Smart Travel Insurance Holiday Accommodation



Similar documents
Golden Travel Insurance - Temporary travel insurance

INSURANCE POLICY FOR FREELANCE JOURNALISTS AND PHOTOGRAPHERS ON ASSIGNMENT

TERMS AND CONDITIONS FOR GOLDEN CARD CARRIERS - CONFORT -

Extract of the EUROPÄISCHE Travel Insurance Terms and Conditions for the Hotel Industry 2005 (ERV-RVB Hotellerie 2005) for Hotelstorno Plus

TERMS AND CONDITIONS FOR BUSINESS CARDHOLDERS VISA BUSINESS -BUSINESS CLASS-

SPECIAL TERMS AND CONDITIONS CANCELLATION

Upgraded coverage with natural disaster and re-route expenses cover

UnitedHealthcare Global Travel Assistance for Liberty Mutual Insurance Program Description

CONTENTS 1. PRIOR TO TRAVEL 2. PERSONAL ACCIDENT/TRAVEL INSURANCE 3. RESTRICTIONS TO TRAVEL FOREIGN OFFICE 4. INSURERS DETAILS AND POLICY NUMBER

UK and European breakdown cover

Westpac Rewards Credit Cards Emergency Travel Assistance.

MEDICAL ASSISTANCE AND EVACUATION MEDICAL SERVICE COLLEGIATE PROGRAM DESCRIPTION

Safely around the world. 365 days cover for your leisure and travel. Worldwide, including Switzerland!

University Business Travel Insurance

Emergency Medical Assistance Service. Expatriate Employee Certificate 1. Group #9061

Standard Insurance Company Emergency Medical Assistance Service Employee Certificate Group #9061

DAN TravelAssist EMERGENCY EVACUATION BENEFIT

Car insurance policy summary. What if I want to cancel? Who provides the cover? Types of cover. Complaints. Making a claim. 1 of 6

Contents. Global Family Insurance 3. Why choose Expat & Co? 4. 5 modules, 2 options 5. Individual Modules 6-8. Options 9

Frequently Asked Questions on Travel and Medical Insurance (World Elite MasterCard Credit Card)

PLUS PROGRAM ASSISTANCE PROGRAM DESCRIPTION

How To Get A Home Insurance Policy In Australia

Swedish State Group Insurance and Personal Insurance (GIF)

URA Insurance. Terms and Conditions of Insurance, 1 July [Title 3]

SGIO Comprehensive Plus Motor Insurance Premium, Excess, Discounts and Helpline Benefits Guide WA

Member Handbook. Mature Membership. This Handbook helps Members fully understand the benefits and limitations of the On Call

Policy & Procedures:... Travel Insurance Cover Note... 5 Appendix 1: Form FT Appendix 2: Form FT Appendix 3: Form FT3...

GENERAL CONDITIONS INCOMING INSURANCE

Leisure Travel Insurance Application. Underwritten by

Optima Plus Car Insurance

On Call International

GLOBAL EMERGENCY SERVICES

International Student and Scholar, Visitor Travel Assistance Services Including: Medical Evacuation and Repatriation Coverage 24 Hour Assistance

All paid up members and voluntary workers of Bicycle QLD.

Policy Summary: Key Information You the Customer need to be aware of

The Swedish State s Erasmus Mundus Insurance

POLICY SUMMARY. Flybe Travel Insurance

Member Handbook. Basic Membership. This Handbook helps Members fully understand the benefits and limitations of the On Call

KEELE UNIVERSITY STAFF TRAVEL INSURANCE

Here is your FrontierMEDEX ID Card

Gouda Expatriate Policy Coverage overview

Angus Council School Journey Policy Summary of Cover

Westpac Holiday Travel Insurance Product Disclosure Statement. Premium, excess and claims guide


NRMA Comprehensive Plus Motor Insurance Premium, Excess, Discounts and Helpline Benefits Guide NSW

Insurance Coverage and Limit of Responsibility. Policy

Van Insurance Summary of cover

QUEST - QBE COMPREHENSIVE MOTOR INSURANCE MASTER POLICY

NRMA Motor Insurance Premium, Excess, Discounts & Helpline Benefits NSW, QLD, ACT & TAS

Saga Annual Multi-trip Travel Insurance

24-Hour Emergency & Travel Assistance Services

Student Travel Insurance

TRAVEL INSURANCE - Claim Procedure

OVERSEAS TRAVEL STUDENTS 2015/2016 INSURANCE INFORMATION

Distribution Guide and General Conditions For your Travel Insurance contract

membership For good sam travelassist

Student Travel Insurance

Business Insurance Personal accident section

Travel Guard International Coverage Summary

INSURANCE CONDITIONS MASTERCARD CORPORATE CLASSIC

Tenancy regulations furnished accommodation. November 2014

ING Lion Travel Stop. General Terms and Conditions Temporary contract.

Emergency Travel Insurance for Short-Term Trips

*The services listed above are subject to a maximum combined single limit of $100,000.

COMPLETE INFORMATION ON INSURANCE

Frontier Travel. Booking Conditions

Group Life. Travel Assistance. Protection You Can Take With You. If I need assistance while I m traveling at any time, from anywhere.

Optima private car insurance

Travel Insurance Insurance Conditions No

See page 2 for. a quick summary. Motor Insurance. Cars & Motorcycles Product Disclosure Statement and Policy Booklet (PDS)

VOYAGE ASSISTANCE TRAVEL COVERAGE THAT NEVER TAKES A HOLIDAY

Group II Benefits. Rescue Transportation Expenses. Return Transportation Costs in Event of Death Insured amount 15,000

The right cover for your individual circumstances

See page 2 for. a quick summary. Motor Insurance. Cars & Motorcycles Product Disclosure Statement and Policy Booklet (PDS)

UNIVERSITY OF MINNESOTA EMERGENCY ASSISTANCE PROGRAM

MEDICAL & SECURITY ASSISTANCE AND EVACUATION ACCESS PROGRAM DESCRIPTION

JetProtect Overseas Travel Claim Form

The Swedish State s Insurance for Foreign Students in Sweden

Universal Travel Insurance

Frequently Asked Questions (FAQ) Below are some commonly asked questions. If you have a question that is not answered below then please contact us.

BE MINI. MINI ROADSIDE ASSISTANCE & ACCIDENT MANAGEMENT.

VISA Silver Card, KEA Card and Student Card

Travel Assistance. Security That Travels With You. Standard Insurance Company. Travel Assistance

The Company will take no responsibility for any situation derived from the medical assistance provided by the doctors or the medical institutions.

