TERM LIFE & DISABILITY IN SURAN CE SCHEM E

Transcription

1 TERM LIFE & DISABILITY IN SURAN CE SCHEM E Pr ovided By Abu Dhabi N at ional Insurance Company In associat ion wit h N at ional Bank of Abu Dhabi W e t ake pleasur e in welcoming you as a N at ional Bank of Abu Dhabi GEM S Cr edit Car dholder t o enjoy benefit s of t his Ter m Life & Disabilit y Pr ot ect ion plan pr ovided by Abu Dhabi N at ional Insur ance Company. W e r equest you t o r ead t hr ough t he cover det ails in or der t o under st and fully t he scope, condit ions and limit at ions of t he cover offer ed. Page 1 of 8

2 SCHEM E HIGHLIGHTS Benefit s Covered : Deat h due t o any Cause (due t o Accident or Sickness) Per manent Tot al Disablement (Accident or Sickness) Rider s applicable Passive W ar Risk Rider Disappear ence Rider Import ant N ot ice 1. Cover aut omat ically st ar t s fr om t he commencement dat e 2. Age Limit s GEM S Childr en of Pr imar y Cr edit car dholder Gems Pr imar y Cr edit (Par ent ) car dholder M inimum 2 0 year s 5 year s Age at ent r y M aximum 5 5 Year s 2 0 year s age at Ent r y M aximum 6 5 year s NA age at Claims 3. The Insur ed M ember (Pr imar y GEM S Cr edit Car dholder ) shall be wit hin t he age limit s specified in t he Policy. 4. Residing in t he UAE, however, all Insur ed M ember s ar e cover ed whilst t r aveling anywher e in t he wor ld on a 2 4 hour basis. M aximum Sum Insured: AED,2,00 0,0 0 0 / - This maximum Sum Insur ed limit s is subject t o maximum enr olleent up t o 4 chidr en.m aximum amount of benefit applicable per child under t his policy is AED5 0 0, In t his policy unless t he cont ext ot her wise r equir es wor ds and phr ases cognat e t o t hose defined her ein or under t he Schedule at t ached her et o and shall be const r ued in accor dance wit h t hose definit ions and t he singular includes t he plur al and t he masculine t he feminine and vice ver sa. Definit ions For t he pur pose of t his Policy, t he following definit ions shall apply unless t he cont ext ot her wise r equir es: 3. The geogr aphical limit of t his policy is W or ldwide/ 2 4 hour s. 4. The Bank is not at any t ime consider ed as an agent of Abu Dhabi N at ional Insur ance Company t he Insur ance Pr ovider. Any claims or cont est at ions for any insur ance cover age can however be negot iat ed dir ect ly wit h Abu Dhabi N at ional Insur ance Company, Abu Dhabi, t hr ough t he Bank s offices 5. The cover is applicable t o Pr imar y Gems Cr edit car d holder s only and excludes any Cor por at e car ds. 6. Deat h or Disablement could be due t o any cause except t hose expr essly excluded. 7. Cover is subject t o Limit s condit ions & exclusions of t his Policy ELIGIBILITY CON DITION S 1. The Insur ed M ember must meet t he eligibilit y cr it er ia st ipulat ed by t he Bank t o become an Insur ed M ember. 2. The Childr en of The Insur ed M ember be pur suing educat ion in GEM S Gr oup of schools in UAE. Page 2 of 8 Accident means wher e deat h/ disablement is sust ained by t he Insur ed M ember dur ing t he Per iod of Insur ance caused solely and dir ect ly by ext er nal violent means, is unexpect ed, unfor eseeable and not at t r ibut ed t o t he Insur ed M ember s int ent ional damage, self inflict ed injur y or suicide. Benefit means t he indemnit y payable under t he scope of t he cover in r espect of Deat h or Per manent Tot al Disabilit y or Cr it ical Illness or Tempor ar y Tot al Disabilit y or Involunt ar y Loss of Employment or M ale & Female cancer, Ter minal Illness, Repat r iat ion of mor t al r emains, Hospit alizat ion Cash Benefit, Secur e W allet of t he Insur ed M ember. Bodily Injury means a bodily injur y which: (a) is sust ained by an Insur ed M ember dur ing t he Per iod of Insur ance. (b) is caused by an Accident, and (c) solely and independent ly of any ot her cause, except illness dir ect ly r esult ing fr om, or sur gical or medical t r eat ment r ender ed necessar y by, such injur y, occasions t he disablement of t he Insur ed M ember wit hin ninet y (90) days fr om t he dat e of

