CNPJ: 96.348.677/0001 -94 SUSEP Process no.: 15414.900603 ... · CNPJ: 96.348.677/0001 -94 SUSEP Process no.: 15414.900603/2015 -11 Update 051216 3 2.4. Luggage Luggage shall be deemed,

CNPJ: 96.348.677/0001-94 SUSEP Process no.: 15414.900603/2015-11

Update 051216 1

INDIVIDUAL TRIP INSURANCE PLAN

GENERAL CONDITIONS-INSURANCE POLICY

1. INSURANCE PURPOSE

1.1. Attention: The trip insurance is not a health insur ance! Carefully read the contractual conditions, paying attention to your rights and obl igations, as well as the threshold of the insured capital contracted for each coverage.

1.2. This trip insurance plan is aimed at assuring insured(s) or their Beneficiary(ies) with indemnity,

limited to the amount of contracted insured capital, as payment of the contracted amount or reimbursement, or also as service provision(s), in case any covered risks occur, provided that associated with the trip, during period as previously determined in the insurance policy, under the terms set-out in these contractual conditions.

1.3. Eventual translation-related charges, as required to settle insurance claims, shall be solely borne

by insurer company.

2. DEFINITIONS

For the purposes of this insurance, the terms and definitions below shall be solely and exclusively construed with the inference and within the meaning assigned by the term- or definition-corresponding text.

2.1. Personal Accident

Event with a characterized date, exclusively and directly external, sudden, involuntary, violent, and causing injury, which, by itself and regardless of any and all other causes, directly leads to death, or full or partial permanent incapacity, of insured, or requiring medical treatment, abiding by the following:

This concept comprises:

a) Suicide, or any attempt thereof, which shall be matched, for the purposes of indemnity, to personal accident, in compliance with the effective law;

b) Accidents arising out of environmental temperature action or atmospheric influence, when insured is subjected to such, due to covered accident;

c) Accidents arising out of accidental gas and steam leakage;

d) Accidents arising out of kidnaping and kidnaping attempts;

e) Accidents arising out of anatomic or functional changes to the backbone, with a traumatic origin, solely caused for fractures or luxation, radiologically attested.


Update 051216 2

This concept excludes:

a) Diseases, including professional ones, of any cause whatsoever, even if caused, initiated or aggravated, directly or indirectly for accident, except for infections, septicemic states and embolisms, resulting from vis ible wound caused due to covered accident;

b) Variations or complications arising out of exams ca rried out, clinical or surgical treatments, when not arising out of covered acciden t;

c) Injuries deriving from, dependent on, prone to or f acilitated by repetitive efforts or cumulative microtraumas, or having the cause-effect ratio with them, as well as injuries rated as: injury due to repetitive effort (LER in P ortuguese acronym), bone-muscular diseases associated with work (DORT in Portuguese a cronym), injury due to continued or ongoing trauma (LTC in Portuguese acronym), or t he like eventually accepted by the medical-scientific class, as well as their post-tre atment consequences, including surgical treatment, at any time; and

d) Events accepted by official social security institu tions or the like, as “accidental incapacity”, in which the injury-causing event is n ot wholly fit to the characterization of personal accident-caused incapacity.

2.2. Terrorist Act

Conduct qualified as such by law, as well as use of force, violence or threat of use thereof, by any individual or group, occurred due to political, religious, ideological causes or the like, aimed at exerting influence over any government or frightening the population or any segment thereof. It also excludes losses, damages, costs or expenditures of any nature, either direct or indirect, arising out of any action exerted to control, avert or suppress terrorism acts or associated therewith. When the acts on which the mentioned exclusions are based represent a crime whose commitments are known to the Justice Courts, insurer shall not be required to pay any benefit for insurance claim, while there is no judicial lawsuit based on constitutional crime acts which are dealt with by this exclusion.

2.3. Violent Act

Violent Act is construed as use of violence against insured, for the purpose of subtracting any assets under their possession.


Update 051216 3

2.4. Luggage

Luggage shall be deemed, for the purpose of the coverage hereof, as every volume, stored under sealed compartment, shipped and certifiably under the liability of carrier company.

Important: For the purposes hereof, hand luggage ca rried by insured shall not be considered.

2.5. Beneficiary

Individual assigned to receive the amounts of the insured assets, upon occurrence of the insurance claim.

2.6. Insurance Policy

Document issued by insurer company formalizing acceptance of the coverage(s) ordered by insured, replacing the individual policy and not requiring a proposal to be filled-out, under specific law.

2.7. Insured capital

Maximum amount for the contracted coverage payable or reimbursed by insurer company, upon occurrence of insurance claim covered by the insurance, in force on the event date.

2.8. Elimination Period

Period during which insured is not entitled to receive indemnity.

2.9. Carrier company

Carrier company responsible for insured’s luggage throughout the insured trip.

2.10. General Conditions

Contractual instrument containing the clauses which govern this insurance, provide for the contracting parties’ obligations and set up the overall insurance characteristics.

2.11. Date of Arrival

Date on which insured returns to their residence and which is listed in the Insurance Policy.