B. Accident insurance for employees. 8. Accident concept

PERSONAL INSURANCE FOR INDIVIDUALS INSURANCE GOOD AND PROPER

Travel Assistance Program

Optima Car Insurance. Policy Summary

VUB has made health insurance compulsory for its students and scholars. It is not possible to register at the VUB without a medical insurance.

Answers to some frequently asked questions THE YOUTH FOR EUROPE GROUP INSURANCE PLAN

MOTOR INSURANCE PREMIUM, EXCESS, DISCOUNTS & HELPLINE BENEFITS GUIDE

LAW ON COMPULSORY TRAFFIC INSURANCE

VISA Almennt and e-card

PREMIUM GLOBAL ASSIST HOTLINE 1

QUÉBEC TRAVEL INSURANCE

The USAway International Major Medical Plan

You are well insured for your trip with cancellation insurance from the Europeesche. Below are a few tips and recommendations for when you travel.

METROPOLITAN LIFE INSURANCE COMPANY NEW YORK, NEW YORK

Motor Insurance. Aussie Assist Benefits Guide

MANDATORY VEHICLE INSURANCE Terms and conditions No. 500

Transcription:

DE EUROPESE GOEDEREN EN REISBAGAGE VERZEKERINGSMAATSCHAPPIJ N.V COMPAGNIE EUROPEENNE D ASSURANCE DES MARCHANDISES ET BAGAGES SA Rue Des Deux Eglises 14 Tweekerkenstraat B-1000 BRUSSELS Tel. 02/220 34 11 Fax. 02/ 218.77.62 Email. travel@europese.be travel@europeenne.be EUROPESE Smart Travel Insurance Holiday Accommodation Insurance Terms and Conditions (REF 0420-STHAEN-010114) Smart Travel Insurance_Holiday Accommodation_General Conditions_EN_12.03.14 FOREWORD Smart Travel Insurance Holiday Accommodation is the short-term online all-in-one insurance from The European. Temporary travel insurance, for holiday renters of vacation houses, apartments, bungalows or other holiday accommodations at home or abroad. It bundles in one package cover for personal assistance, cancellation, holiday interruption and baggage insurance. You can also add optional assistance for your car. COMMON PROVISIONS The following provisions are applicable to the entire insurance contract. 1. DEFINITIONS - Policy holder: The physical or moral person who signs the insurance contract on his/her own account or on behalf of a different person specifically named in the policy. - Insurer:DE EUROPESE GOEDEREN EN REISBAGAGE VERZEKERINGSMAAT- SCHAPPIJ NV, hereinafter called The European, enterprise registered under code number 0420, with registered office in 1000 Brussels Rue des deux Eglises/ Tweekerkenstraat 14. - Insured person: the physical person indicated in the insurance contract and who benefits from cover. - First- or second-degree family members: parents and parents-in-law, grandparents, children, grandchildren, brothers(-in-law) and sisters(-in-law). 2. CREATION OF THE INSURANCE CONTRACT - The insurance contract is created when it has been signed by the policy holder and after acceptance by the insurer. - The insurance contract must be created before the trip s departure date: in relation to insurance for cancellation costs, no later than 15 days after booking the trip, and for flight or train tickets only, no later than the issue date of the tickets. - For insurance contracts with a duration of more than 30 days, the parties have the right to cancel the insurance contract, by registered letter, within 30 days of entering into the insurance contract. Cancellation by the policy holder takes effect immediately. Cancellation by the insurer takes effect only eight days after notification. 3. START AND DURATION OF THE INSURANCE CONTRACT The insurance contract is concluded for the duration indicated in the policy, with a minimum duration equal to the full duration of the trip. The start date of the insurance contract is equal to the date of the contract being signed, subject to payment of the premium. 4. VALIDITY OF COVER - Cover is provided to the insured persons who are resident in Belgium. - Cover is also provided to insured persons residing in an EU member state or Switzerland, only if the trip was organised or sold through a tour operator or travel agency operating in Belgium or the Grand Duchy of Luxembourg. 5. DURATION OF COVER - Cover is provided for the period indicated in the policy and commences as soon as the insured departs his/her place of residence and continues until his/her return to the place of residence. - Cover is limited to a maximum of 120 days of consecutive days of a stay abroad. - Cover for the cancellation cost insurance is valid during the period indicated in the policy, and commences upon the signing of the insurance contract and continues through until the end of the trip. 6. GEOGRAPHICAL COVER Cover is valid, according to what is stated in the policy: - either in Europe (including Turkey, Morocco, Tunisia, Egypt, Israel, the Canary Islands, the Azores, Madeira and Iceland); - or worldwide; - for the vehicles, cover is limited to the countries stated on the green card issued for the insured vehicle. However, for Turkey, cover is limited to the European part. 7. APPLICABLE LAW - TIME LIMITS - The insurance contract is governed by Belgian law. - Any claim arising from this insurance contract has a time limit of three years, to be calculated from the date of the event giving rise to the claim. 8. SUBROGATION The European automatically acquires the rights of the insured with regard to liable third parties up to the amount of its intervention, except for the amounts paid in the context of cover F. Physical accidents. 9.PLACE OF RESIDENCE The place of residence of the contracting parties is elected under the law: - for The European: at its registered office; - for the policy holder: at the address indicated in the policy. All correspondence with The European must be sent to its registered office in order to be valid. 10. MEDICAL EXPERTISE In the event of a physical accident or illness, The European can decide to perform a possible medical examination. The insured person will permit The European to view his/her medical file. 11. GENERAL EXCLUSIONS The European is not required to pay in the event of: a. intentional acts by the insured; b. suicide of the insured; c. excessive use of alcohol, or use of medicines or narcotics not prescribed by a physician; d. natural disasters, such as avalanches, falling stones, shifting rocks, shifting terrain, earthquake, pressure from snowdrifts, hail, high water, forest fire, flood, storm, hurricane and all other weather conditions; e. consequences of nuclear or atomic accidents or radiation; f. war, strike or revolt, as well as civil war or collective acts of violence, unless insured can show that there is no causal connection with the event causing damage; g. indirect costs. A. ASSISTANCE I. ASSISTANCE REGARDING THE INSURED PERSON ABROAD 1. UPON ILLNESS OR PHYSICAL ACCIDENT OF THE INSURED After receiving the call at its alarm centre, The European will immediately contact its medical team and the treating physician in order to make the necessary arrangements in line with the medical advice. If the physicians recommend repatriation, The European organises, completely at its own cost, the repatriation of the insured person to his/her place of residence or the local medical centre, or if necessary to a more appropriate medical centre via: a. air ambulance; b. scheduled flight; c. first class train, sleeping car or couchette; d. ambulance; e. another appropriate means of transport, taking into consideration the circumstances of the repatriation. The repatriation will be conducted under supervision of a physician and/or nurse, as required by the medical condition of the insured. The choice of the means of transport for repatriation and the medical centre is determined solely by the medical welfare of the insured, and will be determined by The European medical team s physician after consultation with the local treating physician. For countries outside Europe, the Mediterranean, the Canary Islands or Madeira, repatriation will only be provided via regular scheduled airline flights. 2. UPON DEATH OF THE INSURED The European reimburses and organises the following according to unanimous choice of the next of kin: - either the full transport costs of the body from the place of death abroad to the cemetery in Belgium, in an EU member state or Switzerland; - or the funeral costs at the location abroad as a result of death abroad up to a maximum of the amount for repatriation of the deceased. The European also reimburses: - the costs of post mortem treatment abroad; - the coffin abroad up to a maximum of 1.500. 3. MEDICAL COSTS AS A RESULT OF ILLNESS OR PHYSICAL ACCIDENT Upon illness or physical accident befalling an insured during the trip abroad, The European reimburses the following up to a total amount of 2.000.000 per insured: a. medical or paramedical fees; b. medicines, prescribed by the treating physician abroad; c. admission and treatment costs upon hospitalisation; d. local transport costs of the wounded or the ill to a medical centre prescribed by the treating physician; e. furthermore: 1. dental care abroad up to a maximum of 250, including urgent repair costs of the insured s dental prosthesis up to a maximum of 50; 2. hotel costs up to 65 per day for a maximum of ten days for the insured and the insured s accompanying partner or travel companion in relation to the extension of the stay on medical advice 3. extra hotel costs with regard to adjustment of hospitality level following medical advice, up to 25 per day for a maximum of ten days; 4. taxi costs for the partner or travel companion abroad in order to visit the insured in hospital. The European s payments are limited to a total of 100 for all insured persons; 5. reimbursement up to a maximum of 250 of costs abroad for contact lenses, glasses with corrective glasses or prostheses, after a physical accident abroad; 6. the costs for a one-time ambulance transport in Belgium to the medical centre that is located closest to the place of residence; 7. up to 12.500 of the costs for psychological assistance or treatment of the 1

