ORIGINAL
DHAKA INSURANCE LIMITED
‘The Tasted House OF insurance
Head Office: Dhaka Insurance Bhaban, 71, Purana Paltan Line, Dhaka-1000.
Phone: 58316139-43, 58316146, 58316147, 58316148 Fax: 880-2-58316144-5
‘emai: contact@dhakainsurancebd,com,dilho@hotmail.com web: wirw.dhakainsurancebd.com
BIN : 002202908.0208,
MONEY RECEIPT
MUSHAK: 6:3
Issuing Office + Local Office
Money Receipt No: LO-2023-1785
Class of Insurance: Miscellaneous Date: 31-12-2023,
Received with thanks from, MEHEDI HASAN, North Betka, Betkahst, Tongibari, Betkahat-1821, Munshiganj
The sum of Tk. 1496.00 (One Thousand Four Hundred Ninety Sx tka)
Mode of Payment Cash Dated 31-12-2028
Drawn on Jamuna Bank Limited., FO.EX.Branch a
Issued against DILLOIOMP-0773/1272023( BH )
a ‘aat00
var cor ‘3500
* Note: fhave ay complain about insurance call 16130. UNIGLYAL
GIST BCA AACS asec pemregee
DHAKA INSURANCE LIMITED 683% (xe)
‘a fer: Onat insurance Bhatan (10-195 oa) 71, Puan Patan Ling, Daka-o0 7/8, Reet
Formon= Schengen Countries:
Insrance wt py yp to he cover show on he Oreress Men cetiaton and Sees tl forte Isr Pason and
Seto Date states the. Overseas Mer leiton ar Sh, whch Seucbe spies rece oes eee
he folonng mea reed expenses resnaty ad recesry eves case be Peoples Rep of Banga oy the eed
Berson a rect esto te sre Paso allen bal uy, Snes, esse eating COVED3B) ce desh Garg te Ped of
"ctisandng te above, Intana Global + Specialty Assist: exrmancs ht conaruce veatmantn Bags sprite he poly
‘aancesto coe medal opens eared ares open Cored pene: Mh
PROVED THAT exeses wll ey be pt ate vl ad customary elo such eres, and fer proved that expenses wl ey be pl for
{rosin ind win Ue 80 (aie) days pret eae aig the fre anesaton of Oe bealy my, sess a (ding
{CovaD-19) tre sre Perso ha tet eben te ene Sate ep
Sanne bist Ssapcasn races
DHAKA INSURANCE LIMITED
en otic: Dna Isurarca Bhan (10-18 fer, 71, Prana Patan Lin, Draka1000
“ek sester9e, sastata,sasre141, 831642, 56016149 (FABX)
Foc 8802589161445 mal contact @dhakaneuancebd com, dno @honalcom
‘Wb. wi dhaxansiranceba com
From pre page pape = 2
(OVERSEAS MEDICLATK POLICY FOR BUSINESS AND HOLIDAY (BAH) TOUR
” For Schengen Countries:
Upt]US 500 or Euro aque pet ocarence fe tal ars fr enacts ree of tala on However etl are
rendre recesny a5 9 ea coves acer sal be Saja Uh bso er sated Ores MeSey
Teena nd Schade: No deduce apples.
