TRAVEL SMART ‫ﺗﺮﺍﻓﻞ ﺳﻤﺎﺭﺕ‬

Policy Schedule and Invoice ‫ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ ﻭ ﺍﻹﻳﺼﺎﻝ‬

Summary of Plan ‫ﻣﻠﺨﺺ ﺍﻟﺘﻐﻄﻴﺔ‬

Product Travel Inbound Plus ‫ﺍﻟﻤﻨﺘﺞ‬ Issuing Date 16/February/2020 ‫ﺗﺎﺭﻳﺦ ﺍﻻﺻﺪﺍﺭ‬
Policy Type Single Trip ‫ﻧﻮﻉ ﺍﻟﻮﺛﻴﻘﺔ‬ Period 17/Feb/2020 To 16/May/2020 ‫ ﺇﻟﻰ‬- ‫ﺍﻟﺼﻼﺣﻴﺔ ﻣﻦ‬
Duration 90 days ‫ﺍﻟﻤﺪﺓ‬ Premium 300 AED ‫ﺻﺎﻓﻲ‬
Area of Travel GCC Countries Only ‫ﺍﻟﺤﺪﻭﺩ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ‬ Fees/Charges ‫ﺍﻷﺗﻌﺎﺏ‬/‫ﺍﻟﺮﺳﻮﻡ‬
Group Policy Size None ‫ﺣﺠﻢ ﺍﻟﻤﺠﻤﻮﻋﺔ‬ VAT @ 5% 15 AED @ ‫ﺍﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
%5
Policy Number 13-ZT-22005-156715-0 ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬ Premium Including 315.00 AED ‫ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ ﺷﺎﻣﻠﺔ ﺿﺮﻳﺒﺔ‬
VAT ‫ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
Deleted Cover None ‫ﺍﻟﺘﻐﻄﻴﺎﺕ ﺍﻟﻤﺰﺍﻟﺔ‬ Other Taxes 0 AED ‫ﺿﺮﺍﺋﺐ ﺃﺧﺮﻯ‬
Adventure Sports Yes ‫ﺗﻐﻄﻴﺔ ﺍﻟﺮﻳﺎﺿﺔ‬ Total Premium 315.00 AED ‫ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ‬
‫ﺍﻟﺨﻄﺮﺓ‬
Reference Policy Generated via ‫ﺍﻟﻤﺮﺟﻊ‬
OLSTravelV2

Payment Details (online payment) (‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﺪﻓﻊ )ﻋﺒﺮ ﺍﻻﻧﺘﺮﻧﺖ‬

Amount ‫ﺍﻟﻤﺒﻠﻎ‬ Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬ Payment Receipt ‫ﺍﻟﻮﺻﻞ‬
315 AED 2/16/2020 7:09:19 PM ZT/UAE/228006

Primary Insured ‫ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

Name ‫ﺍﻷﺳﻢ‬ Gender ‫ﺍﻟﺠﻨﺲ‬ DOB ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬ Nationality ‫ﺍﻟﺠﻨﺴﻴﺔ‬
Varadaraya Kini Gurpur M 19/Mar/1967 IN