insured abroad after a disaster, attack or kidnapping, of which the insured is the victim or direct witness. 7. up to 12.500 of the costs for psychological assistance or treatment of the insured abroad after a disaster, attack or kidnapping, of which the insured is the victim or direct witness. The European also reimburses, for insured persons resident in Belgium, up to 2.500 per insured of the medical and paramedical costs prescribed in Belgium for one year, insofar as they result from a physical accident occurring during the trip in Belgium or abroad. Payments for paramedical costs is limited to 500. This compensation does not apply to medical and/or paramedical costs prescribed in Belgium after illness. II. ADDITIONAL ASSISTANCE REGARDING THE INSURED PERSON ABROAD 1. INTERRUPTION OF THE TRIP AS A RESULT OF EARLY RETURN The European will organise and reimburse either the return trip of the insured and the insured s first and second degree family members, either the round trip by train (1 st class) or by scheduled flight (economy class) of one insured to his/her place of residence, as a result of: a. death, serious illness or physical accident of the insured s partner or a first or second degree family member of the insured; b. severe material damage to the insured s property (real estate), necessitating his/her presence; c. call-up to insured for an organ transplant on condition that he/she is registered in the Eurotransplant waiting list; d. urgent summons of insured by a Belgian court, which was not known or anticipated on the departure date. The European also reimburses the actual transport costs via train (1 st class) or scheduled flight (economy class) of the other travel companions of the insured who are dependent on the insured if they are unable to make the return trip with the planned transport arrangements on their own. 2. FAMILY ASSISTANCE In the event of hospitalisation of the insured abroad as a consequence of illness or physical accident, The European organises and reimburses: a. a round trip for one first or second degree family member by train (first class) or scheduled flight (economy class) in order to be with the insured, if the seriousness of the medical condition justifies this; b. a round trip by train (first class) or scheduled flight (economy class) of one family member or another person designated by the family in order to supervise and to accompany the insured s minor children who are included in the policy, during the return trip to their place of residence, provided he/she is in Belgium, the European Union or Switzerland, and provided they cannot make the journey on their own. The transport costs for the return trip of the insured s minor children are also included in cover. c. in addition: the local accommodation costs of the family member or other designated person are reimbursed up to a maximum of 625. 3. EXTRA RETURN COSTS In the event that The European proceeds with the repatriation of the insured to his/her place of residence or in the event of death of the insured abroad, The European pays the additional transport costs for the return trip by train (first class) or scheduled flight (economy class) to their place of residence, of the insured s family members and of the insured s travel companions who are dependent on the insured and are unable to make the return trip on their own using the means of transport originally scheduled. The European also reimburses the additional transport costs to the place of residence by train (first class) or scheduled flight (economy class) of the insured and of the insured s partner or travel companion, travelling with him/her, in the event the return trip that cannot commence on the scheduled date as a result of an extended stay on medical advice relating to the illness or physical accident of the insured. 4. MEDICAL ADVICE The The European medical team is available 24 hours per day to any insured person who wishes to obtain further information or medical advice relating to the country of destination in the context of a planned trip. 5. SENDING MEDICINES ABROAD In the event of illness abroad, The European provides the insured, after consultation with the medical team, with the essential medication prescribed by a physician if these are not available at the location but are available in Belgium. 6. COMMUNICATION OF URGENT MESSAGES If the insured calls on one of the assistance covers provided in the policy and he/ she wants to inform his/her family members or other people close by of this occurrence, The European will do what is necessary in order to get this message to those concerned. In no case can The European be held liable for the content of the message that is, in any case, subject to Belgian and international regulations. 7. LOSS OR THEFT OF BAGGAGE Upon loss or theft of the insured s baggage abroad, The European organises and pays for sending one suitcase with personal items to the insured s accommodation abroad. This suitcase must be delivered to The European s alarm centre by a family member or by a person designated by the insured. condition that the insured credits the value of the tickets in advance to The European s account. 9. BRINGING BACK PETS Domestic pets will be transported/repatriated if they would otherwise stay behind abroad as a result of an early and insured return home by all the insured persons. 1O. ASSISTANCE UPON HOSPITALISATION OF AN INSURED S CHILD IN BELGIUM The European organises and pays for the repatriation of all the insured persons up to the 2 nd degree family members, if an insured s child (maximum age 18) has to be hospitalised for a minimum of 48 hours. The European also arranges, at the insured s request and in consultation with its medical team, the hospitalisation and pays the transportation costs. The condition of the hospitalised person s health will be monitored by The European s medical team until the parent(s) are back at the place of residence. The hospitalisation costs will be borne by the insured. 11. MONEY ADVANCES ABROAD After The European has received the desired sum (maximum 3.750), it makes it available for the purpose of dealing with unforeseen and urgent expense abroad. 12. SEARCH AND RESCUE COSTS The European will reimburse justified costs incurred abroad, after consultation with, and approval from, its alarm centre, for hiring a search or rescue team in order to safeguard the life of the insured. 13. ASSISTANCE FROM LAWYER - CRIMINAL BAIL The European will make a cash advance for lawyer s fees abroad amounting to a maximum of 1.250 per insured for the defence of the insured s interests as a result of a road accident occurring abroad and insofar as the insured is not covered by legal assistance insurance in the context of car liability insurance. In the event of criminal bail imposed by the local authorities on the insured as a result of a road accident abroad, The European will make a cash advance for the bail amounting to up to 12.500 per insured. The bail must be repaid to The European by the insured within three months after return, or immediately if the bail is released by the local authorities before this time period. 14. TERRORISM - NATURAL DISASTERS EPIDEMICS Terrorism If the insured, due to a terrorist attack, recognised internationally as such, in the country of destination, is prevented from taking his/her return trip on the scheduled date, The European will reimburse the corresponding extra accommodation costs up to a maximum of 125 per day for a maximum of ten days. The European will also reimburse any rebooking fees if the insured is prevented from returning on the originally planned flight. The European will also reimburse, within the limits of the amount insured, the medical costs abroad of the injured insured and will organise, within the limits of the available possibilities, the repatriation of the injured. Natural disasters and epidemics If the insured, due to any of a natural disaster (avalanche, flood, forest fire, earthquake...) or epidemic, recognised as such by the WHO (World Health Organization), in the country of destination, is prevented from making his/her return trip on the scheduled date, The European will reimburse the corresponding extra accommodation costs up to a maximum of 125 per day for a maximum of ten days. The European will also reimburse any rebooking fees if the insured is prevented from returning on the originally planned flight. The European will also reimburse, within the limits of the insured amount, the medical costs abroad of the injured insured and will organise, within the limits of the available possibilities, the repatriation of the injured. The following, however, are always excluded: The consequences of terrorist attacks, natural disasters or epidemics, if in the country of destination, an incident, recognised internationally as such, occurred in the 30 days before booking the trip. 15. ENFORCED EXTENDED STAY If insured cannot return on the scheduled date from the foreign destination due to a general or local closing of airspace, owing to a natural disaster or exceptional weather conditions, even if these did not occur locally at the location abroad, The European will pay an amount of 65 per night, per person, for a maximum of five nights, of proven extra accommodation costs. This cover is only valid insofar as no payment is made by the airline company under an international agreement or EU regulation. The policy cover is also extended until the return to Belgium. III. ASSISTANCE REGARDING THE INSURED VEHICLE AND THE IN- SURED OCCUPANTS This cover can only be added as a supplement on payment of an additional premium. 1. FOR THE INSURED VEHICLE 8. LOSS OR THEFT OF TRAVEL DOCUMENTS ABROAD In the event of loss or theft of necessary travel documents (identity card, passport, driving licence,... ) of the insured abroad, The European reimburses the costs which arise abroad, for their replacement, on the condition that the insured completed all the necessary formalities abroad (reporting to the relevant authorities, police, embassy, consulate,... ).Upon loss or theft of tickets, The European provides, upon insured s request, the necessary replacement tickets to allow him/her to continue the trip, on DEFINITION OF VEHICLE The personal vehicle specified in the policy, registered in Belgium, intended for the transport of persons and of which the highest permitted weight is no greater than 3.5 T, with a maximum of eight seats, including the driver, as well as a towed caravan, or any other trailer. Motorcycles of more than 125cc are also insured. 2

