Corporate Travel Insurance

Transcription

1 Corporate Travel Insurance American Express Corporate Card Effective 1 October 2014

2 As an American Express Corporate Card member you are entitled to automatic travel insurance for both local and international travel when you purchase your travel ticket(s) on your American Express Corporate Card. This insurance has been specifically designed for you, to protect you wherever you travel. You can buy optional topup insurance in addition to the automatic travel insurance. Automatic travel insurance Type of cover required Optional topup cover Period of travel 1 0 days 1 90days days Mandate 1 90 days Period of travel Option 1 R R445 R600 R1 67 R420 Option 1 R Option 2 R R490 R652 R1 499 R462 Option 2 R Option R R542 R709 R1 65 R511 Option R The automatic travel insurance has been designed to protect Cardmembers against unforeseen medical expenses that could be incurred while they are traveling abroad. This insurance applies to unexpected illness or injury. In addition, the automatic travel insurance provides personal-accident cover (for death or disability). By purchasing your travel ticket(s) on your American Express Corporate Card, you will automatically qualify for the automatic travel insurance. Cover for preexisting medical conditions Senior travellers aged between 75 and days 1 90days days Mandate 1 90 days Period of travel 1 0 days 1 90days Mandate 1 90 days R950 R1 279 R 290 R896 Option 1 R R8 R1 148 R786 R1 19 R1 595 R 80 R1 125 R1 608 R2 15 R4 447 R1 517 s, such as the 24-hour emergency medical helpline and replacement of lost travel documents, are also included in the automatic travel insurance. Optional topup cover There are certain events that are not covered under the automatic travel insurance, which is why American Express has optional topup insurance to complement the automatic travel insurance. The inconvenience, not to mention the financial loss, of being uninsured for these events can severely hamper a business trip abroad. The optional topup cover provides additional benefits to cater for your travel insurance needs. These benefits include additional cover for emergency medical expenses and personalaccident cover. The benefits of the optional topup cover are listed below under What cover do I get on my Card?. Mandate insurance option The mandate insurance option is a convenient way of ensuring comprehensive travel protection every time you travel. If you pre-register for the mandate option, we will automatically collect a topup premium each time a travel ticket is purchased on the Corporate Card. You enjoy added convenience, as you don t need to phone us to arrange for cover every time an employee travels. Once the preregistration has taken place, a debit topup is processed automatically. The mandate option conveniently provides 90 days worth of additional cover at a price less than that of a 0-day topup policy. Please call us on or complete the form to preregister. Which topup cover options are available? Arrange of topup cover options are available for your travel insurance needs. page 1

3 What cover do I get on my Card? Each Corporate Card is unique and is therefore designed to Maximum claim values single premium Corporate Gold Card Corporate Green Card Corporate Purchasing Card Business Travel Account (BTA) provide unique cover. There are slight differences in the cover for each card, which are highlighted in the table below: Standard automatic cover Domestic International R R R R Automatic cover Benefits provided under automatic cover Emergency medical and related expenses s Personal accident Baggage loss Baggage delay Travel, missed connection Ticket upgrade Home guard Hijack Corporate Gold Card Corporate Green Card Corporate Purchasing Card Business Travel Account (BTA) Option 1 optional cover Option 2 optional cover Option optional Domestic International R R R Domestic International R R Domestic Benefit provided under optional topup Corporate Gold Card Corporate Green Card Corporate Purchasing Card Business Travel Account (BTA) cover International R R R Optional topup cover Emergency medical and related expenses Legal assistance abroad Hospital cash benefit Alternative employee or resumption of assignment Personal accident Cancellation or curtailment Baggage loss Included in automatic Baggage delay Included in automatic Travel delay Travel, missed connection Included in automatic Ticket upgrade Included in automatic Natural disaster Loss of cash or travel documents See the schedules of benefits in this brochure for more detailed information. What is the maximum claim value that AIG South Africa would pay on a single premium for optional topup cover purchased? Each Card has a maximum accumulation limit for domestic and international travel. This limit is the maximum amount that Travel Guard will pay under any policy purchased. For more information on the cover available please refer to the schedules of benefits in this brochure visit our website at americanexpress.co.za or call us on to discuss the terms and conditions that apply. You can also Important Please note that this brochure is only a summary and that the provision of the insurance services and benefits is always subject to the terms, conditions and exclusions of the master policy, which can be viewed at any of our branches or on our website at americanexpress.co.za. A copy of the master policy may also be obtained from the Travel Guard Sales and Service Call Centre on Alternatively, you may fax a request for them to page 2