2.12. Date of Departure

Date on which insured originally scheduled as beginning of their trip and which is listed in the Insurance Policy.

2.13. Sudden Disease

Morbid event, the cause of which is not accidental, occurred to insured or that has been


Update 051216 4

onset during the trip and requiring therapeutic treatment by a physician.

2.14. Covered Event

Future, uncertain event, of involuntary nature, as described in item 3 . COVERAGES and occurred during the insurance trip.

2.15. Deductible

Percentage, number of days or hours, as set-out in the Insurance Policy, as the case may be, representing mandatory participation by Insured in each insurance claim.

2.16. Aggravated Theft

Action committed for subtraction of personal property, with destruction or breaking of any obstacle to subtraction of the property, upon abuse of trust, or fraud, climbing or skill, by using false keys or upon concourse of two or more individuals, leaving traces, i.e., certified by means of a police investigation.

2.17. Indemnity

Payment to Beneficiary(ies) or to Insured him/herself, of the contracted amount or reimbursement, or even of service provision(s), in case any covered risks occur, provided that associated with the trip, during the period as previously determined in the Insurance Policy, under the terms set-out in these contractual conditions.

2.18. Required Drug

Prescription made by the physician when:

• Consistent to the symptoms, diagnosis and treatment of insured’s condition;

• Appropriate in relation to the correct medical practice standards.

2.19. Physician

Professional legally licensed to practice medicine.

Insured him/herself, his/her spouse, his/her depend ents, blood-related relatives or the like shall not be accepted as physician, even if qualifi ed to practice medicine, no indemnity being required, in such cases, to be given by insur er.

2.20. Insurance Premium

Amount, expressed in national currency, Insured pays to insurer so that insurer assumes certain risk or set of risks.

2.21. Applicant


Update 051216 5

Insurable individual, i.e., who applies for his/her inclusion into the insurance and who shall be insured by insurer.

2.22. Insurance Representative

Legal entity undertaking to promote, non-eventually and with no dependent relationships, insurance on behalf of insurer.

2.23. Theft

Construed as subtraction for oneself or third parties of some other party’s personal property upon severe threat or violence to the individual or after taking hold of such property by any means reduced to the possibility of resistance;

2.24. Insurer

Legal entity legally organized which undertakes to pay an indemnity due, upon occurrence of an insurance claim arising out of risk covered by the Insurance Policy.

2.25. Insured

Individual included into the trip insurance – Policy, who has met all conditions set forth by insurer for such inclusion. Insured may be deemed as primary or dependent. In this latter case, he/she shall necessarily be spouse or son/daughter of primary insured.

2.26. Insurance claim

Occurrence of an event covered by the coverages contracted in the insurance, occurred during the insurance trip and able to lead to monetary liabilities to Insurer.

2.27. Insured trip

Period of time ranging from the effective date and the conclusion date of the trip insurance policy. The trip for indefinite period, either in group or individually, is not construed as insured trip.

3. COVERAGES

3.1. Coverages contracted and ratified in the Insurance Policy shall be covered by this insurance plan.

3.1.1. The Special Conditions refer to the provisions of all coverages with specification of the covered risks.

3.2. This insurance plan has basic coverages (Medical, hospital and/or dental expenses in


Update 051216 6

domestic trip, Medical, hospital and/or dental expenses in trip abroad, Body transportation, Sanitary Regress, Medical Transportation, Death during the Trip, Accidental Death during the Trip and Full or partial permanent incapacity due to trip accident) and additional coverages.

3.2.1. At least one basic coverage is required to be contracted for the insurance plans covering domestic trips.

3.2.2. The basic coverages of Medical, hospital and/or dental expenses in trip abroad (DMHO in trip abroad), Body transportation, Sanitary Regress and Medical Transportation are required to be contracted for the insurance plans covering trips abroad.

3.2.3. The Body transportation coverage may not be severally contracted.

3.2.4. When the basic coverages of Medical, hospital and/or dental expenses in domestic trip, Medical, hospital and/or dental expenses in trip abroad are contracted, the Medical Transportation coverage shall be necessarily contracted.

3.3. Insured or, as the case may be, his/her beneficiary may choose service providers at his/her free choice, provided that these are legally qualified, being reimbursed by the expenses incurred into up to the maximum threshold of the contracted insured capital.

3.4. This trip insurance plan may provide for coverage of events occurred in one or more trips during the insurance effective period, as set forth in the Contractual Conditions. In such case, coverage of one or more trips shall be listed in the Insurance Policy.

