CERTIFICATE OF INSURANCE

Dear PUTRA ABDILLAH TANJUNG

Thank you for purchasing Chubb Travel Insurance for your latest reservation at Traveloka.

Please find your travel benefit details as follow:

Certificate Number : TTIIDAA1841393

Plan Selected : Round Trip - Premium

Issue Date : 13 Feb 2017
Travel Period : 15 Feb 2017 to 19 Feb 2017
Destination : KNO - SUB
Total Premium : IDR 230,000.00
Passenger/Guest Date of Birth ID No./Passport No.

PUTRA ABDILLAH TANJUNG - -

PIGAMITHA DIMAR - -
NURHAIDA HASBI AHMAD - -
ROSMAWATI ROSMAWATI - -
SITI AISYAH HASBI - -

Chubb Travel Insurance is especially designed for Traveloka customers and is underwritten by PT Chubb General Insurance Indonesia. For full details of the Terms and Conditions of Chubb
Travel Insurance please refer to the Policy Wording.
 Chubb confirms that the Insured Person(s) shown on this Certificate for whom premium has been paid are covered, subject to
terms, conditions and exclusions, of the Policy Wording.

Please see your Schedule of Benefits attached in this Certificate of Insurance. Please note that the Beneficiary will be subject to
the provisions of laws of the Republic of Indonesia.

Should you require further assistance, please contact our Customer Service at 1500 257 or email at travel.id@chubb.com.

Thank you for your trust and support in Chubb Travel Insurance. We look forward to be of service to you in the near future.

Yours sincerely,

Accident & Health Insurance Division

PT Chubb General Insurance Indonesia
www.chubb.com/id

This is a computer-generated letter and does not require any signature.

PT Chubb General Insurance Indonesia is registered and supervised by Otoritas Jasa Keuangan.

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