CERTIFICATE OF INSURANCE

Dear SAMSUL AMRI

Thank you for purchasing Chubb Travel Insurance for your latest reservation at Traveloka.
Please find your travel benefit details as follow:
Certificate Number

TTIIDAA1355170

Plan Selected
Issue Date
Travel Period
Destination
Total Premium

:
:
:
:
:

One Way - Premium

23 Nov 2016
27 Nov 2016 to 27 Nov 2016
PKU - CGK
IDR 23,000.00

Passenger/Guest

Date of Birth

ID No./Passport No.

SAMSUL AMRI

Chubb confirms that the Insured Person(s) shown on this Certificate for whom premium has been paid are covered, subject to
terms, conditions and exclusions, of the Policy Wording.
Please see your Schedule of Benefits attached in this Certificate of Insurance. Please note that the Beneficiary will be subject to
the provisions of laws of the Republic of Indonesia.
Should you require further assistance, please contact our Customer Service at 1500 257 or email at travel.id@chubb.com.
Thank you for your trust and support in Chubb Travel Insurance. We look forward to be of service to you in the near future.

Yours sincerely,

Accident & Health Insurance Division

PT Chubb General Insurance Indonesia
www.chubb.com/id
This is a computer-generated letter and does not require any signature.
PT Chubb General Insurance Indonesia is registered and supervised by Otoritas Jasa Keuangan.

Chubb Travel Insurance is especially designed for Traveloka customers and is underwritten by PT Chubb General Insurance Indonesia. For full details of the Terms and Conditions of Chubb
Travel Insurance please refer to the Policy Wording.