3.4.1. All coverages offered herein shall be associated with the trip.

4. RISKS EXCLUDED FROM ALL GUARANTEES

4.1. This insurance shall not indemnify in any of its gu arantees the following events and their resulting consequences:

a) Suicide, either willful or not, and attempt thereof , if occurring on the first two years of initial insurance effectiveness, or as of renewal t hereof after suspended;

b) Epidemics, endemics and pandemics as stated by the applicable agency;

c) Willful illegal acts practiced by insured, by benef iciary or by either of such parties’ legal representative. In insurances contracted by legal e ntities, the same applies to their managing partners, directors and


Update 051216 7

administrators, by the beneficiaries, and by the re spective representatives;

d) Any type of hernia and the consequences thereof, wh en not directly deriving from personal accident and, in case of the coverage of D MHO during trips abroad, when also not deriving from sudden, acute disease;

e) Childbirth or abortion and the consequences thereof , when not directly deriving from personal accident;

f) Anaphylactic shock and the consequences thereof, wh en not directly deriving from personal accident and, in case of the coverage of D MHO during trips abroad, when also not deriving from sudden, acute disease;

g) Pregnancy, including provision of services related to diagnosis and treatment of infertility or any other conditions associated with fertility, Birth control, including surgical interventions and devices for such purpose , Induced abortions, medical expenses and any other expenses related to the newb orn (when the delivery and the consequences thereof are not the direct result of p ersonal accident);

h) Psychiatric (mental, nervous or emotional) disorder s;

i) Use of nuclear material, including nuclear explosio n, either induced or not, as well as radioactive contamination or exposure to nuclear or ionizing radiations;

j) Acts or operation of any war, either declared or no t, chemical or bacteriological war, civil war, guerrilla warfare, insurrection, uprisin g, insurgence, riot, sedition, upheaval or any other disturbances of the public order and d eriving from them, except that insured is certifiably providing military services or if his/her acts are justified by humanity gestures in support to third parties;

k) Terrorist act, which insurer shall attest upon lega l documentation, followed by detailed report characterizing the attempt nature, regardles s of the purpose thereof, and provided that it has been duly certified as an atte mpt to the public order by the applicable authority;

l) Hurricanes, cyclones, earthquakes, seaquakes, volca nic eruptions and other natural convulsions;

m) Injuries deriving from, dependent on, prone to or f acilitated by repetitive effort or cumulative microtrauma, or with cause-effect relati onship with them, as well as injuries rated as: injuries due to repetitive effort (LER), bone-muscular diseases associated with work (DORT), injury due to continued or continuous trauma (LTC) or the like, eventually accepted by the medical-scientific class, as well a s consequences thereof after treatments, including surgical treatments, at any t ime;


Update 051216 8

n) Events known or compared, by the official social se curity institutions or similar entities, to the “accident-related incapacity”, in which the injury-causing event is not fully fit to the characterization of personal accident-caused in capacity;

o) Accidents arising out of practice of extreme sports and notably dangerous, even when practiced as hobby, such as mountain climbing, glid er, parachuting and gliders, fighting sports, such as boxe and martial arts, cav e exploitation, bungee-jumping, self-diving over thirty (30) meters deep or requiring de compression, winter sports, such as skiing or snowboarding out of regulated or unauthor ized tracks and practice or participation by insured in sports contests on ice or snow. Furthermore, automobile, motorcycle racing and engine-propelled nautical spo rts, as driver or passenger and use of snowmobile or similar vehicles are not cover ed.

This insurance plan does not exclude death or incap acity of insured when arising out of using risky transportation means, out of militar y service provision, out of sports practice, or of humanity acts in support to others.

5. GEOGRAPHIC SCOPE

5.1. The territorial coverage scope is the earth, in compliance with the purpose hereof and the trip described in the insurance policy.

6. ELIMINATION PERIODS AND DEDUCTIBLES

6.1. No elimination periods shall be applied in the cove rages hereof.

6.1.1. The insurance claims arising out of Personal Accide nts have no elimination period, except in case of suicide or attempt thereof, when such period shall correspond to two continuous years, counted as of the date when t he insurance is contracted, or renewal thereof after suspended.

6.2. Deductibles, when applied, shall be established in the Special Conditions hereof.

7. CONTRACTING OF/AMENDMENT TO THE INSURANCE POLICY

7.1. Contracting of the insurance shall be as Policy.

7.2. Contracting of insurances by means of a Policy may be upon verbal request by


Update 051216 9

the stakeholder, provided that unequivocally made, the certification of which shall be under insurer’s liability.

7.3. In case of including individuals younger than 14 ye ars of age, offering and contracting

coverages associated with expense reimbursement or with service provisions, either as primary insured or dependent, is exclusively allowe d. The dependent component’s insured assets, when possible to include into the insurance , in any guarantees, may not be greater than that of the primary component.

8. EFFECTIVE PERIOD

8.1. The insurance policy shall detail the initial and c onclusion dates of the effective period of each contracted coverage. The coverage hereof shall begin and end at twenty-four hours (24 a.m.) – time of Brasilia – on the dates contain ed in the insurance policy.

8.2. The coverages, whose triggering event is non-occurrence of the insured trip, shall begin to be

effective on the date prior to that scheduled for beginning of the trip, as described in the insurance policy.

8.3. In case insured cannot return due to a Covered Event, the effective period of the coverages shall

be automatically extended until insured returns to his/her domicile or to the trip initial place, abiding by the threshold of the contracted insured capital.

8.4. If insured returns earlier than the insured trip, the insurance is cancelled as of insured arrives at

the trip’s place of origin or his/her domicile, as the case may be, being covered eventual insurance claims occurred prior to cancellation.

9. EXTENSION

9.1. This insurance shall not be extended. If insured is interested in continuing the coverage, new insurance policy shall be contracted.

