
inform the insurer prime
lhsurance Company Limited in writing before hisiher departure from Bangladesh. claims lmportant
lnformation sheet
attached. disease are covered under this poricy. Excruded 'EBoLA* "zrcA,,
Subject to COVlDlg endorsement attached here to.

Covid-19 is covered subject to provide negative certificate before boarding or departure

SIGNED br ahd on'behalf of prine lnsurance company LU. at Dhaka

ocbber 30 2023
M.R. NO. :2327 Date.: 30-OCT-23
PrD- 1532 For and on behalf of
Prime lnsuranc,e Company Ltd

lly Re-lnsured witr SBC

Overseas Re-lnsurers as

i'
;,
Per Re-lnsurance Treaty
Aulhorised Officer