4 Schedule of benefits 2014/2015 Effective 1 October 2014 AUTOMATIC COVER (trips up to 0 days) CORPORATE GOLD CARD CORPORATE GREEN CARD CORPORATE PURCHASING CARD BUSINESS TRAVEL ACCOUNT (BTA) CARD Age limit* Up to and including 75 years Domestic International Domestic International Domestic International SECTION 1 EMERGENCY MEDICAL RELATED EXPENSES AND ASSISTANCE 1A Emergency medical and related expenses Injury Illness Excess in-patient Excess out-patients Burial, cremation or return of mortal remains Coffin expenses Return of travel companion Return of children Visit by a family member 1B AIG Assist Travel guard cash assistance Consular referral Emergency travel and accommodation arrangements Legal assistance abroad 24-Hour medical emergency and assistance telephone line Replacement of lost travel documents Transmission of urgent messages 1C Medical evacuation, repatriation or transportation SECTION 2 PERSONAL ACCIDENT Public conveyance 24-hour cover SECTION 4 BAGGAGE LOSS excess Loss, theft, damage to baggage or personal effects Maximum Insured value of any one item SECTION 5 BAGGAGE DELAY 24-hour excess SECTION 6 TRAVEL DELAY AND MISSED CONNECTION 6B Travel missed connection (6-hour excess) SECTION 7 TICKET UPGRADE SECTION 10 HOME GUARD Crime guard protection (up to 0 days) Home care SECTION 12 HIJACK PUBLIC CONVEYANCE 12-hour excess R750 per day for up to 10 days R R R R R R R4 000 R100 per day R100 per day 2 hours + callout 2 hours + callout R R R R100 per day 2 hours + callout R R R100 per day 2 hours + callout R R R R R R * Clients under the age of 75 years qualify for automatic cover and our optional topup insurance. page

5 Schedule of benefits 2014/2015 Effective 1 October 2014 OPTIONAL COVER (IN ADDITION TO AUTOMATIC COVER) CORPORATE GOLD CARD, CORPORATE GREEN CARD AND CORPORATE PURCHASING CARD AND BTA CARD Option 1 Option 2 Option Domestic International Domestic International Domestic International Age limit* Premium per trip 10 days Premium per trip 190 days Premium per trip 1180 days Premium per trip mandate (1 90 days) Up to 75 years R445 R600 R1 67 R420 Up to 75 years R490 R652 R1 499 R462 Up to 75 years R542 R709 R1 65 R511 SECTION 1: EMERGENCY MEDICAL AND RELATED EXPENSES AND ASSISTANCE 1A: Additional emergency medical and related expenses and assistance injury or illness Emergency medical expenses due to terrorism Excess: In-patient Excess: Out-patient 1B: Legal assistance abroad 1D: Hospital confinement as a result of an accident or illness for a period not exceeding 20 days 1E: Alternative employee or resumption of assignment expenses SECTION 2: PERSONAL ACCIDENT Public conveyance 24-hour cover Terrorism extension SECTION : CANCELLATION AND CURTAILMENT ( excess) A: Cancellation of journey B: Curtailment of journey SECTION 4: BAGGAGE LOSS ( excess) Loss or theft of or damage to baggage or personal effects Maximum insured value of any one item Loss of cash/travel documents SECTION 5: BAGGAGE DELAY (in excess of 24 hours) SECTION 6: TRAVEL DELAY AND MISSED CONNECTION 6A: Travel delay 6B: Travel, missed connection SECTION 7: TICKET UPGRADE (in excess of six hours) SECTION 8: NATURAL DISASTER (in excess of 48 hours) SECTION 9: PERSONAL LIABILITY Bodily injury and material damage SECTION 10 HOME GUARD Crime guard protection (up to 0 days) Home care SECTION 12: HIJACK PUBLIC CONVEYANCE (in excess of 12 hours) R750 per day for up to 10 days R R R5 000* * * * 000 R100 per day 2 hours + callout R R R5 000 R R R * * * * 000 R100 per day 2 hours + callout R R R * * * * 000 R100 per day 2 hours + callout R R5 000 R R R R R R R15 000* * R 000* * R4 000* 000 R100 per day 2 hours + callout R R R * * * * 000 R R5 000 R5 000 R R R R R R20 000* * R 000* R 500* * R4 000* 000 MAXIMUM ACCUMULATION LIMIT R R R R R R * These benefits are provided under the automatic cover for the Corporate Gold Card. ** This benefit is provided under the automatic cover for the Corporate Gold Card and Corporate Green Card. ** It is provided under Option of the optional topup cover for the BTA Card. page 4