In the event of the vehicle being immobilised en route as a result of a mechanical defect, damage due to accident, fire or theft, The European will reimburse: a. the towing costs of the vehicle to the nearest garage or the local transport costs to a car repair shop, amounting to 500; b. costs of sending spare parts that are essential for the proper operation of the vehicle and that cannot be found in that country. The cost price of the spare parts always remains at the expense of the insured, who commits to their repayment within 15 days after his/her return; c. the repatriation of the vehicle from abroad to the insured s place of residence or the local garage on condition that the vehicle cannot be repaired where it is within five working days. The costs charged to The European may not, in any event, exceed the actual value of the repatriated vehicle at the time of the call; d. parking/storage fees for the vehicle from the day of immobilisation up to the day of repatriation, as well as any toll costs for the insured vehicle; e. expert or bailiff fees up to 625 in order to protect the interests of the insured as a result of material damage to the vehicle due to a road accident abroad; f. in addition: expert fees up to 250 for the documentation of incorrect repair performed abroad on the vehicle. In the event of theft of the insured vehicle abroad: a. if the vehicle, after the return of the insured to his/her place of residence, is not recovered in a drivable condition, The European pays the costs of repatriation of the vehicle up to the limit of the actual value of the vehicle at the moment of the recovery; b. if the vehicle is recovered, after the return of the insured to his/her place of residence, in a drivable condition, The European will either arrange for a driver for the insured, or a train ticket (1 st class) or a ticket for a scheduled flight (economy class) for the purpose of recovering the vehicle. 2. FOR THE INSURED OCCUPANTS If the insured s vehicle is immobilised en route as a result of a mechanical defect, damage due to accident, fire or theft, The European will reimburse: a. in the event that the vehicle is repaired locally in expectation of continuing the trip, up to 250 per insured: 1. hotel costs or: 2. the costs of a taxi or rental car in order to reach the destination or the insured s place of residence. The costs for fuel, repair, tolls and taxes remain at the expense of the insured. b. in the event that the vehicle cannot be repaired within five working days and will be repatriated from abroad by The European or the car wreck is left behind at the site or upon theft of the vehicle; c. the return trip costs of the insured occupants to their place of residence by train (first class) or scheduled flight (economy class); d. if, as a result of illness or accident, the insured is no longer able to drive his/her vehicle, and no other occupant can replace him/her, The European will arrange to have a replacement driver available for the purpose of bringing the vehicle back to the place of residence in Belgium by the most direct route. The fuel, toll charges and taxes remain at the expense of the insured. IV. EXCLUSIONS a. Physical injuries as a result of accident, illness or chronic illness, for which, at the date of entering into the insurance contract, medical or paramedical treatment was necessary according to the treating physician and which entailed special complications during the trip. b. Psychological, psychosomatic, mental or nervous disorders, unless these demand urgent hospitalisation as a consequence of their initial manifestation. c. Voluntary interruption of pregnancy, childbirth and their procedures and consequences. d. Services relating to repatriation without approval from The European. e. Assistance in connection with minor conditions or injuries that can be treated on location and that do not prevent the insured from continuing his/her trip, except for the medical costs. f. Work performed by the insured insofar as exceptional labour or business risks are associated with it. g. Sports: 1. practising sports as a profession or for remuneration; 2. practising the following sports: skiing (alpine or cross-country), mountaineering, spelunking, bob-sleigh, skeleton, combat sports, underwater diving with autonomous breathing apparatus, ski jumping, bungy jumping, paragliding, hang gliding, jet-skiing, parachute jumping, snow scooter, big game hunting and motorsport; h. Air travel, unless as a paying passenger with a plane approved for public transport of travellers. i. Medical costs for: 1. thermal cures, preventive medicine; 2. aesthetic procedures or treatment (unless medically necessary as a result of physical injury); 3. treatments and medicines for illness prescribed in the insured s country of residence; 4. dental care in Belgium; 5. prostheses and medical material prescribed in Belgium. j. Vehicle: 1. normal maintenance costs; 2. costs for parts and repair; 3. running out of fuel; 4. apparent poor condition of the vehicle. k. All exclusions provided in the common provisions. V. OBLIGATIONS OF THE INSURED The insured is required to: a. immediately inform the The European alarm centre, to comply with their instructions and to provide its medical team with all the information and/or documents that they consider necessary or useful; b. upon urgent hospitalisation abroad, the insured is required to take the necessary steps, upon his/her return in Belgium in order to obtain the compensation legally due from his/her health insurance fund and/or other health insurance and to transfer this to The European if the latter has already paid the medical costs. The medical costs paid by the insured abroad will be paid by The European after payments by the health insurance fund and/or any other insurer. The medical and hospitalisation costs in Belgium, as a result of a physical accident occurring in Belgium or abroad, will be paid by The European after payments by the social security and/or any other insurer. If the insured is not correctly insured with the social security and/or any other insurer, or does not comply with the requirements of these organisations, The European only pays for the part that cannot be repaid by the mutual life insurance company. c. justify the costs by presenting relevant documents. Assistance that does not fall under the headings of the cover provided, can be performed by The European under the condition of prior written agreement to repay the actual costs by the insured or the requesting party. The European cannot be held liable for any delay or obstruction in the execution of the assistance in the event of force majeure such as natural disasters, epidemics, climatological phenomena, strikes and suchlike. B. BAGGAGE INSURANCE 1. DEFINITION OF BAGGAGE All items, property of insured, which he/she brings along on the trip for his/her personal use, including: a. articles of clothing or items to wear; special and valuable items such as jewellery, watches, furs, binoculars, photographic, camera and video equipment, GSM, portable computers,... up to a maximum of 50% of the total insured capital for the total of the special and valuable items; b. sports equipment; If this equipment is composed of a set of multiple objects, each object is insured separately for an amount equal to the total value of the equipment divided by the number of objects; c. camping equipment, limited to tent and camping necessities. Each item is insured separately to a maximum of 25% of the total insured capital. 2. INSURED CAPITAL 2.500 in 1 st risk per insured for the combined formulas. The European insures baggage against complete or partial damage, theft, as well as the non-delivery of baggage entrusted to a transport company. a. In the event the baggage is delivered by a transport company with a delay of a minimum of 12 hours abroad, The European also reimburses the proven purchase of essential items amounting to a maximum of 250 per insured. b. Baggage transported in a personal vehicle, mobile home or caravan used by the insured is only covered against complete or partial damage as a result of a road accident, including fire and theft with visible signs of break-in, committed between 6:00 and 22:00, on the condition that they were placed out of view in a boot space separated from the passenger area of a completely closed vehicle. If the type of vehicle does not permit this, cover is not provided. c. Baggage under supervision of insured, as well as the items and clothing worn on the body, are only insured against complete or partial damage as a result of a physical accident, fire, explosion, forces of nature or against theft committed with physical violence against the person. d. Baggage that is located in a hotel room or holiday accommodation is only covered against complete or partial damage as a result of fire, explosion or water damage and theft with visible signs of break-in. e. Camping material set up on a regulated camping area is covered against complete or partial damage as a result of fire, flood, lightning, storm or other forces of nature, as well as resulting from an established robbery attempt. f. Upon loss or theft of an international passport or identity card abroad, The European will contribute to the administrative costs incurred abroad up to a maximum of 125. 4. EXCLUSIONS a. - Works of art, antiquities, carpets, furniture, musical instruments, nonportable film, video and audio equipment, goods, frames and equipment of a professional nature; - prostheses, contact lenses and glasses; - documents, money or valuable papers, collections; - all weapons or ammunition. b. Complete or partial damage of the baggage due to: - weather conditions, vermin, own fault, normal wear and tear, inadequate packing, electrical, electronic or mechanical malfunctions or due to repair, cleaning or restoration; - the outflow from containers, dents, scratches, the peeling of enamel and the breakage of fragile objects, unless this damage is the result of a road accident. c. Complete or partial damage and theft of: - sports equipment, motorcycles, bicycles, baby carriages, wheelchairs and such during their use; - baggage transported with a two-wheel vehicle, in a convertible vehicle or open vehicle or outside of or on the vehicle, unless as a result of a road accident; - special or valuable items entrusted to a transport company as well as the nondelivery of these items. d. Theft of special or valuable items from a personal car or any other form of transportation, tent or caravan. e. Theft of baggage in a vehicle at night between 22:00 and 6:00. f. Forgetting or losing baggage (except for identity papers) or the theft of baggage left unsupervised, as well as any damage incurred in these circumstances. g. The confiscation, withholding or seizure of baggage by any authorities. h. Loss of use and all other indirect damage. 3