» For non = Schengen Counties:
Up 0 US & 500 per acurence for eral ects ar inmate re of dena pn on. However eral care rendered
casary 2 rot of covered acetal beste eit ot cove and Deduct aed nthe Overs MCE
Ieee ana Seae
ers or pyscan ordre emergency meal va.an incng medal appepateVarspraton ad recesary medal caro
Toe, othe hearst stable hosp whe the ttre Person's Cty or ued an nossa ere site sue fo
‘bre approval fhe Prgram Medal ABST: nae erergences na rnte wea where
cant be cate tbe medal erection ms be repre othe st avalon physan and he anes atte Cons
ierss fr mesic! evacuation nudes varpataten and medal care en rst 0 2 Mrptl or the Ise Pers noms pce of
reeceves In be Pees Repub e Sangosesh when deemed mascaly eavwabie y the Program ea! aavsnr on te seeng
sean,
te sured Pease des ose he Pope's Repu aries he gens or prepara thea Yarspratn of the ema for
‘epatn fhe Pope epic of Bases up t an euvalere amour fr 8a butler eematon the ne where ea
‘reed l expenses rast be aporoed by Van heya UX Uk) Spocy est Us. ttre heresies prepare for areporaton
‘he Pepi Repo Bane or fora bur or ramon
‘No cen be pad in espe a adil cron hat was row bythe wed Person te adr been ented the store
or mney preeng ie acive dite MS Snag
osama whee the ised arn
2) tavelng annette ave psn;
©) Iona wag it er spaces medal eatnert decor he Physio’ Report an Cree;
©) tava forthe purpose cng mesca extent of
4) paste tein promos for # ede conan;
No dam be gid espe f expenses er Weert wheh cud renensby be delayed ur the Insured Pasa’ een tothe Pele
Repo of arcesh The austen of what Can o Cama be Yeasonsy aye wl be eed jy bythe wean Pyacan ade
Fream Me Rav
No cam wl e pad whee the expenses ae ls thn he Dette sn nthe Oversas Meclin Ideiaton and See, The
Dect sh spy to ea sree eet and shal be bare by bw Ined eso Tia condone apoiabi on fot non
No im nrepet of cosmete suger wb pad, uns U2 coxnete surgery renee neces 99 esi corre Ek
cm nt paring a a eu of zed true Deters (IS) a ADS Rae Comex AC) Powe hs
ree as bean saute maybe hme
egal eisai Pom ac, ets, me he i eA un, veneer abet gtr
1 dy i be i respec ci cams ayer anon Whe he ee dca nparmert
"oc wb an espe of mae tesa an rete servis otal win he Pope's Republic of Banga,
"No camwbe a ark em he insures Person's tg pat nly orc operations,
"caw be pl ark om war, as or wa.
“Ts narance des rt cover ny im arig am he so estucton ee danage any propery wince fay os oF eA
aso resting oa hereto ay cose es ret deceased ya ante Oyo tg Me
2) taming etn or certain by oat fom ary rae wae fromthe conbuson of uc ul
9) teracoacve tx xplasve other hazardous opertes fan lene racer ase Fm componente
‘Nim wi be ot arsing rom Aviation ues the Ise en es 25 2 pasenger nana propery ana oc pagers
No dar wl be pi ring tro parceatn n mortanewing (wha ropes or ues ar atomaly wed), ng or dig acs oF
fats, pt oir, sen avo eer undarwseatty. maaan oy cberhanscau or ptt engrafted
[Seer unbaned at yal or tes nroper espe cist Sapa frrcos
DHAKA INSURANCE LIMITED
aa fer: Ona surance Bain (10-13 fa), 71, Purana Pan Une, Daka-1000
“ol 58516739, 56316140, 98570141, 8642, 58016143 (PARK)
Fax 880.2-58816144-5, Ema contact chakansuraneeb.com, st ho@hoimalom
Web, wi chaxansureneeba om
From pe age page= 3
(OVERSEAS MEDICLALK POLICY FOR BUSINESS AND HOLIDAY (4H TOUR
"No dam wl be pal asin rm paps pesos Spr er Spas yt
‘nares are rote pune ths insane any aunt ere under ay azapatens net pan, ter Reh anc, nts
eal sirens seme or pub sstance program o” sh eer Wsuroncecaverng te sae Fees eee tht ears ke
Payment ona fot an Ire Peano cus cored uray er Suc saree or Rsance scheme, Ise Posen
Sarees toast ares any i of ear unr such sche)
“is narance wi nt cone prepare, nudges cit, mscarag, aban er compton tayo ese
The ote ows at prove over in respect of EBOUNZIA but cr COMID19
APPLICABLE IN RESPECT OF CHILDREN AGED 5 YEARS AND UNDER:
‘Tis psoy exces ovr for vesimertreéting to "Murs, Chichan Pox, Messe, Geman Heass, Sl Ba, Whaopg = Coun,
Dies clones, Neng ar Seat Fever ardor cosequences ano tee Sesos ere o g tere om
War, Teroram and Mase Destruction Excuslon
‘ett any roson tthe coneary wii Os suaceo ary endorser there saree Bat hs surance ects ary sso exes of
ascent dec ret arsng eto crtrted te, cased by, res a, oe crmecton with ny fe low repos ef ye!