3 t he accident by which such injur y is caused. Bank means N at ional Bank of Abu Dhabi (N BAD) having it s r egist er ed Head Office in Khalifa St eet,po Box-4, Abu Dhabi, Unit ed Ar ab Emir at es (UAE) Cardholder/ Insured member means a pr imar y GEM S Cr edit car dholder who has not unsubscr ibed t o t he benefit s under t his policy and has not been disqualified by t he pr ovisions of t his policy t o be eligible t o r eceive t he benefit s under t his policy. Company means Abu Dhabi N at ional Insur ance Company (ADN IC), having it s r egist er ed Head Office at Khalifa St r eet, P.OBox 8 3 9, Abu Dhabi, (UAE) Close Relat ive s means mot her, fat her, sist er, br ot her, wife, husband, daught er, son, gr andpar ent, gr andchild, par ent -in-law,son-in-law, daught er -in-law, sist er -in-law, br ot her -in-law, niece,nephew, st ep par ent, st ep child, st ep sist er, st ep br ot her, fost er child,legal guar dian, next of kin, fiancé/ fiancée. Commencement Dat e means t he dat e t he Car dholder is enr olled for t his Policy by t he Bank or t he dat e of incept ion of t his cover whichever is lat er. Car dholder s ar e enr olled for t his cover by checking t he check box in t he cr edit car d applicat ion or by giving ver bal consent t o t he Bank over t he r ecor ded t elephone lines. Credit : means t he cr edit car d or ot her for m a financial accommodat ion pr ovided by t he Bank t o t he car dholder under t he cr edit car d facilit y. Credit card facilit y means t he Bank s cr edit car d facilit y including t he supplement ar y car ds, which have been nominat ed as t he facilit ies t o which t he benefit s under t he cover ar e t o apply. Deat h means deat h r esult ing fr om any cause except as st at ed under t he List of Exclusions ment ioned under t his Policy. Dat e of Event means any one of t he following: I. In r espect of Deat h (N at ur al/ Accident ) t he dat e of Deat h r esult ing fr om any cause except t hose expr essly excluded, happening or manifest ing aft er t he Commencement Dat e and dur ing t he Per iod of Insur ance II. In r espect of Per manent Tot al Disablement (PTD) t he dat e of r ecognit ion of Per manent Tot al Disablement by a Compet ent Aut hor it y r esult ing from an accident or sickness happening or manifest ing aft er t he Commencement Dat e and dur ing t he Per iod of Insur ance Permanent Tot al Disabilit y (PTD) means t he t ot al and per manent inabilit y of t he Insur ed M ember, due t o accident or sickness, occur r ed pr ior t o at t ainment of 6 5 year s, on t he basis of medical evidence of insur abilit y sat isfact or y t o t he Company,t o t he ext ent of being unable t o ever engage in or wor k for r ewar d in any occupat ion. If at t he t ime of t he disabilit y event, t he Insur ed M ember is unemployed, PTD means t he per manent and t ot al inabilit y t o per for m, wit hout assist ance of a t hir d par t y, at least 5 out of 6 of t he following act s of daily living: 1. W ashing: t he abilit y t o w ash in t he bat h or in a shower (including get t ing int o and out of t he bat h or shower ) or wash sat isfact or y by ot her means; 2. Dr essing : t he abilit y t o put on, t ake off, secur e and unfast en all gar ment s and as appr opr iat e, any br aces,ar t ificial limbs or ot her sur gical appliances; 3. Tr ansfer r ing: t he abilit y t o move fr om bed/ chair t o an upr ight posit ion or wheelchair and vice ver sa; 4. M obilit y: t he abilit y t o move indoor s fr om r oom t o r oom on level sur face; 5. Toilet ing: t he abilit y t o