6 Schedule of benefits 2014/2015 Effective 1 October 2014 PREEXISTING CONDITIONS COVER (IN ADDITION TO AUTOMATIC AND OPTIONAL COVER)* Age limit CORPORATE GOLD CARD, CORPORATE GREEN CARD, CORPORATE PURCHASING CARD AND BTA CARD Option 1 Option 2 Option Domestic International Domestic International Domestic International Up to 75 years Premium per trip 10 days Premium per trip 190 days Premium per trip 1180 days Premium per trip for mandate insurance (190 days) A preexisting condition is any medical condition for which an insured person has received treatment or advice or a recommendation for treatment at any time before the commencement of a journey. The insured person must be hospitalised as an in-patient, following medical advice, for more than 48 hours. R950 R1 279 R 290 R896 R R1 19 R1 595 R 80 R1 125 R R1 608 R2 15 R4 447 R1 517 R SENIORS COVER Age limit * Automatic and optional cover Premium per trip 10 days Premium per trip 190 days Premium per trip for mandate insurance (190 days) SECTION 1: EMERGENCY MEDICAL AND RELATED EXPENSES AND ASSISTANCE 1A: Emergency medical and related expenses and assistance injury or illness Emergency medical expenses due to terrorism Excess: In-patient Excess: Out-patient Return of mortal remains Coffin expenses Return of travel companion Return of children Visit by a family member 1B AIG Assist Travel guard cash assistance Consular referral Emergency travel and accommodation arrangements Legal assistance abroad 24-Hour medical emergency and assistance telephone line Replacement of lost travel documents Transmission of urgent messages 1C: Medical evacuation, repatriation or transportation SECTION : CANCELLATION OR CURTAILMENT ( excess) A: Cancellation of journey B: Curtailment of journey SECTION 4: BAGGAGE LOSS ( excess) Loss or theft of or damage to baggage or personal effects Maximum insured value of any one item Loss of cash/travel documents SECTION 5: BAGGAGE DELAY (in excess of 24 hours) SECTION 6: TRAVEL DELAY AND MISSED CONNECTION 6A: Travel delay incurred expenses up to an amount of (in excess of 24 hours) SECTION 8: NATURAL DISASTER (in excess of 48 hours) SECTION 9: PERSONAL LIABILITY Bodily injury and material damage SECTION 10: HIJACK PUBLIC CONVEYANCE (in excess of 12 hours) R750 per day for up to 10 days CORPORATE GOLD CARD, CORPORATE GREEN CARD, CORPORATE PURCHASING CARD AND BTA CARD Domestic R years R8 R1 148 R786 International R R MAXIMUM ACCUMULATION LIMIT (SENIORS COVER) R R Clients under the age of 75 years qualify for automatic cover, optional topup cover and for preexisting conditions. page 5

7 Notes to schedules The benefit of the optional topup cover are in addition to the benefits of the automatic cover. Cardmembers aged 75 to 84 years do not qualify for automatic cover and must purchase seniors cover. Except for seniors, an extended period of insurance from 90 days to 180 days can be purchased. Cover for preexistingmedicalconditions is not available for persons aged 75 years and over. The excess for in-patient claim is waived if the optional topup cover is selected. Premiums include 10% commission and a R5 policy administration fee if a sale is concluded through the call center. Mandate premiums include 20% commission and a R5 policy administration fee if a sale is concluded through the call center. Premiums include 20% commission and a R5 policy administration fee if a sale is concluded through a travel agency. What is covered? Emergency medical and related expenses Medical expenses (in-patient and out-patient). Medical evacuation, repatriation and transport to a medical center. Return after medical treatment. Visit by a family member if you are hospitalised. Return of accompanying child/children and/or travel companion (if insured by Travel Guard). Return of mortal remains. Coffin expenses. Personal accident Death and permanent disability 24 hours a day and while on a public conveyance (up to and including 74 years old). Loss of unused, non-refundable deposits due to the cancellation of the journey resulting from the following: Your unexpected death, illness or injury, or that of your spouse, your child/children, your business associate, a relative, travel companion or the person overseas with whom you intended to stay. The non-availability of the person who was intended to take care of your dependent or disabled children due to death, illness or injury. Cancellation or diversion of scheduled public transport services as a result of strikes or other industrial action. A traumatic event, involving medical advice, experienced by you, your spouse, your child/children, your business associate, relative or the person overseas with whom you intended to stay within 0 days of the date of departure and where travel is not advised. Loss or theft of travel documents. The termination of your employment for economic reasons within 0 days of departure (including retrenchment). Considerable damage to real estate owned by you, caused within 0 days of departure. Theft or complete immobilisation of your private vehicle at the moment of departure or towards the point of embarkation due to a traffic accident, fire or hijacking. Delay at the point of embarkation resulting from immobilisation of your private vehicle for more than one hour due to a traffic accident or circumstances beyond your control (force majeure) during the trip towards the place of embarkation or on arrival. Loss of unused, non-refundable deposits due to the curtailment of the journey resulting from the following: The unexpected death or imminent death of your spouse, your child/childn, a relative, your business associate, your travel companion or the person overseas with whom you intended to stay. Cancellation or diversion of scheduled public transport services as a result of strikes or other industrial action. Loss or theft of travel documents. page 6