i. The costs for the replacement of locks and keys. j. The exclusions provided under the general provisions. 5. DETERMINATION OF COMPENSATION a. The European will pay, within the limits of the insured amount and a maximum of 25% of the insured amount per object, the purchase value of the damaged, stolen or non-delivered baggage, taking into account the decrease in value as a result of age or wear and tear, established at a flat-rate of 10% per year or part of year, calculated from the invoice date of the goods in question. b. The payment by The European under the cover for Purchase of essential articles, will in any case remain limited to a maximum of 250 per insured, regardless of the number of baggage policies entered into with The European by the insured. c. Upon partial or total loss and upon lack of sufficient justification, The European reserves the right to calculate the amount of the claim based on the proportion of the missing weight and the total weight of the insured baggage. d. If the amount of the claim cannot be determined by agreement, it will be estimated by two experts appointed by both parties and possibly a third expert, chosen by the first two experts, in order to resolve the issue. Their decision is binding on both parties. e. Specific claim settlement for irreparable damage to or non-delivery of a checked-in suitcase: If the registered baggage is irreparably damaged or can be considered as definitively lost, and the purchase value of the travel case was higher than 75, the insured can opt for a free replacement of the damaged or lost suitcase by a SAMSONITE suitcase of the OYSTER type, which will be provided to the insured via his/her travel agent. 6. OBLIGATIONS OF THE INSURED The insured is required to fulfil the following obligations: a. to take all necessary and useful to protect the baggage; b. if the baggage is located in a vehicle, lock the doors and the suitcase and completely close the windows and the sunroof; c. special or valuable items and jewellery that the insured is not wearing should be stored in the safe of the hotel or the holiday accommodation; d. when submitting a claim: 1. in the event of theft: have a report made immediately by the local authorities where the theft occurred or was established and have the signs of break-in recorded; 2. in the event of complete or partial damage or non-delivery by a transport company: hold the transporter liable within the legal time-frame and create and present a statement of objection and a certificate of definitive loss by the transporter; 3. the proof of transport and baggage labels must be kept; 4. in the event of complete or partial damage due to a road accident: have a report made immediately by the local authorities where the accident occurred; 5. reserve all rights with respect to any potentially liable third party; 6. in all events, to inform The European within 48 hours after return in the place of residence, (except in the event of force majeure), to comply with its instructions and to provide it with all the documents that are necessary or useful; 7. to demonstrate the quality and quantity of the damage and to present proofs of purchase of special and exceptional items. C. PHYSICAL ACCIDENTS 1. DETERMINATION OF ACCIDENT Accident is understood as: an unexpected and sudden occurrence that causes physical injury and of which the cause or one of the causes is outside of the victim s body. The following are treated as accidents: - drowning, poisoning; - effects of freezing, severe cold or high heat; - injuries incurred during rescue of persons in distress; - complications of injuries, initially triggered by a covered accident; - sprains, strains, fractures, bruises or muscle ruptures due to a sudden effort. 2. INSURED CAPITAL - in the event of death: 25.000 - in the event of permanent disability: 25.000 If the insured becomes the victim of a covered accident, The European will pay compensation: a. upon sudden death or within three years of the covered accident, the planned insured capital to the legal heirs or to the beneficiary indicated in the special conditions; b. upon permanent disability, a capital calculated on the basis of the planned insured capital in proportion to the extent of disability determined using the official scale of disabilities which applies in the consolidation. If several permanent partial disabilities result from the same accident, the total claim may not exceed the defined insured capital. The determination of disability may not be increased by an already pre-existing disability. The degree of permanent disability will be determined no later than three years after the insured accident. The compensation for death and for permanent disability will never be combined. Cover remains provided, subject to Article 5 for accidents befalling insured: a. as the driver or passenger of a private vehicle; b. as a paying passenger of a recognised transport company on land, by sea or in the air; c. as a result of exercising a sport as an unpaid amateur. Winter sports, however, are excluded. The compensation for the death of persons under five years of age will be replaced by the reimbursement of funeral expenses for a maximum of 1.250. The compensation for death of persons over 75 years of age will be limited to 50% of the insured capital. In the event of a permanent disability of persons who are 65 years or older at the time of the accident, an annual annuity will be paid, equal to 8% of the calculated permanent disability. 4. FAMILY COVER If, during the trip, both parents become victims of a fatal accident, the death capital sum payable to the surviving minor children, will be doubled, but with a maximum of 125.000 per parent, regardless of the number of policies entered into with The European. 5. EXCLUSIONS The European does not pay for accidents resulting from: a. activities arising from the exercise of professions that are known to be hazardous, such as, among others, entering mines and quarries, presence of explosives in factories, demolition works,...; b. practising sports as a profession or for remuneration; c. practising the following sports: skiing, mountaineering, spelunking, bob-sleigh, skeleton, combat sports, underwater diving with autonomous breathing apparatus, ski jumping, bungee jumping, paragliding, hang gliding, jet-skiing, parachute jumping, snow scooter, big game hunting and motor sports; d. the use of a two-wheel vehicle with a cylinder size of more than 50 CC with or without a side-car; e. air travel, unless as a paying passenger on a plane approved for the public transport of travellers; f. the exclusions provided in the common provisions. 6. OBLIGATIONS OF THE INSURED OR OF THE BENEFICIARY The insured or the beneficiary must: a. immediately inform The European and send it a written report within seven days as of the moment that insured has the opportunity to do so; b. comply with the instructions from The European and provide it with all the information and/or documents that it considers necessary or useful. D. CANCELLATION OF INSURANCE 1. DEFINITIONS a. Travel contract: each journey, stay or rental of a holiday accommodation, whether or not combined, entered into by the insured in the capacity of traveller and/or renter with a professional travel organisation and/or agent. b. Departure date: - the departure date of the trip stated in the travel contract. - the start date of the rental of the holiday residence, reasonably taking into account the duration of the trip in order to directly reach the holiday destination on the date provided in the travel contract. c. Registration date: the date on which the reserved operations were booked with a professional travel organisation and/or travel agent. If only flight tickets are involved, the registration date is equal to the issue date of the ticket. d. Travel companion: the unique person or the unique couple, including the family members who live under the same roof, with whom the insured or the insured couple decided to take a trip together or to rent a holiday accommodation. e. Life partner: the person with whom the insured forms an actual or legal life partnership and who lives together with him/her long-term at the same residence. f. Illness: impairment of health, determined, before the departure date, by a qualified physician and that makes the travel contract entered into, medically speaking, impossible. g. Accident: impairment of physical soundness by an external cause, determined, before the departure date, by a qualified physician and that makes the travel contract entered into, medically speaking, impossible. h. Major material damage to real estate: exceptional and accidental damage, occurring within 30 days before departure, to the real estate or to the business buildings that the insured owns or rents. 2. INSURED AMOUNT The total cost price of the trip stated in the policy up to a maximum of 2.000 per insured person. The cover is intended to compensate the costs of cancellation or the modification that, according to the application of the terms and conditions of the travel contract, are to be borne by the insured in the event of cancellation or modification due to one of the following reasons: a. illness, accident or death of: - the insured, his/her life partner, a blood relative or kin up to the second degree, including in-law family members; - a person who lives together with the insured in the same residence and who is in his/her care or is his/her dependent; - an official fiancé(e), as well as his (her) family members up to the 1 st degree; b. death or hospitalisation of a member of the host family with whom the insured planned to spend his/her holiday, insofar as this member lived together in the same residence as the host family, during the planned trip; c. cancellation by the employer due to economic reasons of the employment contract of the insured or his/her life partner; d. cancellation by the employer of the insured s already granted leave due to the unavailability as a result of illness, accident or death of a colleague who the insured has to replace; e. mandatory presence of the insured resulting from the entering into a new employment contract with a minimum duration of three consecutive months; f. necessary presence of the insured who practices a free or independent profession due to unavailability as a result of illness, accident or death of the insured s professional replacement, indicated in the policy; g. unavailability as a result of illness, accident or death of the person indicated in the 4