use t he lavat or y or ot her wise manage bow el and bladder funct ions so as t o maint ain a sat isfact or y level of per sonal hygiene; 6. Feeding: t he abilit y t o feed oneself once food has been pr epar ed and made available. The t ot al and ir r evocable loss of t he sight of bot h eyes or t he loss by sever ance of I) t wo or mor e limbs or ii) one limb at or above t he wr ist or ankle and t he loss of sight of one eye, by t he insur ed will be consider ed a t ot al per manent disabilit y and t hus any claim ar ising t her eof is subject t o set t lement w it hout delay. The company r eser ves it s r ight t o seek a second opinion at own cost t o sat isfy t heir decision pr ior t o invoking t he appr opr iat e clause. Assessment of PTD and subsequent pot ent ial payment of benefit is made aft er (1 2 ) mont hs Page 3 of 8

4 cont inuous disabilit y following t he event giving r ise t o t he claim. However, t his t ime limit shall not apply t o cases of physical sever ance or amput at ion of limbs. Period of Insurance means t he per iod commencing fr om commencement dat e of Insur ance for w hich t he pr emium is fully paid. Pre-Exist ing Condit ion means any physical condit ion for which t he Insur ed member has sought medical advice, consult at ion or t r eat ment pr ior t o t he incept ion of cover. Scheduled Airline means any civilian air cr aft oper at ed by a civilian scheduled air car r ier holding a cer t ificat e, license or similar aut hor izat ion for a civilian scheduled air car r ier t r anspor t issued by t he count r y of t he air cr aft s r egist r y, and which in accor dance t her ewit h flies, maint ains and publishes t ar iffs for r egular passenger ser vice bet ween named cit ies at r egular and specified t imes, or r egular or char t er ed flight s oper at ed by such car r ier. Sickness means sickness or disease of t he Insur ed M ember which commences and manifest s it self aft er he/ she meet s t he eligibilit y r equir ement s, t he dat e of endor sement or r einst at ement of t his benefit s whichever is lat er. TERRORISM means t he an act ivit y t hat sat isfies bot h of it ems (I) and (II) below: I. involves a violent act or an act danger ous t o human life, t angible or int angible pr oper t y or infr ast r uct ur e, causing damage t o pr oper t y or injur y t o per sons, or a t hr eat t her eof; and II. appear s t o be int ended t o: Int imidat e, coer ce or incit e a civilian populat ion: or inflict economic loss or disr upt s any segment of a local, nat ional or global economy; or influence, pr ot est, int imidat e or coer ce against t he policy or conduct of a gover nment by any means, including mass dest r uct ion, mur der, kidnapping, hijacking, host age-t aking. Travel means any t r anspor t conveyance which is deemed t o include pr ivat e mot or vehicle as well as public air cr aft, ships, t r ains and busses licensed by t he appr opr iat e gover nment al aut hor it y t o car r y passenger s on a per mit t ed r out e w it h scheduled por t s, t er minals or st at ions of embar kat ion and disembar kat ion. UAE means Unit ed Ar ab Emir at es. W ar means war, whet her declar ed or not, or any war like act ivit ies, including use of milit ar y for ce by any sover eign nat ion t o achieve economic, geogr aphic, nat ionalist ic, polit ical, r acial, r eligious or ot her ends. W ar like Operat ions means host ilit ies, mut iny, r iot, civil commot ion, civil war, r ebellion, r evolut ion, insur r ect ion, conspir acy, milit ar y or usur ped power and mar t ial law or st at e of siege. Sum Insured AED 5 0,0 0 0 (per child) t imes t he balance number of year s t he child is expect ed t o gr aduat e at GEM S school, subject t o a maximum of 1 0 year s. Eg: If a child is aged 5 & st udying at Gr ade I, SI shall be AED 5 