8 Loss of baggage, personal effects, documents, money and credit cards: Accidental loss or, theft of or damage to your accompanying baggage and personal effects. Non-recoverable cost of replacing travel documents, airline tickets, credit cards and travelers cheques. Assistance with the advancement of funds should cash, banknotes, postal or money orders or other negotiable instruments be damaged, lost or stolen. Loss arising from the unauthorised use of travel documents, credit cards or travelers cheques as a result of fraud. Baggage delay resulting from: The carrier is delaying, misdirecting or misplacing your baggage. Travel delay resulting from: Loss or theft of travel documents. An accident involving the conveyance in which you had arranged to travel in, or were traveling in. Delay of a scheduled departure of a public conveyance due to industrial strikes other action adverse weather conditions; or mechanical and/or electrical breakdown of the conveyance in which the insured person had arranged an insured journey. Failure of the public transport services. Cover is provided for the activities listed below: Badminton, baseball, softball, basketball, cricket, handball, netball, squash, tennis, volleyball, water polo, canoeing (open water within territorial waters), sailing (leisure within territorial waters), fishing (from shore), fishing (at sea-recreational and within territorial waters), windsurfing, swimming in a pool, swimming in open water (within 100m of the shore), scuba-diving (as a licensed diver in waters less than 50m deep), snorkel ing, scuba-diving as an unlicensed diver and supervised, snowboarding/skiing on blue slopes, snowboarding/skiing on red slopes, 4x4 driving on the road, leisure cycling (for a distance less than 200 km), skateboarding, rollerblading, ice skating, field athletics, biathlon, cross country, powerlifting, fencing, ballet, dancing, gymnastics, mountaineering up Mount Kilimanjaro with an accredited guide and archery. (Cover under medical and related expenses is limited to 000.) Cover is provided for the activities listed below. Hockey, rugby, American football, soccer, speed boating, canoeing (less than 100 km/h), kayaking (white waters/ extreme), white-water rafting (white waters/extreme), supervised sailing, scuba-diving (as a licensed diver), scubadiving (as an unlicensed diver), surf skiing, surfing, wakeboarding, water-skiing, high diving, ice hockey, black and offpiste skiing, snowboarding, off road 4 x 4 driving, competitive cycling, BMX extreme, go-kart racing, mountain biking, quad biking, iron man, pentathlon, marathon, triathlon, martial arts (excluding kick-boxing), wrestling, elephant riding, horseback safari, dog sledding, horse riding, polo, gorge swimming, war games, bungee jumping, hiking/ trekking (on a clearly marked trail with a registered guide) and show jumping. (No cover is available under section 2 (Personal Accident). Natural disaster Unavailability of booked accommodation, due to fire, flood, earthquake or storm. Personal liability Accidental injury to another person. Accidental loss of or damage to another s property. page 7