policy, charged with the care of the insured s minor or handicapped child; h. major material damage to the real estate owned or rented by the insured, including damage to the real estate as a result of theft, occurring within 30 days before the departure date; i. mandatory presence of the insured as: - witness or jury member for a court; - student for retaking an exam in the period between the departure date and 30 days after the date of return from the trip; j. when the insured or a family member up to the 1 st degree is summoned for: - the legal acts of official organisations upon the adoption of a child; - for an urgent organ transplant (as donor or as recipient); k. when the insured may not receive the vaccinations required for the trip for medical reasons and this was not known at the time of signature; l. complications with the pregnancy of the insured or a first degree family member, including premature delivery at least one month before the normal expected date; m. the pregnancy of the insured or her life partner, on the condition that the trip is during the last three months of the pregnancy and this was not known at the time of registration for the trip; n. refusal of the entry visa by the authorities of the country of destination; o. theft or total immobilisation as a result of a road accident or fire of the insured s personal vehicle within seven days before departure or en route to the holiday destination. Cases of mechanical failure, however, are not insured; p. delay at the time of embarkation as provided in the travel contract, on initial departure or at a later stage of the journey, as the result of immobilisation for more than one hour caused by a road accident en route to the point of embarkation. Cover will be extended to delay in the event of a mechanical failure, on condition that a certificate from a towing company or known automobile club can be presented. Cover will also be granted to the insured in the event of cancellation by the travel companion as a result of one of the aforementioned reasons, insofar as he/she also entered into an insurance contract, with cancellation cost cover, with The European and the insured is obliged, due to the cancellation by the travel companion, to take the trip alone. 4. EXCLUSIONS a. Physical injuries as a result of an accident or illness for which, when entering into the insurance contract, medical or paramedical treatment was being prescribed by the treating physician. b. Degenerative diseases. c. A chronic or pre-existing illness of the insured, unless no medical or paramedical treatment was necessary during the month before the registration date for the trip, and according to the treating physician no contra-indication existed against taking the trip. d. Accidents or disorders as a result of: 1. mountain climbing along unmarked routes, big game hunting, spelunking and undersea fishing or combat sports; 2. participation in any races, speed attempts or competitions; 3. the exercise of sports for a professional title or for payment, including training for this; e. Psychological, psychosomatic, mental or nervous disorders, unless at the time of cancellation a full-time hospitalisation of at least one week is prescribed. f. Voluntary interruption of pregnancy. g. Insolvency of the insured. h. Delay due to traffic difficulties and other normal incidents. i. Documentation, administration, visa and other similar costs. j. Exclusions provided in the common provisions. The aforementioned exclusions apply not only to the insured, but also to the persons whose medical condition is the reason for the request for payment. 5. DETERMINATION OF COMPENSATION The European will reimburse the insured: a. 1. for all reservations except flight only: upon cancellation before the start of the travel contract: 100% of the cancellation reimbursement contractually due by the insured to the travel organisation; 2. for flight only: in the event of cancellation by the insured before the start of the flight, the cancellation costs charged by the airline company and/or the agent plus any costs of issuance by the travel agent. In any case, the payment will never be higher than 100% of the insured amount. b. if, in the event of cancellation by the travel companion, the insured decides to depart alone on the trip: the corresponding extra hotel and/or modification costs. The payment by The European will, in any case, be limited to the contractually mandatory compensation upon cancellation; c. in the event of immobilisation of their personal vehicle, the insured can still start the trip with a rental car. In that case, The European will pay the net price rental car up to an amount equal to the chargeable cancellation costs. Tolls, petrol and/or any insurance costs will not be compensated. In no case will payments by The European exceed the defined insured amount, and they will always be calculated based on the cancellation costs due on the basis of the terms and conditions of the travel contract for cancellation within 48 hours after the insured knew about the event that caused the cancellation. 6. OBLIGATIONS OF THE INSURED The insured will fulfil the following obligations: a. send a written report to The European within 48 hours of the insured knowing about an event that causes the cancellation of the trip; b. comply with the instructions from The European and provide it with all the information and/or documents that it considers necessary or useful; c. take all necessary and useful measures in order to reduce the cancellation costs to a minimum, that is, that as soon as the insured is aware of an event that may cause the cancellation of the trip, he/she will immediately inform the travel agency or the tour operator about it. E. HOLIDAY INTERRUPTION 1. DEFINITIONS See under D. 1. of the Cancellation costs insurance. 2. INSURED AMOUNT The total cost price of the trip stated in the policy up to a maximum of 2.000 per insured person. Cover is intended to compensate for the lost days of holiday if the insured has to interrupt his/her trip prematurely due to one of the following reasons: a. illness, accident or death of: - the insured, his/her life partner, a blood relative or kin up to the second degree, including in-law family members; - a person who lives together with the insured in the same residence and who is in his/her care or is his/her dependent; - an official fiancé(e), as well as his (her) family members up to the 1 st degree; b. death or hospitalisation of a resident member of the host family, with whom the insured is spending his/her holiday; c. the necessary presence of the insured who practices a free or independent profession due to unavailability as a result of illness, accident or death of the insured s professional replacement, indicated in the policy; d. unavailability as a result of illness, accident or death of the person indicated in the policy, charged with the care of the insured s minor or handicapped child; e. major material damage to the insured s real estate occurring during the trip, including theft in the residence; f. mandatory presence of the insured as a witness or jury member for a court; g. when the insured or a first degree family member is summoned for: - the legal acts of official organisations upon the adoption of a child; - for an urgent organ transplant (as donor or as recipient); h. complications with the pregnancy of the insured or a first degree family member, including a premature delivery at least one month before the normal expected date; i. theft or total immobilisation as a result of a road accident or fire of the insured s personal vehicle at the moment of departure or en route to the holiday destination. Cases of mechanical failure, however, are not insured; j. delay at the time of embarkation as provided in the travel contract, on initial departure or at a later stage of the journey, as the result of immobilisation for more than one hour caused by a road accident en route to the point of embarkation. Cover will be extended to delay in the event of a mechanical failure, on condition that a certificate from a towing company or known automobile club can be presented. Cover will also be granted to the insured in the event of cancellation by the travel companion as a result of one of the aforementioned reasons, insofar as he/she also entered into an insurance also entered into an insurance contract, with cancellation cost cover, with The European and the insured is obliged, due to the cancellation by the travel companion, to take the trip alone. 4. EXCLUSIONS a. Physical injuries as a result of an accident or illness for which, when entering into the insurance contract, medical or paramedical treatment was being prescribed by the treating physician. b. Degenerative diseases. c. A chronic or pre-existing illness of the insured, unless no medical or paramedical treatment was necessary during the month before the registration date for the trip. d. Accidents or disorders as a result of: - mountain climbing along unmarked routes, big game hunting, spelunking and undersea fishing or combat sports; - participation in any races, speed attempts or competitions; - the exercise of sports for a professional title or for payment, including training for this; e. Psychological, psychosomatic, mental or nervous disorders, unless at the time of cancellation a full-time hospitalisation of at least one week is prescribed. f. Voluntary interruption of pregnancy. g. Insolvency of the insured. h. Delay due to traffic difficulties and other normal incidents. i. Documentation, administrative, visa and other similar costs. j. Exclusions provided in the common provisions. The aforementioned exclusions apply not only to the insured, but also to the persons whose medical condition is the reason for the request for payment. 5. ESTABLISHMENT OF THE COMPENSATION The European reimburses: a. the part of the paid travel sum which cannot be recovered, in proportion to the number of unused holiday days, to be calculated from the moment of return to the place of residence or the day of hospitalisation abroad. The unused holiday days are calculated as follows: - if the insured returns at the expense of one or other assistance cover, the claim will be calculated on the basis of the hotel nights not used; - if the insured returns at his/her own expense, the compensation will be calculated on the basis of the hotel nights not used and the originally purchased ticket; - if the insured has rebooked his/her return ticket, the price of the rebooking will be reimbursed (and therefore not the original return flight) on condition that the rebooking does not exceed the price of the return ticket; - if the travel contract only includes transport, The European includes in the repayment of the part of the transport price which cannot be recovered, to the extent that the return trip costs were not repaid under a different insurance cover (assistance,...). b. in the event of immobilisation of the private vehicle during the trip, the insured can still continue his/her trip with a rental car. In that case, The European will pay the net price rental car up to an amount equal to the normally calculated payment for interruption to the holiday. Tolls, gasoline or any insurance expenses will not be compensated. 5