0,0 0 0 X 1 0 =5 0 0,0 0 0 If child is aged 1 5 & st udying at Gr ade X, SI shall be 5 0,0 0 0 X 2 = 1 0 0,0 0 0 SCOPE OF COVER I. Deat h Due t o Any cause In case of deat h (due t o Accident or sickness) of a Insur ed M ember, (Pr imar y Cr edit Car d holder ) t he beneficiar y shall be ent it led t o r eceive t he Sum Insur ed.cover for t he Insur ed M ember will cease upon payment of t his benefit. II. Permanent Tot al Disablement due t o Accident / Sickness) In case of Per manent Tot al Disabilit y (due t o Accident or sickness) of a Insur ed M ember, (Pr imar y Cr edit Car d holder ) t he beneficiar y shall be ent it led t o r eceive t he Sum Insur ed.cover for t he Insur ed M ember will cease upon payment of t his benefit. Passive W ar / Passive Terrorism risk is cover ed for Deat h by any cause, Per manent Tot al Disabilit y (Accident ) benefit s subject t o special condit ions ment ioned under Condit ions Applicable DISAPPEARAN CE CLAUSE: In consider at ion of t he pr emium paid her eon it is her eby agr eed t hat, subject t o all t he t er ms, limit at ions, condit ions and exclusions of t his insur ance except as specifically pr ovided her ein, if a Insur ed member under t his scheme disappear s dur ing t he cur r ency of t his insur ance and his body is not found wit hin one year aft er his disappear ance and sufficient evidences ar e pr oduced sat isfact or y t o t he company t hat leads t o t hem inevit ably t o t he Page 4 of 8

5 conclusion t hat he sust ained accident al bodily injur y and t hat such injur y caused his deat h, t he company shall for t hw it h pay t he deat h benefit under t his insur ance pr ovided t hat t he per son or per sons t o whom such sum is paid shall sign an under t aking t o r efund such sum t o t he company if t he insur ed is subsequent ly found t o be living. Underwrit ing Requirement s For enr olling mor e t han 2 & up t o 4 childr en t he cover will be subject t o sat isfact or y healt h declar at ion & any medical under wr it ing r equir ement s. TERM IN ATION OF COVER The benefit s under t his Cover shall t er minat e upon t he happening of any one or mor e of t he following. 1. Failur e t o pay t he pr emium ; 2. Cancellat ion of t he Car dholder s Cr edit Car d Facilit y; 3. The Car dholder having at t ained t he Age of 65 year s for Deat h benefit and Per manent Tot al Disabilit y. 4. The Insur ed M ember s Deat h or Per manent Tot al Disablement. 5. The Enr olled child ceasing t o be a full t ime bonafide st udent of GEM S gr oup of schools in UAE. 6. Cancellat ion of t he benefit s under t his Cover by t he Bank or t he Insur ed M ember at any t ime in accor dance wit h t he t er ms and condit ions of t his Cover. EXCLUSION S For Deat h any Cause Benefit are excluded t he consequences of : a) Dir ect ly or indir ect ly occasioned t hr ough war, invasion, act of for eign enemy, host ilit ies (whet her war be declar ed or not ), civil war, r ebellion, r evolut ion, insur r ect ion, milit ar y or usur ped power, r iot or st r ike or mut iny, mar t ial law, st at e of siege or any of t he event s or causes which det er mine t he pr oclamat ion or maint enance of mar t ial law or st at e of siege, violence, loot ing, sacking or pillage and t er r or ism. b) Dir ect ly or indir ect ly occasioned t hr ough accident al or deliber at e Page 5 of 8 spr ead or use of at omic, biological or chemical mat er ial including deat h dir ect ly or indir ect ly caused by, r esult ing fr om, or in connect ion wit h any act ion t aken in cont r olling, pr event ing, suppr essing or in any way r elat ing t o any event w her e at omic, biological and chemical mat er ial is involved. c) Dir ect ly or indir ect ly occasioned t hr ough any unlawful or cr iminal act of t he Insur ed Per son. If t he Company alleges t hat by