9 s Cash assistance. Consular referrals. Emergency travel and accommodation services. 24-hour medical emergency and assistance telephone line. Transmission of urgent messages. Your premature return in the event of the death, illness or injury of your spouse, your child/children, a relative or your business associate. Legal assistance abroad. What is not covered? Travel Guard will not be liable to pay any benefit under a claim caused by or arising directly or indirectly from the following: War and terrorism (there is limited terrorism cover under optional cover). Nuclear, biological and chemical contamination. Engaging in occupational activities underground or requiring the use of explosives. Deliberate exposure to danger (except in an attempt to save a human life). Intentional self-inflicted injury, suicide or attempt thereat. Deliberate violation of criminal law. Travelling by air, except as a passenger on a legally licensed aircraft, or where the insured person is acting as part of the aircraft crew. Mental disorders. Pregnancy of or childbirth by the insured person (except for an unexpected medical complication or emergency occurring during the first 26 weeks of the pregnancy). Sexually transmitted diseases and the conditions thereof, regardless of how they are acquired or caused. Myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome and postviral fatigue syndrome and commonly referred to as yuppie flu. Non-adherence to medical advice. Being under the influence of alcohol, drugs or narcotics. Any preexisting medical condition, unless cover for preexisting conditions was purchased (terms and conditions apply). Any cardiac or cardiovascular or vascular or cerebrovascular illness or conditions or sequelae thereof or complications that, in the opinion of a medical practitioner appointed by the company, can reasonably be related thereto, if the insured person has received medical advice or treatment (including medication) for hypertension 12 months before the commencement of the insured journey. An insured person traveling against medical advice or to seek medical attention or advice or with a terminal condition that was diagnosed before the insured journey, or when the insured person is unfit to do so. Employment involving manual labour, unless the insured person is off-duty. Undertaking employment on a permanent or contract basis (not casual) other than while on a leisure trip. Participating in any sport as a professional player or participating in school sports. Any hazardous pursuits, sports or activities, such as hunting, boxing and kickboxing, motor sports, heli-skiing, tobogganing, bobsleighing, skydiving, flying and air sports. Consequential loss of any kind or financial loss and/or expenses not otherwise specifically covered. Any claim arising from the fact that the tour operator, airline or any other company, firm or person became insolvent, or is unable or unwilling to fulfill any part of its/his/her obligation to the insured person. The insured person s intention to emigrate. Being in the service of or on duty with or undergoing training with any military or police force, or any militia or paramilitary organisation. Any terrorist or member of a terrorist organisation, narcotics trafficker, or purveyor of nuclear, chemical or biological weapons. Traveling into or through Cuba or Iraq. Being a crewmember on a ship. Any search-and-rescue costs. page 8

10 Contact details Important information For more information on our travel insurance programme please contact us on You can also us at or visit our website at americanexpress.co.za. The Sales and Service Call Centre is open from Monday to Thursday from 08:00 to 18:00, on Fridays from 08:00 to 17:00 and on Saturdays from 08:00 to 1:00 (South African time), excluding public holidays. Medical claims For claims in respect of emergency medical and related expenses please contact the 24-hour alarm Centrex immediately on: Tel: Fax: +27 (0) Note: If your claim is not approved by Travel Guard, liability will be limited to for any one incident. Non-medical claims Other claim requests should be submitted on your return to South Africa. All original supporting documentation should be submitted to Travel Guard Claims, PO Box 198, Braamfontein, You may also contact us on or at: SA ShareCall: Tel: Fax: satravelclaims@travelguard.com The claims department is open from Monday to Friday between 08:15 and 16:0 (South African time), excluding public holidays (all calls are recorded). About Travel Guard Travel Guard is one of the world s leading providers of emergency assistance and offers a wide range of services through its wholly owned assistance centres located in Asia, Europe and the Americas. Its assistance centres operate around the clock and are staffed with multilingua, multicultural specialists and medical staff and a vast team of highly trained client service professionals. To complement its emergency medical service the company has units dedicated to the support of claims, security, travel, relocation and concierge services. Travel Guard helps leisure and business travelers the world over solve problems and manages risks. Its global reach, unparalleled service quality and proven operational capabilities give its clients and policyholders best-in-class client care. Travel Guard (UK) serves a client base resident throughout Europe, the Middle East, parts of Asia and, more recently, South Africa. Note: Clients who do not purchase their travel tickets on their Corporate Card will not qualify for the automatic cover or the optional topup cover. About the underwriter American Express Card travel insurance is underwritten by AIG South Africa Limited registration number 1962/00192/06. AIG South Africa Limited (AIG) is a financial services provider (FSP) in terms of the Financial Advisory and Intermediary Services Act, The AIG FSP number is page 9