10. INSURED CAPITAL

10.1. Insured capital is the maximum amount for the contr acted coverage payable or reimbursed by insurer company, upon occurrence of insurance cl aim covered by the Policy, in force on the event date.

10.2. Event date, for the purpose of determining the insured capital, upon settlement of the insurance claims, is deemed as:


Update 051216 10

a) For Personal Accident coverages, the accident date; b) For the coverage of risk due to incapacity, not resulting from an accident, the date set-out in

the medical certificate; c) For the remaining risk coverages, the date when the Covered Event occurred.

10.3. In case of partial incapacity, the insured capital shall be automatically reinstated after each insurance claim.

10.4. Permanent incapacity shall be attested by a medical certificate. Retirement due to incapacity granted by official social security inst itutions, or the like, does not characterize by itself the permanent incapacity sta tus.

10.5. If after paying indemnity for permanent incapacity due to accident insured dies due to the same accident, the sum previously paid for perm anent incapacity shall be deducted from the amount of the capital insured for death, i f such coverage is contracted.

10.6. For domestic trips, all sums shall be expressed in national currency.

10.7. For international trips, the insured capital of the coverages providing for reimbursement or payment of indemnity related to expenses incurred into by insured abroad may be expressed in foreign or local currency.

10.8. When the insured capital is established in foreign currency:

a) the corresponding premium shall be paid in national currency, converted on the date of contracting thereof, based on the provisions of the specific standards of the National Monetary Council - CMN and the Brazilian Central Bank - Bacen, as applicable; and

b) the contractual documents of the insurance shall state the insured capital set in foreign currency.

10.9. Reimbursement or payment of indemnity related to expenses incurred into abroad shall be in national currency, abiding by the insured capital of each contracted coverage, established in national or foreign currency, the amount of which shall be converted by the Commercial Dollar exchange rate and monetarily adjusted, under specific law, based on the date:

a) of effective payment made by insured, in case of coverage providing for reimbursement of expenses; or

b) of the event, for the purpose of determining the insured capital, in case of coverage providing for payment of the insured capital.

10.10. Reimbursement or payment of indemnities related to expenses incurred into abroad, provided that requested by insured or beneficiary, may be settled in foreign currency, if on the effective settlement date, insured or beneficiary is still abroad.


Update 051216 11

11. UPDATING OF THE INSURANCE SUMS

11.1. The insured assets and the premiums shall be adjusted on an annual basis, on the date of insurance anniversary, by fluctuation of the National Broad Price Index to Consumer – IPCA / IBGE or, in case the index covenanted is extinguished, the General Price Index to Consumer/ Fundação Getúlio Vargas (IPC/FGV) shall be adopted. The IPCA/IBGE index applied shall be that accumulated over the twelve (12) months prior to the month before the insurance anniversary.

11.2. Adjustment shall occur based on the fluctuation calculated between the latest index

published prior to the date of the monetary obligation eligibility and that published immediately prior to the date of effective settlement thereof.

11.3. Payment of sums associated with the monetary adjustment and default interest shall be

made regardless of notice or judicial notification, at once, jointly with the remaining insurance sums.

11.4. If the Insurance is cancelled, the amounts to be returned shall be monetarily adjusted upon

request of cancellation or as of the date of effective cancellation, if it occurs by insurer initiative.

11.5. If indemnity is not paid within the term set forth in item 17.2., it shall imply application of

monetary adjustment by the National Broad Price Index to Consumer – IPCA / IBG E and default interest as of occurrence of the event until the date of such effective indemnity.

11.5.1. In case the index covenanted is extinguished, the General Price Index to Consumer/

Fundação Getúlio Vargas (IPC/FGV) shall be adopted.

11.6. When single or annual premium is paid, the insured assets payable for death or incapacity shall be adjusted by the covenanted index, as provided for in sub-item 11.1 until the date when the respective triggering event occurs, and in case of annual periodicity, to be counted as of the latest adjustment.

12. DEFAULT INTEREST

12.1. Failure by insurer in complying with the obligations as outlined herein shall subject it to the default interest of one percent (1%) per month, plus the monetary adjustment as outlined in item 11.

12.2. The sums related to the obligations arising out of this insurance shall be accreted of fine of two percent (2%) the amount for the obligat ion and the interest described above, when the terms for payment are not complied with hereunder.


Update 051216 12

12.3. The default interest shall apply as of the first da y after conclusion of the terms set herein.

13. PAYMENT OF PREMIUMS

13.1. The premiums hereof shall be paid lump sum on a date prior to beginning of the covered trip.

13.2. If the due date for cash payment of the premium coincides to a day when there are no bank operations, the payment may be made on the first business day when there are bank operations.

13.3. Failure to pay the premium lump sum shall imply ins urance cancellation.

13.4. Cancellation of the insurance whose premium has been paid in cash, upon funding obtained

with financial institutions, when insured fails to pay the funding, is hereby prohibited.

13.5. This plan shall not be amended under insured age rate.

14. INSURANCE CANCELLATION

14.1. The Insurance Policies may not be cancelled during the effective period by insurer company on the allegation of changing nature of the risks.