{us or event conrovbg concur orm oy ote sequene to teas epee
sr, testes or are operators (whether war be ecaed ent,
‘Ace ener oe tothe natonaty ofthe nse Persone te curry io ovr we the 2 ccs,
awa,
et
fe,
Reouten
‘ert o ne gay conte goer,
oa asamig the prope fer amoung 30 urn,
‘ayer supa power,
Eeiecons f Wa Weapons,
Ueaon f taear, Chemical er Biogea! weapons of mas derctonhoaoetr ese maybe dtrntad or comin,
tre at nme rer Sno ve en at TET, No MY eS
‘reer Ay,
For the purpose of tis exusion;
>
»
»
”
a
Tera Acty mans a ac Faso any pen, or oun) of pans cones fr pole, repos, Wesel os purpose wth
{he itnon to orca ay goverment art at te publ, ny Seen oe unex. Teert ave) ean ne, bt Pt Be
Ieited t,he sual we of foe o kere andor hereto tch use, Fatman, the perpetrators of trent si can ete be ning
‘eng oF bear of ocean wth ay ergenaatons) veers)
scat of nuclear Weaoes mass destruction meas Be we ean exe nus” weapn deve othe emis, dare, C552,
Te reap oe rately 8 ve of abaciy cps ng raprtatg aone eh arnt Pepe O
Luszaton of Chari Weapons of mass desruton means the ension,dcare, depos réease or escape o any sl au o g3sous
‘heralconpound whi when uta dae, scape hs epoca eater or ea ancngs pepe FBT
Uuszaten of stg Weapons of mass cerucion mans he emission, aacurge, der lease of exape of any pathogen (Sense
reduc) mee crgansris) ander Bebgkaly produced tons) (Reding genatcaly Moaedegarisrs ane chery yee xs)
‘arena of acing weapctagdablemert or 250 amongst peel |
As ec tren ny fo expen of whasonver rte dec rec ari out f, oertd to, caused by, resting fom, or a
‘amnion mth any acon taken nconeaing, peer, or spresng ny erat of) ws) oor,
Inthe evr ary portion ef ts exc oun to be inva weno, he remand’ shal ean ia ffoe and ees
‘coMoITiONs
“Te condos bel py rouou ths rsxanc, arto consi wth than may be pedi to 8 am,
Medic eral and wanspoatn rested dam wt be pa except atte ual customary and reasonable evel of charges for sh Secs
‘Amaea| evauan oF vaspertaten of moral reas must eaproved in a.ace by Entana Global + Specialty Assist os thor
"cdi! Aavcrs nde emergence net pre aeas wre the Pag Medal Ata cna be otacea te ral
raion mst be porte fo eis eal pysoan ad tte eres alge Corsa, wisest Sapa fararcoa
DHAKA INSURANCE LIMITED
ae met Dra InsuanceBhaban 019 ee) 71, Pra Patan Line, Daka-1000
“es SE516199, 58315140, 5ES16141, 58516442, 58016143 (PABX)
Fax: 880-2:586161445, Ema: contact dhakansuranebd com, dhe @hotmalcam
‘Web. chakensprapogbaae—
(OVERSEAS MEDICLATI FOLICY FOR BUSINESS AND HOLIDAY (BAH) TOUR
3
w
2
Ince shal be fy a completely subrogee Pere aa partes who mey be ate to roi ery ef make 8
otto n espe ty mar wer be ube of cl ude hs sac
‘The Ind Pesan ter reso co-operate uy wth Insrer sen such nd certian cud where apropre, Ises
Inatnirgprosedngs Be onn exer agains pres te rae the oes Person
‘The Isrers may requ he Inaed Feo ofan 2 sown exgnseacaeates, romain, gros other evens of cms. The
Frees Frequrea roy sprouse oon fo ry sc Quy who Pas Cele the Me eae,
“The lea repeat fn Insured Pen sa have he ft tat fran nse Person ho napa Secrse
“This rane dows rot eprtebeand prod ef 180 (one hanced iy) Gays conus abc fom he People's Remi of Bngadesh
es specteaty ares.
‘is oly and Overseas Mein deteton and Schetle sall be rbd ogeber a oe contac, and any wed cx exesson to wich &
‘ecb akang ho bch sacedn oy par of hs pole or he Cv Meio ieefiaton and Snead sal Bear sich pee mean
stove ay appear
DISPUTE RESOLUTION PROCEDURE:
‘Tis combate insane ices he long pt elton proce wh i exchsive and 3 mat pot ois Corr of nasa.