r eason of any of t he above ment ioned exclusions (a) t o (c) inclusive, claim is not cover ed by t his insur ance t he bur den of pr oving t he cont r ar y shall be upon t he Insur ed / Insur ed per son / Insur ed Per son s Legal Repr esent at ives. d) Suicide pr ovided however t hat such an event happens wit hin 1 2 (t welve) mont hs fr om t he Or iginal Incept ion of Cover, self-inflict ed injur y. e) The Insur ed is member of t he Ar my, N avy, Air For ce, Police For ce, or any ot her Secur it y For ce of any st at e, count r y or nat ion For Permanent Tot al Disabilit y, In addit ion t o above, shall be excluded t he consequence of: a) Dir ect ly or indir ect ly caused by, cont r ibut ed t o aggr avat ed by: 1. Insanit y, int oxicat ion, alcohol or dr ugs not pr escr ibed by a licensed medical pr act it ioner, childbir t h, pr egnancy, ment al and/ or ner vous disor der s. 2. Pr e-exist ing illness or condit ion not declar ed in t he applicat ion for m. b) Human Immune Vir us (HIV) infect ion, Acquir ed Immune Deficiency Syndr ome (AIDS) or an AIDS r elat ed condit ion: c) Kidnap or Hijack. d) Insur ed per sons engaging or t aking par t in any of t he following hazar dous spor t s or act ivit ies.( list non exhaust ive) as a pr ofession and/ or for income: W int er spor t s ot her t han skat ing and cur ling and

6 skiing at any wint er spor t s r esor t, Skin diving involving t he aid of br eat hing appar at us, diving beyond a dept h of 2 0 met er s, r ock climbing or mount aineer ing, nor mally involving t he use of r opes or guides pot holing, caving, par achut ing, hunt ing on hor seback or equest r ianism in compet it ion, or dr iving or r iding in any kind of r ace, mar it ime navigat ion beyond 2 0 naut ical miles fr om coast al shelt er, spor t s of combat, bungee jumping, r aft ing, any act ivit y in deser t ar eas, or spor t s needing t he use of a mot or engine. Dr iving or r iding on mot or cycles or mot or scoot er s for t he pur pose of r acing or compet it ion. e) Aviat ion, gliding or any for m of aer ial flight ot her t han as a passenger in a fully licensed passenger car r ying air cr aft, pr ovided t hat t he t er m passenger, for t he pur pose of t his Policy, shall not include any per son who is a member of t he cr ew of t he air cr aft or who is in such air cr aft for t he pur pose of under t aking any t echnical oper at ion t her ein. CON DITION S APPLICABLE I. This policy shall be gover ned by and const r ued in accor dance wit h t he laws of t he Emir at e of Abu Dhabi and Unit ed Ar ab Emir at es. Any claims and or disput e ar ising out of or r elat ing t o t his policy shall be subject t o t he exclusive jur isdict ion of t he compet ent cour t s of t he Emir at e of Abu Dhabi. N o legal act ion for a claim can be brought against t he Insurance Company unt il sixt y (6 0 ) Days aft er proof of loss are received. N o legal act ion for a claim can be brought against t he insurance Company more t han t hree (3 ) years aft er t he occurrence of t he assured event. Under no circumst ances shall t his Policy be deemed t o provide cover and no liabilit y be incurred t o pay any claim or provide any II. III. IV. Page 6 of 8 benefit hereunder t o t he ext ent t hat t he provision of such cover, payment of such claim or provision of such benefit would expose t he Company t o any sanct ion, prohibit ion, or rest rict ion under Unit ed N at ions resolut ions or t he t rade or economic sanct ions, laws or regulat ions of t he European Union, Unit ed Kingdom or Unit ed St at es of America. The observance by t he credit card holders of t he t erms of t his policy and t he t rut h of t he st at ement s and t he answers by credit card holders in t he Underwrit ing Quest ionnaires and ot her mat erial informat ion provided by t he Insured