Policy Benefits and Limits (in AED/SAR/QR) (‫ ﺭﻳﺎﻝ ﻗﻄﺮﻱ‬/ ‫ ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬/ ‫ﻣﻨﺎﻓﻊ ﻭ ﺣﺪﻭﺩ ﺍﻟﻮﺛﻴﻘﺔ )ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬
The following benefits apply to each of the Insured Persons mentioned ‫ ﺗﺄﻣﻴﻦ ﺍﻟﺴﻔﺮ ﻟﺘﺄﺷﻴﺮﺓ ﺍﻟﺰﻳﺎﺭﺓ ﺻﺎﻟﺤﺔ ﻓﻘﻂ ﻓﻲ ﺩﻭﻝ‬.‫ﺍﻟﻤﻨﺎﻓﻊ ﺍﻟﺘﺎﻟﻴﺔ ﺗﻄﺒﻖ ﻟﻜﻞ ﻓﺮﺩ ﻣﺆﻣﻦ ﻟﻪ ﻣﺬﻛﻮﺭ ﺃﻋﻼﻩ‬
above. Visit Visa Insurance valid only in GCC countries. ‫ﻣﺠﻠﺲ ﺍﻟﺘﻌﺎﻭﻥ ﺍﻟﺨﻠﻴﺠﻲ‬
Benefits Limits ‫ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ‬ ‫ﺍﻟﻤﻨﺎﻓﻊ‬
A Emergency Medical expenses 150,000.00, Excess: 400.00 ‫ﻣﺼﺎﺭﻳﻒ ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻄﺎﺭﺋﺔ‬ ‫ﺃ‬
C Emergency Medical transportation 50,000.00 ‫ﻧﻘﻞ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻄﺎﺭﺋﺔ ﻟﻠﻌﻼﺝ‬ ‫ﺝ‬
E Repatriation of mortal remains 15,000.00 ‫ﺗﻐﻄﻴﺔ ﻣﺼﺎﺭﻳﻒ ﺇﻋﺎﺩﺓ ﺍﻟﺮﻓﺎﺕ‬ ‫ﻩ‬
L Cancellation or curtailment 5,000.00 ‫ﺇﻟﻐﺎﺀ ﺃﻭ ﺍﺧﺘﺼﺎﺭ ﺍﻟﺮﺣﻠﺔ‬ ‫ﻝ‬
M Delayed departure 1,500.00 ‫ﺗﺄﺧﺮ ﺍﻟﻤﻐﺎﺩﺭﺓ‬ ‫ﻡ‬
N Delayed baggage 750.00 ‫ﺗﺄﺧﺮ ﺍﻷﻣﺘﻌﺔ‬ ‫ﻥ‬
O Loss of personal baggage and personal money 10,000.00, Excess: 400.00 ‫ﺍﻷﻣﺘﻌﺔ ﻭ ﺍﻷﻣﻮﺍﻝ ﺍﻟﺸﺨﺼﻴﺔ‬ ‫ﺱ‬
P Loss of passport 1,500.00, Excess: 400.00 ‫ﻓﻘﺪﺍﻥ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬ ‫ﻉ‬

AXA VAT registration No: 100291881900003

AXA ASSISTANCE - Garmischer Str. 10 - 80339 Munich - Germany - 0049 89 500 70 2096
AXA Insurance (Gulf) B.S.C. (c) - www.axa-gulf.com
UAE - P.O. Box 290 - Tel: 800 48 45
 TRAVEL SMART ‫ﺗﺮﺍﻓﻞ ﺳﻤﺎﺭﺕ‬
Policy Schedule and Invoice ‫ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ ﻭ ﺍﻹﻳﺼﺎﻝ‬

Important Notice: This Policy Schedule contains a summary of cover only.
For full Terms, Conditions and Exclusions please refer to the Policy
Wording.
Cover is valid for visitor traveling to GCC countries only.
All material facts must be disclosed and failure to do so will invalidate this
policy.
The scope of cover under the subject policy excludes losses or claims due
to incidents occurred within the geographical area of any country declared
by the United Nations as a war zone.
For medical emergencies, please call
+971 4 429 4003
For complete details please refer to details terms and conditions at
www.axa-gulf.com
.‫ ﺟﺪﻭﻝ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ ﻳﺤﺘﻮﻱ ﻋﻠﻰ ﻣﻠﺨﺺ ﻟﻠﺘﻐﻄﻴﺔ ﻓﻘﻂ‬:‫ﻣﻼﺣﻈﺔ ﻫﺎﻣﺔ‬
‫ﻳﺮﺟﻰ ﺍﻟﺮﺟﻮﻉ ﺇﻟﻰ ﻛﺘﻴﺐ ﺍﻟﻮﺛﻴﻘﺔ ﻟﻠﺸﺮﻭﻁ ﻭ ﺍﻻﺳﺘﺜﻨﺎﺀﺍﺕ ﺍﻟﻜﺎﻣﻠﺔ‬
‫ﺍﻟﺘﻐﻄﻴﺔ ﻣﺘﺎﺣﺔ ﻓﻘﻂ ﻟﻠﻤﺴﺎﻓﺮﻳﻦ ﺍﻟﻰ ﺩﻭﻝ ﻣﺠﻠﺲ ﺍﻟﺘﻌﺎﻭﻥ ﺍﻟﺨﻠﻴﺠﻲ‬
‫ﻳﺠﺐ ﺍﻟﻜﺸﻒ ﻋﻦ ﻛﻞ ﺍﻟﺤﻘﺎﺋﻖ ﺍﻟﺠﻮﻫﺮﻳﺔ ﻭﻋﺪﻡ ﺍﻟﻘﻴﺎﻡ ﺑﺬﻟﻚ ﺳﻴﺆﺩﻱ ﻹﺑﻄﺎﻝ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
‫ﻳﺴﺘﺜﻨﻲ ﻧﻄﺎﻕ ﺍﻟﺘﻐﻄﻴﺔ ﺿﻤﻦ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ ﺍﻟﺨﺴﺎﺋﺮ ﺃﻭ ﺍﻟﻤﻄﺎﻟﺒﺎﺕ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺘﻲ ﻭﻗﻌﺖ ﺩﺍﺧﻞ ﺃﻱ‬
‫ﻣﻨﻄﻘﺔ ﺟﻐﺮﺍﻓﻴﺔ ﻣﻦ ﺃﻱ ﺑﻠﺪ ﺃﻋﻠﻨﺘﻪ ﺍﻷﻣﻢ ﺍﻟﻤﺘﺤﺪﺓ ﻛﻤﻨﻄﻘﺔ ﺣﺮﺏ‬
:‫ﻟﺤﺎﻻﺕ ﺍﻟﻄﻮﺍﺭﺉ ﺍﻟﻄﺒﻴﺔ ﻳﺮﺟﻰ ﺍﻹﺗﺼﺎﻝ ﻋﻠﻰ‬
+971 4 429 4003
‫ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ ﺍﻟﺘﻔﺎﺻﻴﻞ ﺍﻟﻜﺎﻣﻠﺔ ﻳﺮﺟﻰ ﺍﻟﺮﺟﻮﻉ ﺇﻟﻰ ﻛﺘﻴﺐ ﺍﻟﺸﺮﻭﻁ ﻭﺍﻷﺣﻜﺎﻡ ﻋﺒﺮ‬
www.axa-gulf.com