6. OBLIGATIONS OF THE INSURED The insured will fulfil the following obligations: a. immediately inform The European and send it a written report within seven days as soon as the insured has the opportunity to do so; b. comply with the instructions from The European and provide it with all the information and/or documents that it considers necessary or useful; c. in the event of illness or accident abroad, present a medical certificate from the treating physician abroad who advises the return trip. INSTRUCTIONS IN THE EVENT OF PROVISION OF ASSISTANCE HOW TO CALL THE EUROPEAN FROM ABROAD By telephone: +32 (3) 253.64.15 By fax: +32 (3) 252.69.58 ALWAYS PROVIDE THE FOLLOWING INFORMATION: Identity, age, place of residence of the person concerned Number of your policy The fastest way to contact you The full address where you can be reached IN THE EVENT OF ASSISTANCE TO THE INSURED PERSONS Name, address and telephone number of the doctor at the location Nature of the illness or the injuries Treatment given Name and address of the family members to be informed IN THE EVENT OF ASSISTANCE TO INSURED VEHICLES Exact location where the vehicle can be found Make, type, year of manufacture and chassis number Description of the damage Reference numbers of any documents to be sent and manufacturer s stamp of the electrical components The telephone costs for contacting the alarm centre from abroad will be fully reimbursed. 6