M embers shall be condit ion precedent t o any liabilit y of t he Company. If t he circumst ances in which t he insurance cont ract was ent ered int o by mat erially alt ering any informat ion or wit hout t he writ t en consent of t he Company, t he policy shall become null and void. This clause is only applicable t o loans exceeding t he Free Cover Limit. V. Any false declarat ion, non-disclosure or misrepresent at ion made by t he insured member in t he medical quest ionnaire shall render his cover null & void. VI. The Company shall have t he r ight t o r equir e sat isfact or y evidence of age befor e any benefit is paid in r espect of any claimant under t his policy. If it shall be est ablished t hat at t he t ime t he Cr edit Car dholder fir st became insur ed her eunder his age was under st at ed, t he liabilit y of t he Company shall be limit ed t o a r et ur n of t he pr emium paid in r espect of t hat Car dholder. N o Benefit s shall be paid in r espect of a Car dholder who at t ains t he M aximum Cover age Age specified in t he schedule of t his policy (at which t ime t hat Car dholder shall cease t o be cover ed). All monet ar y amount s specified in t his policy ar e expr essed in t he cur r ency of t he Unit ed Ar ab Emir at es, r efer r ed t o her ein as UAE Dir ham. The Insur ed M ember / Car dholder shall fur nish t he Company wit h any infor mat ion t he Company may r equir e (including det ails of t he st at e of healt h) in r espect of t he Car dholder for t he benefit s her eunder. The Company may, at it s sole discr et ion, r equir e t he Car dholder t o under go a medical examinat ion by a legally qualified medical pr act it ioner in t he manner t he Company deems r equir ed or fit. IX. N o Benefit s shall be paid in r espect of a Car dholder who at t ains t he M aximum Cover age Age. X. If any claim under t his Cover is in any way fr audulent or unfounded, all benefit s under t his Cover shall be for feit ed in r espect of t he par t icular car dholder. VII. VIII.

7 XI. XII. The maximum cumulat ive amount of benefit s payable under t his cover shall not exceed t he amount ment ioned her ein ir r espect ive of t he number of policies in for ce or number of cr edit car d facilit ies in r espect of which t he car dholder has obt ained a similar benefit as pr ovided her ein. If any claim or declarat ion shall in any way respect be false or fr audulent means or devices are used by t he user or anyone act ing on his/ her behalf t o assert right s t o benefit. All benefit and premium shall in such case be forfeit ed. Telephone : / Fax N o: You may cont act Abu Dhabi N at ional Insur ance Company (ADN IC) at t he t oll fr ee no /,or send an t o Consumer [email protected] Insur ed M ember or Insur ed M ember s r epr esent at ive will cont act ADN IC and submit all t he applicable claim document s as advised by ADN IC s claim depar t ment. GEN ERAL CLAIM S PROCEDURE Special condit ions applicable t o Passive W ar Risk Rider Passive W ar / Passive Ter r or ism r isk is cover ed for Deat h by any cause, Per manent Tot al Disabilit y (Accident ) benefit s pr ovided t he Insur ed M ember is a non-par t icipant and is an innocent by-st ander subject t o exclusions of any claims as a r esult of N uclear W eapons or Device or chemical or biological agent s. Passive W ar Cover is excluded in a) Ir aq, Afghanist an, Libya, and any ot her count r y wher e war or war like oper at ion t akes place; b) W her e a Insur ed member r emains in a count r y for mor e t han 2 8 days following an out br eak of war in t hat count r y; and c) W her e a member is t r avelling t o or visit ing a count r y aft er war has been declar ed in t hat count r y or aft er it has been r ecognized as a war zone by t he Unit ed N at ions or wher e t her e ar e war likes