14.2. The insurance may only be terminated by agreement b etween the contracting parties.

14.3. In case of full or partial insurance termination, a t any time, by initiative of either

contracting party and upon mutual agreement, the fo llowing provisions shall be abided by:

I. Prior to beginning the covered trip: Insurer sha ll withhold, at most, the emoluments.

II. After beginning of the covered trip: Insurer company may withhold from the premium

received, in addition to the emoluments, the share in proportion to the time elapsed .

15. LOSS OF RIGHTS TO INDEMNITY

15.1. Insured shall lose the right to indemnity, if he/sh e willfully aggravates the risk.


Update 051216 13

15.2. Insured shall communicate to insurer company, as so on as he/she is advised thereof, any fact tending to aggravate the covered risk, und er penalty of losing the right to coverage, if it is evidenced that he/she failed to communicate in bad faith.

15.3. Insurer company, provided that doing so within the fifteen (15) days following those of receiving the risk aggravation notice, may infor m, in writing, its decision to cancel the insurance or, by agreement between the parties, restrict the contracted coverage or charge the applicable premium difference.

15.4. Insurance cancellation shall only be effective thir ty (30) days after the notification, and the premium difference shall be refunded, calcu lated in proportion to the period to elapse.

16. HOW TO PROCEED IN CASE OF INSURANCE CLAIM

16.1. Insured or, as the case may be, his/her beneficiary may choose service providers at his/her free choice, provided that these are legally qualif ied, being reimbursed for the expenses incurred into up to the maximum threshold of the co ntracted insured capital.

16.2. If insured does not choose service providers at his /her free choice, he/she shall contact the insurer service center through the phone number listed in his/her insurance policy.

16.2.1. In such phone call, insured shall inform:

a) His/her name and the insurance policy number;

b) The place and phone number of the location in which he/she is;

c) The issue and type of information or assistance required.

17. DOCUMENTATION REQUIRED IN CASE OF INSURANCE CLA IM

17.1. The Special Conditions provide for the respective basic documents outlined to be provided for each type of coverage.

17.2. Upon delivery of the basic documentation for settlement of insurance claims of each coverage, insurer has thirty (30) days for settlement thereof, and insurer company may, in case of grounded and justified doubt, request other documents in addition to those listed above.

17.3. In case of documentation request, the term for insu rance claim settlement shall be suspended. Thus, the term shall continue to be coun ted as of the business day following that in which the requirements are wholly complied with.


Update 051216 14

17.4. Failure to pay the indemnity within the term set in the plan shall imply application of default interest of one percent (1%) per month as of such date, without prejudice to adjustment thereof, under specific law.

17.5. The amounts related to the obligations arising out of this insurance, shall be accreted of fine of two percent (2%) of the amount for the obli gation and the aforementioned interest, when the payment terms are not complied with hereun der.

17.6. The default interest, counted as of the first day following conclusion of the term established, shall

be equivalent to the rate in force for default of the payment of taxes due to the National Treasury Department.

17.7. Amounts of the monetary obligations of the insurer companies are subject to the monetary adjustment by the positive fluctuation of the index covenanted in item 11 hereof as of the event date, in case of non-compliance with the term for payment of the respective monetary obligation. Adjustment shall be made based on the fluctuation calculated between the last index published prior to the date when the monetary obligation is enforceable and that published immediately prior to the date of effective settlement.

17.8. In case of discrepancies on the cause, nature or extent of injuries, as well as assessment of the incapacity related to insured, insurer company shall propose to insured, by means of written communication, within fifteen (15) days, counted as of the dispute date, arrangement of a group of physicians. The group of physicians shall be comprised of three (03) members, one of them being appointed by insurer company, another one, by insured and a third one, arbitrator, chosen by both appointees. Each of the parties shall pay the respective assigned physician’s fees; the third physician’s fees shall be paid, in equal portions, by insured and by insurer company. The term for arranging the group of physicians shall be, at most, fifteen (15) days counted as of the date of appointing the member assigned by insured.

18. BENEFICIARY CLAUSE

18.1. Indemnity shall be paid to the beneficiary appointed by insured. However, if for any reason whatsoever, such appointment fails to prevail, the parties appointed by law shall be beneficiaries.

18.2. If the insurance does not hold as declared cause the guarantee of any obligation, replacing the beneficiary is legally possible, by an inter-vivo or last will act. If insurer is not timely informed of the replacement, it shall be released from the liability, with insured paying capital to the former beneficiary.

18.3. If no person or beneficiary is appointed, or if for any reason the one that was made, does not prevail, the insured capital will be paid half to the spouse not judicially divorced and the rest to the insured's heirs, obeying the order of the hereditary vocation.

18.4. If no person is appointed, those attesting that ins ured’s death deprived them from


Update 051216 15

means required for living shall be the beneficiarie s.

18.5. The spouse may be stated as beneficiary, if upon is suance of the Policy, insured was judicially separated, or was already factually sepa rated.

18.6. A legal entity may only be the beneficiary of this insurance, if the legal interest for it to be under such condition is evidenced.