EUROPESE GOEDEREN EN REISBAGAGE VERZEKERINGSMAATSCHAPPIJ N.V TWEEKERKENSTRAAT 14, B-1000 BRUSSEL Tel. 02/220 34 11 Fax. 02/ 218.77.62 Email. travel@europese.be Onderneming toegelaten onder code 0420 EUROPESE CLAIM FORM 1. Name and address of the insured:... Bank account number of the insured: 2. Policy number:... Departure date:... Duration:... Destination:... * Cancellation of the trip (SEND THIS FORM TO THE EUROPEAN WITHIN 24 HOURS) - Name of the patient:... Degree of kinship with insured:... - Price of the trip... Amount of the cancellation costs:... - Registration date:.../.../... Departure date:.../.../... Date of cancellation:.../.../... - Reason for the cancellation (the unnecessary withdrawal): illness - accident - death - other reason:... ATTACH: MEDICAL CERTIFICATE OR OTHER + COPY OF THE ORDER FORM FOR THE TRIP * Baggage (SEND IN THIS FORM IMMEDIATELY AFTER YOU RETURN TO BELGIUM) - Circumstances of the claim: - Claim amount:... (ATTACH: ORIGINAL CERTIFICATES OR SUPPORTING DOCUMENTS) * Medical costs abroad - Circumstances: - Claim amount:... (ATTACH HEALTH INSURANCE FUND PAYMENT) * Other: description: - Claim amount:... (ATTACH SUPPORTING DOCUMENTS) * Agency or website address of your reservation:... Date and signature 7