Sanctions and Limitations Exclusion: :‫ﺍﻟﻌﻘﻮﺑﺎﺕ ﻭﻗﻴﻮﺩ ﺍﻻﺳﺘﺒﻌﺎﺩ‬

We shall not be deemed to provide cover and we shall not be liable to pay ‫ﺍﻧﻨﺎ ﻧﻌﺘﺒﺮ ﺍﻧﻨﺎ ﻟﻢ ﻧﻮﻓﺮ ﺃﻱ ﻏﻄﺎﺀ ﻭﻟﻦ ﻧﻜﻮﻥ ﻣﺴﺌﻮﻟﻴﻦ ﻋﻦ ﺗﺴﻮﻳﺔ ﺃﻱ ﻣﻄﺎﻟﺒﺔ ﺃﻭ ﺗﻘﺪﻳﻢ ﻣﻨﻔﻌﺔ ﺇﺫﺍ ﻛﺎﻥ ﺫﻟﻚ ﻳﺆﺩﻱ‬
any claim or provide any benefit hereunder to the extent that the provision ‫ﺇﻟﻰ ﺗﻌﺮﺿﻨﺎ ﻷﻱ ﻋﻘﻮﺑﺔ ﺃﻭ ﺣﻈﺮ ﺃﻭ ﻗﻴﻮﺩ ﺑﻤﻮﺟﺐ ﻗﺮﺍﺭﺍﺕ ﺍﻷﻣﻢ ﺍﻟﻤﺘﺤﺪﺓ ﺃﻭ ﺍﻟﻌﻘﻮﺑﺎﺕ ﺍﻟﺘﺠﺎﺭﻳﺔ ﻭﺍﻻﻗﺘﺼﺎﺩﻳﺔ‬
of such cover, payment of such claim or provision of such benefit would .‫ ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻤﺘﺤﺪﺓ ﺃﻭ ﺍﻟﻮﻻﻳﺎﺕ ﺍﻟﻤﺘﺤﺪﺓ ﺍﻷﻣﺮﻳﻜﻴﺔ‬، ‫ﺃﻭ ﺍﻟﻘﻮﺍﻧﻴﻦ ﻭﺍﻷﻧﻈﻤﺔ ﺍﻟﻤﻌﻤﻮﻝ ﺑﻬﺎ ﻓﻲ ﺍﻻﺗﺤﺎﺩ ﺍﻷﻭﺭﺑﻲ‬
expose Us to any sanction, prohibition or restriction under United Nations
resolutions or the trade or economic sanctions, laws or regulations of the
European Union, United Kingdom or United States of America.