‘Ths nara Conare e lowing Dap Rezcen Case, wih ss moi pa ths rrr:
2) ‘Nature ot coverage:
“This py ot gener heath suace poy, i tnd ny for usa of Insured Pern inthe eet of suden and
Tenet sees scent aay wen the Iasi the Peo Repub Bargadesh
bee ting xctusons:
“ris poly i ot degned to prove an nde nsec of Maca Sere he need for whch ares utc re ~ extng
Caen
© Pmt Conon:
soy gece Pena en me eset ne rect) me te oer
‘cHorce oF Law:
“Toe partes 0 ths Insurance Ply eresiyapet tat ewe ofthe People's Repubic of Bagldesh sal gover the vl, easton,
Imereti ed ee i ole
1 ay erence arses at he amount ob yal ude hs poly aly bing erie arta, uch erence sak be fre he
‘aslo arn arta be sponte in wth bye prez nec cf ey cmc gree puna sre elu, he oreson of
‘SS srccsors one to be aopobt n reg by ech om porn, wn oe ler ment after ag een ree wns 10d Dy
‘rere pores orn cue he moat onc ages a ume fo De appearing bythe errs bree axe uo he
"Se, ecg th omar res or neg Th rt Be non ec oy
(acon agar nes
o ‘COVER AVAILABLE FOR SCHENGEN COUNTRIES:
Unt of cover fr tig Scnengen courts io 30,000 fr both accident and ins subi o() satisfy Provo
(2) ited prewetng ecisers
o ‘COVER FOR NON-SCHENGEN COUNTRIES:
‘spr ply Iereation an bed
|W WITNESS WHEREOF the vndesiged Beg duly aur by and on tah the Company have here to ster and Os 3k Gay of
Decenner202)
race Onaka
aes203
Fer and on beat
asia United
wd }
he nsured i particu cequestes to eed ths Poy ands encosures A Shy Sher adr Mvesrption were fund,
‘Be patey shoul be reumed tthe sung of before dparture for immed correction. cist Sapcas Traces
DHAKA INSURANCE LIMITED
ua fer: Ora surance Bhatan (0-19 oo), 7, Purana Pan Line, Dhaka-1000
“ol s8516139, 58916140, 58576761, 58376142, 8276143 (PARK)
Fax 880-258516144 5, Ema contal@ dhaksinsuranesb.com, 3 he@otmalcam
‘Web. wn dhakainsuranceba com
(OVERSEAS MEDICLATM INSURANCE POLICY: CLAIM IMPORTANT INFORMATION
‘What todo in the case ofa medical emergency:
Inthe event of ness or Acient which may lead to Hospital treatment or Cutaliment of your ip, Pease Contact:
orrery
2 London BridgesLondon,
‘SELSRA, UK.
Telephone: + 44 207 902 7134(opsassist)
mall opsassist@crisis24.com,
Ns (1) T avid reserve charge calls the claimant andor someone cating on his/her behalf ver above tlephone/faxbe requested
toghe his/her telephone number so thet te Criss 24, can inmedaely call back asking fr other parila.
(2) crise 24, are acing as The Party Administrators Assistance provide to render services respect of
im to the Overseas Meda Poly hades.
{In the event ofa claim, please apply to Crisis 24 fora Claim Form. When completed, please submit rect to
‘isis 24 together with Teurance Certcate and relevant documentation,
Subject to COVID-19 Endorsement attached hereto.
id )
ie se eset ON) Dhaka Insurance Limited
OVERSEAS MEDICLAIM IDENTIFICATION (B&H) AND SCHEDULE
Plan A: For Non-Schengen Countries and Worldwide excluding USAICANADA.
This Overseas Meciclaim insurance is only aailable to Bangladeshi Citizens betwoon 6 months and 79 years of age who are
Undertaking bonfide tips outside Bangladesh which wil not imehe any form of manual work ane do not exceed 160 days in
‘uration unless specifically extended
Policy No, DILLO‘OMP-0773/122023( 88H) Dawe: 3196623
Pian Caton on Medical sin.
0f, Name ned persen MEHED! HASAN
C2. hao tn comeltd years wth Date frit): 7 Years 3011086
68, Residence Aces Noth eta, Bethe, Tongan, Bekah 1521, Master
Ot Residence Telephone! Mobile oreoostse8
€5, sured Ocean (Spc) Bowes
06, Passport No arze008
7. Namo of ual Physicon Dr. Md. Mahabubuzzeman, MBBS, BIRDEM Hospital,
heaton ‘Dhaka, Bangladesh. Reg. # A<34245,
Home
(08, Plan Type Plan A Voyage fom Hazrat Shatalal Int Airport, Dhaka to Any Aiport
of Australia to Hazrat Shahjaial nt! Aiport, Dhaka,
(09, Lina of Cover (See Conction-12) Bangladesh.