oper at ions. Cover age is not pr ovided t o Insur ed member s in Ir an,ir aq, Afghanist an, Libya, Syr ia and any ot her count r y wher e war or war like oper at ion t akes place unless pr ior accept ance has been obt ained fr om t he company. How t o Claim Upon happening of an event giving r ise t o a claim under t his policy, t he Insur ed M ember / Insur ed M ember s legal r epr esent at ive(s) shall give immediat e wr it t en not ice t o t he Company but not lat er t han 9 0 days fr om t he dat e of event. Any and all communicat ions r elat ed t o a claim should be addr essed t o t he following addr ess, mar ked t o t he at t ent ion of ADN IC s Claims Depar t ment : Abu Dhabi N at ional Insurance Company P. O. Box: 8 3 9, Abu Dhabi, Unit ed Ar ab Emir at es. Page 7 of 8 I. W r it t en not ice of accident / deat h/ injur y/ illness which could r esult in a claim being made under t he Policy must be given t o ADN IC immediat ely. Such not ificat ion, apar t fr om st at ing name of t he insur ed member in r espect of whom t he claim is r epor t ed, should pr ovide basic det ails including dat e of deat h/ accident / sickness and t he t ype of benefit claimed. II. Upon r eceipt of Claim N ot ificat ion, ADN IC shall: Regist er t he claim and allocat e a claim number, t o be quot ed in all subsequent communicat ions r elat ing t o t hat claim. Advice t he claim number t o t he Insur ed and r equest document at ion consider ed necessar y and r easonable for pr ocessing of t he claim. III. Upon r eceipt of t he above, t he cor r esponding Claim For m complet e in all r espect s shall be submit t ed t o ADN IC t oget her wit h all suppor t ing document s r equest ed. IV. Upon r eceipt of t he document ed claim fr om t he Insur ed, ADN IC shall advise any fur t her document at ion r equir ed t o subst ant iat e t he claim or pr ocess t he claim for set t lement. V. For all valid claims payable in accor dance wit h t he t er ms and condit ions of t he Policy, t he Dischar ge Receipt would be issued wit hin t went y one (2 1 ) wor king days of r eceipt by ADN IC of all necessar y suppor t ing document s. VI. Set t lement of t he claim would be effect ed t o wit hin t went y one (2 1 ) wor king days of r eceipt by ADN IC of t he duly signed and st amped Dischar ge Receipt. DOCUM EN TATION CHECKLIST Deat h Claims: i. Claim For m duly complet ed and signed by aut hor ized signat or y ii. Accident Repor t of t he Employer concer ned (in case of Accident )

8 iii. Deat h Cer t ificat e (in or iginal). In case of deat h t aking place out side U.A.E., such or iginal Deat h cer t ificat e issued abr oad should be at t est ed by U.A.E. aut hor it ies concer ned iv. Post M or t em Repor t (wher ever r equir ed) v. Police Repor t if deat h due t o accident / Road Tr affic Accident vi. M edical Repor t fr om a hospit al wit h a det ailed diagnosis, hist or y of illness (if nat ur al deat h) and cause of deat h, if t he same is not clear ly ment ioned in deat h cer t ificat e. vii. Copy of Passpor t of t he employee including visa page viii. Any ot her document found necessar y i. Claim For m duly complet ed and signed by aut hor ized signat or y ii. Accident Repor t of t he Employer concer ned (in case of Accident ) iii. M edical Repor t (in or iginal) confir ming exact degr ee of per manent disabilit y issued by t he M edical Boar d iv. Police Repor t if disabilit y is as a r esult of accident / Road Tr affic Accident v. M edical Repor t fr om a Hospit al wit h a det ailed diagnosis, hist or y of illness (if disabilit y due t o sickness) and cause of disabilit y vi. Copy of Passpor t of t he employee including visa page vii. Any ot her document found necessar y Permanent Tot al Disabilit y/ Temporary Tot al Disabilit y Claims (due t o Accident / Sickness) Page 8 of 8