18.7. In case of concurrent death (simultaneous death) of primary insured and the dependent insured(s), the insured assets concerning the insur eds’, primary insured’s and dependent(s)’ coverages, shall be paid to the respe ctive beneficiaries indicated or, in absence thereof, to the insureds’ legal heirs.

19. COURT

19.1. The judicial quandaries arising out between insured or beneficiary and insurer company, shall be settled before the insured’s or beneficiary’s domicile court, as the case may be.

19.2. In case there is no dependence relationship between the parties, election of the adverse jurisdiction shall be valid.

20. DISCLOSURE MATERIAL

20.1. The promotional and advertising materials shall be disclosed upon express authorization and supervision by insurer company, strictly comply ing with the general and special conditions and the actuarial technical note submitt ed to SUSEP.

21. READJUSTMENT OF THE FEES

21.1. The pure fees for this insurance shall be annually reviewed, when the total amount of the insurance claims exceed fifty percent (50%) the total amount of premiums earned. The new fees shall solely apply to new operations.

22. SERVICE NETWORK

22.1. Insured or, as the case may be, his/her beneficiary may choose service providers at his/her free choice, provided that these are legally qualified, being reimbursed by the expenses incurred into up to the maximum threshold of the contracted insured capital.

IMPORTANT: cost for the contracted service shall be in accordance with the pricing and tariffs practiced in the country where such service has been provided.


Update 051216 16

22.2. Insurer company, provided that keeping on the insured’s trip destination place(s) an authorized service network, may trade trip insurance plans which, in replacement with payment of the insured capital as reimbursement or indemnity in cash, offer the corresponding service provision, when outlined in the contractual conditions of the plan.

22.3. Insurer company shall keep a toll-free insured service phone number, available twenty-four (24) hours and service in Portuguese language, which shall be visibly mentioned in the Policy.

22.4. If contact with the toll-free phone number made available by insurer and/or use of professionals and/or authorized service network is/are not possible, insured or beneficiary may choose service providers at his/her free choice, provided that these are legally qualified, with insurer company being liable for reimbursement of the expenses up to the maximum threshold of the contracted insured capital.

22.5. Insurer shall inform to insured as to existence of the authorized service network on insured’s trip destination place(s).

23. MISCELLANEOUS

23.1. Insured may desist from the contracted insurance, p rovided that prior to the trip, within seven (7) calendar days counted as of issuan ce of the Policy or the effective premium payment, whichever comes later.

23.2. Insurer company, or its insurance representatives, and the qualified insurance broker, as the case may be, shall provide insured w ith immediate confirmation of the receipt of the right of regret.

23.3. If the insured exercises the right of regret outlin ed herein, the amounts eventually paid, on any account, during the term referred to i n item 23.1., shall be immediately returned.

23.4. The return referred to in item 23.3. shall be made by the same means and method of the premium payment, without prejudice to other mea ns available by insurer and expressly accepted by insured.

23.5. Registration of such insurance plan with Susep (Pri vate Insurance Superintendence) does not imply, by such agency, incentive or recomm endation to its trading.

23.6. Insured may search for the enrollment status of his/her insurance broker, on the website www.susep.gov.br, by means of the respective number of enrollment with Susep, full name, Corporate (CNPJ) or Individual Taxpayers’ Register (CPF).


Update 051216 17

23.7. The taxes shall be paid by whomever the law determi nes.

23.8. The statutes of limitations are those determined by law.

23.9. This insurance plan was structured in a divisional financial regime; accordingly, premium return or redemption to insured or benefici ary is not provided for.


Update 051216 18

SPECIAL CONDITION OF THE BASIC COVERAGE

MEDICAL, HOSPITAL AND/OR DENTAL EXPENSES

IN DOMESTIC TRIP (DMHO IN DOMESTIC TRIP)

1. PURPOSE

1.1. This Special Condition is aimed at including the Medical, hospital and/or dental expenses in domestic trip coverage into the Trip Insurance – Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS 2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring

insured with payment of the indemnity for reimbursement, limited to the amount of the insured capital, of the Medical, hospital and/or dental expenses incurred into by insured for his/her treatment, under medical guidance, caused by personal accident or sudden, acute disease occurred during the domestic trip period and once insured is noticed to have departed from his/her domicile city or provision of the corresponding service, when outlined in the contractual conditions of the plan, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

2.1.1. This coverage covers crisis events caused by pre-existing or chronic disease, when triggering an emergency or urgent clinical condition, up to the threshold of the insured capital contracted for the coverage, of the expenses associated with stabilization of insured’s clinical condition allowing for him/her to continue to travel or return to his/her residence place, there being no coverage to continue and control prior treatments, check-ups and prescription extension.

2.1.2. Chronic and pre-existing disease crises occurring d uring the trip period shall be covered, limited to the insured capital, except for continuing and controlling prior treatments, check-ups and prescription extension.

2.1.3. Accidents resulting from Practice of Amateur and Pr ofessional Sports shall be covered, within the insured capital threshold defin ed for such purpose and as set-out in the Insurance Policy.