‘NON MEDICAL
Hines
‘Accident USS 50,000 1) USA/CANADA :itness us § 100,000
1) Other than USA/CANADA :ness us $ 50,000 Accidont
b)Dental Treatment: US$ 500 or EUR equivalent
10. Deductible For Schengen Counties : No deductible
Fr Non Schengen Counties: USS 100,
Emargency Dental Care : USS 50
1, Amount of Premium (Standars) Net Premium te) 180800
Vat 15% a)
Tela Te 1486.00
12. Date of Puchase SHOECZS
12, No, ofDays Comred 29(Twony Eight Only) Days, From: C2IAN-24 to 29IAN24
14. First day of Insurance (date & time) : 02UAN-24
‘commencing fom time of boarding the aircraft or
‘ther mode of transport fom Bangladesh.
15, Adcross of esuing Offco Local Ofce
‘Amin Couet (th Fl), 62-63, Mathes! C/A, Dhaka
16. Telephone No. (02223984950, 02223986720
17. Telex/ Fax No
‘SIGNED for and on botal ofthe Company at Dhaka the day of 31-DEC-2023
Warranty
rar try straonnoieatn/cncaliton obs Peli nea, ensured mat om Oka ences
inveting tr Hehar dear fur Berleosh “Subject to COVID-19 Endorsement shes atacins
MIR. No. : 1785 Date : 31-0023, For and on behalf of
Limited
fy PROPERLY RE NSUREDAS PER TREATY =
WTA SADAAN BUA CORPORATION
(Wd. Jahangir Hossain)
Deputy Vie President (UM)
mi COVID ~ 19 Endorsement
Attaching to and forming part of Policy No. LOlon Ha \ia}oe
Deductible:
ra GOVaY does nt cover the st USDS,000 of any loses aring from Covid-9,
and any variant thereof, in the Country of Thailand,
Covid -19 Coverage Definition:
The Coverage definition detailed below applies to all global territories, including
Thailand: .
Gualified and registered medical practioner who determines hat the individual in
uestion could suffer death or serious dsabily i hisfher symptoms are not treated
as matter of urgency. -
The policy does not afford coverage for ‘any medical experises, ‘aogarhmodation
fea ses & any Costs incurred when the reason for these expenses ate due to
'ccal, national or goverment legislation forthe purpose of salon or ctherwivs DHAKA INSURANCE LIMITED
text omer: Dina uae Bata 0-9 oat, Puana Pan "
orate Sebi Soviet Sieiee teh BN.
Fax 8025806165 Eater latarecttonn alSeahoinal.com
Ve doses cet
ELECTRONIC DATA ENDORSEMENT “B"
Ged Sr SU nance uimiteo
1 Electronic Data Exclusion
Notwithstanding any provision to the contrary within the Policy or any endorsement
thereto, it is understood and agreed as follows :
(a) This Policy does not insure Loss. damage, destruction, distortion, erasure,
corruption or alteration of ELECTRONIC DATA from any cause whatsoever
(including but not limited to COMPUTER VIRUS) or loss of use, reduction in
functionality, cost, expense of whatsoever nature resulting therefrom, regardless of
any other cause or event contributing concurrently or in any other sequence to the
loss
ELECTRONIC DATA means facts, concepts and information converted to a form
usable for communications, interpretation or processing by electronic and
electromechanical data processing or electronically controlled equipment and
includes programmes, software and other coded instructions for the processing and
manipulation of data or the direction and manipulation of such equipment,
COMPUTER VIRUS means a set of corrupting, harmful or otherwise unauthorised
instructions or code including a set of maliciously introduced unauthorised
instructions or code, programmatic or otherwise, that propagate themselves
through a computer system or network of whatsoever nature.
COMPUTER VIRUS includes but is not limited to'Trojan Horses’, 'worms' and 'time
or logic bombs’.
(b) However, in the event that a peril listed below results from any of the matters
described in paragraph (a) above, this policy, subject to all its terms, conditions and
exclusions, will cover physical damage occurring during the Policy period to
property insured by this Policy directly caused by such listed peril.
Listed perils
Fire
Explosion
2. Electronic Data Processing Media Valuation
Notwithstanding any provision to the contrary within the Policy or any endorsement
thereto, it is understood and agreed as follows: Should electronic data processing media insured by this Policy suffer physical loss or
damage insured by the Policy, then the basis of valuation shall be the cost of the blank
media plus the costs of copying the ELECTRONIC DATA from back-up or from originals
of a previous generation. These costs will not include research and engineering nor any
costs of recreating, gathering or assembling such ELECTRONIC DATA. If the media is
not repaired, replaced or restored the basis of valuation shall be the cost of the blank
media. However this Policy does not insure any amount pertaining to the value of such
ELECTRONIC DATA to the Assured or any other party, even if such ELECTRONIC DATA
cannot be recreated, gathered or assemebled.
25/01/01
NMA 2915,