11 The amount of commission paid to Nedbank Group Insurance Brokers (NGIB) for the sale of American Express Card travel insurance is 10% of the quoted premium and 20% on mandate travel insurance if a sale is concluded through the Travel Guard Sales and Service Call Centre. If a sale is concluded through the travel agency, 20% of the quoted premium is paid to the travel agent who made the booking. This premium includes a regulated commission payment to the agent and a fee paid to Travel Guard. About Nedbank Group Insurance Brokers Nedbank Group Insurance Brokers (NGIB) a division of Nedbank Limited, is a financial services provider with FSP number 96 in terms of the Financial Advisory and Intermediary Services Act, NGIB provides short-term insurance and holds professional and indemnity insurance. Recordings of telephonic discussions will be made available to you on request. For unresolved complaints the NGIB Compliance Department can be contacted on +27 (0) Complaints and dispute resolution We have developed an internal procedure for complaints and dispute resolution so that, if our products or services have not satisfied your expectations, you can contact our compliance officer on +27 (0) or at complaintssa@aig.com. Our complaints and dispute resolution procedure will ensure that your complaint is reviewed by management. You may access this procedure on our website ataig.com. If you are still not satisfied, you may take your complaint to the Short-term Insurance Ombudsman by calling +27 (0) or writing to PO Box 24, Braamfontein, Alternatively, you may contact the Financial Services Board on +27 (0) or at PO Box 5655, Menlo Park, American Express Cards is operated under licence in South Africa by Nedbank Limited Reg No 1951/000009/06. An authorised financial services and registered credit provider (NCRCP16). page 10

12 Application form for travel, mandate and optional topup travel insurance Yes, I have purchased my travel ticket(s) on my valid American Express Corporate Card issued in South African, and I qualify for the additional cover below. I feel that this cover meets my needs and I wish to take advantage of the exclusive benefits of the American Express corporate travel insurance for local and/or international travel. I acknowledge that the cover involved is described in this brochure and that I understand clearly. Please print clearly. Cardmember details First name Surname Company name Postal address Initials Title Code ID number Telephone (work) (home) Fax Cell address American Express Card number Expiry date Card type Corporate Gold Card Corporate Green Card BTA Card Purchasing Card Select insurance option By selecting the cover below you authorise AIG South Africa Ltd to bill you automatically for the selected cover. RATE TABLE FOR AMERICAN EXPRESS CORPORATE GREEN, CORPORATE GOLD, PURCHASING CARD AND BTA CARD STANDARD TOPUP OPTIONS (CLIENTS AGED UP TO 74 YEARS) Option 1 R Option 2 R Option R Trip no longer than 0 days R445 p/p for ticket(s) R490 p/p for ticket(s) R542 p/p for ticket(s) Trip no longer than 90 days R600 p/p for ticket(s) R652 p/p for ticket(s) R709 p/p for ticket(s) Trip no longer than 180 days R1 67 p/p for ticket(s) R1 499 p/p for ticket(s) R1 65 p/p for ticket(s) Mandate insurance trip no longer than 90 days R420 p/p for ticket(s) R462 p/p for ticket(s) R511 p/p for ticket(s) COVER FOR PREEXISTING MEDICAL CONDITIONS (FOR INTERNATIONAL JOURNEYS) Option 1 R Option 2 R Option R Trip no longer than 0 days R950 p/p for ticket(s) R1 19 p/p for ticket(s) R1 608 p/p for ticket(s) Trip no longer than 90 days R1 279 p/p for ticket(s) R1 595 p/p for ticket(s) R2 15 p/p for ticket(s) Trip no longer than 180 days R 290 p/p for ticket(s) R 80 p/p for ticket(s) R4 447 p/p for ticket(s) Mandate insurance trip no longer than 90 days R896 p/p for ticket(s) R1 125p/p for ticket(s) R1 517 p/p for ticket(s) SENIORS COVER (CLIENTS AGED 75 TO 85 YEARS) Option 1 R Trip no longer than 0 days R8 p/p for ticket(s) Trip no longer than 90 days R1 148 p/p for ticket(s) Trip no longer than 180 days to senior clients Mandate insurance trip no longer than 90 days R786 p/p for ticket(s) Traveller s details Full name Passport number Date of birth Departure date Return date Yes, please debit me for the cover I have selected. If I have selected the mandate insurance option, please debit me every time I purchase a public conveyance ticket using my American Express Corporate Card (debit includes 20% commission and a R5 policy administration fee). Please sign below Signature of Cardmember (where applicable) Full names of authorised business signatory Date D D M M Y Y Y Y Signature This brochure has been developed for marketing purposes only and the provision of the insurance and services is always subject to the terms, conditions,exclusions and traveller s obligations more specifically detailed in the master policy, which is reviewed and updated annually basis. The master policy is available from the Travel Guard Sales and Service Call Centre on or can be viewed at americanexpress.co.za. Date D D M M Y Y Y Y 1985 Remember to return this application immediately after completion to activate your cover option. Fax it to AIG Travel on or mail to PO Box 62, Fontainebleau, 202.