2.2. It is hereby considered:

a) Emergency: event where insured requires immediate care, because of death risk;

b) Urgency: event where insured requires care, not characterized as emergency,


Update 051216 19

but he/she can wait for the emergency case care events.

§1. Treatment shall be initiated throughout the ins ured trip. Treatment continuity after insured’s return to Brazil shall be borne by insure d.

§2. Insured shall freely choose the medical, hospit al and dental service providers, provided that these are legally qualified.

3. EXCLUDED RISKS 3.1. In addition to the excluded risks in item 4 – RISKS EXCLUDED FROM ALL GUARANTEES of

the General Conditions, are excluded from this cove rage:

a) Variations or complications arising out of exams ca rried out, clinical or surgical treatments, when not arising out of covered persona l accident or sudden, acute disease;

b) Plastic surgeries or aesthetic treatments, except f or the certifiable purpose of repairing a damage caused by covered personal accident or sudde n, acute disease;

c) Convalescence states, after medical discharge and t he companions’ expenses;

d) Devices related to orthosis of any nature and perm anent prosthesis, except for the prostheses for the loss of natural teeth.

4. EVENT DATE 4.1. For the purpose of calculating the indemnity, the e vent date upon settlement of insurance

claims shall be deemed as the date contained in the documents attesting to the requirement of the covered expenses.

5. DEDUCTIBLE 5.1. No deductible shall be applied in this coverage.

6. ELIMINATION PERIOD 6.1. No elimination period shall be applied in this cov erage.

7. DOCUMENTS IN CASE OF INSURANCE CLAIM 7.1. In complement to item 17 – DOCUMENTATION REQUIRED I N CASE OF INSURANCE CLAIM

of the General Conditions hereof, for analysis of i nsurance claim of this coverage the following documents shall be delivered to Insurer, in original or certified copies :


Update 051216 20

a) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

b) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out;

c) Police Report, if any;

d) Invoices and other original certificates of the expenses incurred into;

e) National Driver’s License (CNH), in case the insurance claim involves a vehicle driven by insured;

f) Report or opinion filled-out by the qualified professional who provided the care service, with the technical and diagnostic specifications required.

8. MISCELLANEOUS 8.1. The remaining General Conditions of the Trip Insurance – Policy of QBE Brasil Seguros S.A.

which were not revoked by this Special Condition, are hereby ratified.


Update 051216 21


MEDICAL, HOSPITAL AND/OR DENTAL EXPENSES

IN TRIP ABROAD (DMHO IN TRIP ABROAD)

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Medical, hospital and/or dental expenses in trip abroad into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of the insured capital, the Medical, hospital and/or dental expenses made by insured for his/her treatment, under medical guidance, caused by personal accident or sudden, acute disease occurred during the period of trip Abroad and once insured’s departure from the domicile country is noticed, or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance – Policy.

2.1.1. This coverage covers crisis events caused by pre-existing or chronic disease, when triggering an emergency or urgent clinical condition, up to the threshold of the insured capital contracted for the coverage, of the expenses associated with stabilization of insured’s clinical condition allowing for him/her to continue to travel or return to his/her residence place, there being no coverage to continue and control prior treatments, check-ups and prescription extension.

2.1.2. Crises occurring during the trip period, limited to the insured capital, except for continuing and control of prior treatment, check-up s and prescription extension, shall be covered as chronic and pre-existing disease.

2.1.3. Accidents arising out of Practicing Amateur and Pro fessional Sports, within the insured capital threshold defined for such purpose and as s et-out in the Insurance Policy, shall be covered.

2.2. It is hereby considered:

a) Emergency: event where insured requires immediate care, because of death risk;


Update 051216 22

b) Urgency: event where insured requires care, not characterized as emergency, but he/she can wait for the emergency case care events.

§1. Treatment shall be initiated throughout the ins ured trip. Treatment continuity after insured’s return to Brazil shall be borne by insure d.

§2. Insured shall freely choose the medical, hospit al and dental service providers, provided that these are legally qualified.

3. EXCLUDED RISKS

3.1. In addition to the risks excluded in item 4 – RISKS EXCLUDED FROM ALL GUARANTEES of the General Conditions, the following risks are exc luded from this coverage:

a) Variations or complications arising out of exams ca rried out, clinical or surgical treatments, when not arising out of covered persona l accident or sudden, acute disease;

b) Plastic surgeries or aesthetic treatments, except for the certifiable purpose of repairing a damage caused by covered personal accident or sudde n, acute disease;

c) Convalescence states, after medical discharge and t he companions’ expenses;

d) Devices related to orthosis of any nature and to p ermanent prosthesis, except for the prostheses for the loss of natural teeth.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the e vent date upon settlement of insurance claims shall be deemed as a date contained in the d ocuments attesting to the requirement of the covered expenses.

5. DEDUCTIBLE

5.1. No deductible shall be applied in this coverage.

6. ELIMINATION PERIOD

6.1. No elimination period shall be applied in this cov erage.

7. DOCUMENTS IN CASE OF INSURANCE CLAIM


Update 051216 23

7.1. In complement to item 17 – DOCUMENTATION REQUIRED IN CASE OF INSURANCE CLAIM of the General Conditions hereof, for analysis of i nsurance claim of this coverage the following documents shall be delivered to Insurer, in original or certified copies :





e) National Driver’s License (CNH), in case the insurance claim involves a vehicle driven by insured;

f) Report or opinion filled-out by the qualified professional who provided the care service, with the technical and diagnostic specifications required.