Applicable Taxes: :‫ﺍﻟﻀﺮﺍﺋﺐ ﺍﻟﻤﻄﺒّﻘﺔ‬

You accept and agree to pay any taxes on this Policy, in compliance with
the laws and regulations applicable in the territory of sale, including but
not limited to value added tax (“VAT”), which are due on Your Policy,
within fifteen working days from the date of request to pay by AXA. AXA
will contact You in the event that VAT is applicable to Your Policy. Failure
by You to pay any applicable taxes may result in Your Policy being
rendered null and void or cancelled at AXA's discretion.
‫ ﻭﻓﻘﺎ ﻟﻠﻘﻮﺍﻧﻴﻦ ﻭﺍﻟﻠﻮﺍﺋﺢ ﺍﻟﻤﻌﻤﻮﻝ ﺑﻬﺎ ﻓﻲ‬،‫ﺃﻧﻚ ﺗﻘﺒﻞ ﻭﺗﻮﺍﻓﻖ ﻋﻠﻰ ﺩﻓﻊ ﺃﻱ ﺿﺮﺍﺋﺐ ﻣﻔﺮﻭﺿﺔ ﻋﻠﻰ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
‫ ﻓﻲ‬،‫ ﺑﻤﺎ ﻓﻲ ﺫﻟﻚ ﻭﻟﻜﻦ ﻻ ﺗﻘﺘﺼﺮ ﻋﻠﻰ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ﺍﻟﻤﺴﺘﺤﻘﺔ ﻋﻠﻰ ﻭﺛﻴﻘﺘﻚ ﺍﻟﺨﺎﺻﺔ‬،‫ﺇﻗﻠﻴﻢ ﺍﻟﺒﻴﻊ‬
‫ ﺳﻮﻑ ﻳﺘﺼﻞ ﺑﻚ ﻣﻮﻇﻔﻲ ﺃﻛﺴﺎ ﻓﻲ‬.‫( ﻳﻮﻡ ﻋﻤﻞ ﻣﻦ ﺗﺎﺭﻳﺦ ﻃﻠﺐ ﺍﻟﺪﻓﻊ ﻣﻦ ﻗﺒﻞ ﺃﻛﺴﺎ‬15) ‫ﻏﻀﻮﻥ ﺧﻤﺴﺔ ﻋﺸﺮ‬
‫ ﻗﺪ ﻳﺆﺩﻱ ﺇﺧﻔﺎﻗﻚ ﻓﻲ ﺩﻓﻊ ﺃﻱ ﺿﺮﺍﺋﺐ ﺳﺎﺭﻳﺔ ﺇﻟﻰ ﺟﻌﻞ‬.‫ﺣﺎﻟﺔ ﺗﻄﺒﻴﻖ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ﻋﻠﻰ ﺍﻟﻮﺛﻴﻘﺔ‬
‫ﻭﺛﻴﻘﺘﻚ ﺑﺎﻃﻠﺔ ﺃﻭ ﻣﻠﻐﺎﺓ ﻭﻓﻘﺎ ﻟﺘﻘﺪﻳﺮ ﺃﻛﺴﺎ‬

This insurance is ‫ﺗﻢ ﺇﺻﺪﺍﺭ ﺍﻟﻮﺛﻴﻘﺔ‬

marketed by AXA UAE ONLINE ‫ﻳﺘﻢ ﺗﺴﻮﻳﻖ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ ﻋﺒﺮ‬ Issued by Online Services
‫ﻣﻦ ﻗﺒﻞ‬
and underwritten by AXA Insurance. All ‫ﻭ ﺗﺘﻢ ﻋﻤﻠﻴﺔ ﺍﻻﻛﺘﺘﺎﺏ ﻣﻦ ﻗﺒﻞ ﺃﻛﺴﺎ ﻟﻠﺘﺄﻣﻴﻦ ﻭ ﻳﺘﻌﻴﻦ‬ In Dubai, ‫ﻓﻲ‬
claims under the policy should be directed ‫ﺗﻮﺟﻴﻪ ﺟﻤﻴﻊ ﺍﻟﻤﻄﺎﻟﺒﺎﺕ ﺇﻟﻰ ﺃﻛﺴﺎ ﻟﻠﺘﺄﻣﻴﻦ‬ On 16/Feb/2020 ‫ﺑﺘﺎﺭﻳﺦ‬
to and will be handled by AXA Insurance.

For the Company ‫ﻧﻴﺎﺑﺔ ﻋﻦ ﺍﻟﺸﺮﻛﺔ‬ Stamp ‫ﺍﻟﺨﺘﻢ‬

AXA VAT registration No: 100291881900003

AXA ASSISTANCE - Garmischer Str. 10 - 80339 Munich - Germany - 0049 89 500 70 2096
AXA Insurance (Gulf) B.S.C. (c) - www.axa-gulf.com
UAE - P.O. Box 290 - Tel: 800 48 45