8. MISCELLANEOUS

8.1. The remaining General Conditions of the Trip Insurance – Policy of QBE Brasil Seguros S.A. which were not revoked by this Special Condition, are hereby ratified.


Update 051216 24


BODY TRANSPORTATION

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Body transportation into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity, for reimbursement of the expenses with release and transportation of insured’s body, from the place wh ere the Covered Event occurred up to the domicile or the burial place, limited to the amount of the insured capital, including into such expenses all procedures and objects essential to body transportation, or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance – Policy.

2.2. IMPORTANT: If insured’s family chooses to cremate insured’s body, the insurance shall transport the urn containing the ashes.

3. EXCLUDED RISKS

3.1. The risks excluded in item 4 - RISKS EXCLUDED FROM ALL GUARANTEES, of the General Conditions, are excluded from this coverage.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date when insured dies.

5. DEDUCTIBLE



6.1. No elimination period shall be applied in this cove rage.


Update 051216 25


7.1. In complement to item 17 – DOCUMENTATION REQUIRED I N CASE OF INSURANCE CLAIM of the General Conditions hereof, for analysis of i nsurance claim of this coverage the following documents shall be delivered to Insurer, in original or certified copies : a) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate; b) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out; c) Insured’s Death Certificate; d) Invoices and other original certificates of the expenses incurred into.

8. MISCELLANEOUS



Update 051216 26


SANITARY REGRESS

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Sanitary Regress into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, consists in the indemnity, for reimbursement of the expenses with insured’s return trip to the original trip place or the insured’s domicile , limited to the amount of the insured capital, as defined in the contractual conditions, if insured is not able to return as regular passenger due to covered personal accident or disease, or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition of the Trip Insurance – Policy.

2.2. IMPORTANT: This coverage shall also include the hotel/hospital transportation to the airport in a vehicle compatible to insured’s health condition.

3. EXCLUDED RISKS


a) Sanitary Regress not deriving from personal acciden t or disease attested by a physician.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date when the return transportation is required as attested by qualified physician.

5. DEDUCTIBLE



Update 051216 27




7.1. In complement to item 17 – DOCUMENTATION REQUIRED I N CASE OF INSURANCE CLAIM of the General Conditions hereof, for analysis of i nsurance claim of this coverage the following documents shall be delivered to Insurer, in original or certified copies :


b) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and signed;


d) National Driver’s License (CNH), in case the insurance claim involves a vehicle driven by insured;

e) Report or opinion filled-out by the qualified professional who provided the care service, with the technical and diagnostic specifications required pointing to the required Sanitary Regress;

f) Invoices and other original certificates of the expenses incurred into.

8. MISCELLANEOUS

8.1. The remaining General Conditions of the Trip Insurance of QBE Brasil Seguros S.A. which were not revoked by this Special Condition, are hereby ratified.


Update 051216 28


MEDICAL TRANSPORTATION

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Medical Transportation into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, consists in the indemnity, for reimbursement of the expenses with insured’s removal or transfer to the nearest clinic or hospital in conditions to assist him/her, limited to the amount of the insured capital, due to covered personal accident or disease , or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition of the Trip Insurance - Policy.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date when the Medical Transportation is required as attested by qualified physician.

5. DEDUCTIBLE





Update 051216 29





c) Report or opinion filled-out by the qualified professional who provided the care service, with the technical and diagnostic specifications required pointing to the required Medical Transportation;

d) Invoices and other original certificates of the expenses incurred into.

8. MISCELLANEOUS



Update 051216 30


DEATH DURING THE TRIP

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Death during the Trip into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring the Beneficiary(ies) appointed in the Policy, at once, with payment of the insured capital indemnity, in case of insured’s death, due to natural or accidental cause s, during the trip period, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition of the Trip Insurance - Policy.

IMPORTANT: When the insured is younger than 14 year s of age (inclusive), the indemnity shall be solely intended to reimbursement of the bu rial expenses, which shall be evidenced by providing original certification invoices. The i ndemnity shall be limited to the insured capital contracted for this guarantee.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the e vent date upon settlement of insurance claims shall be deemed as the date of insured’s dea th.

5. DEDUCTIBLE





Update 051216 31





c) Insured’s Death Certificate;

d) Police Report, if any;

e) National Driver’s License (CNH), in case the insurance claim involves a vehicle driven by insured.

8. MISCELLANEOUS



Update 051216 32


ACCIDENTAL DEATH DURING THE TRIP

1. PURPOSE

1.1 This Special Condition is aimed at including the coverage of Accidental Death during the Trip into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

This Special Condition, provided that contracted and the premium is paid, is aimed at assuring the Beneficiary(ies) appointed in the Policy, at once, with payment of the insured capital indemnity, in case of insured’s death, due to personal accident o ccurred during the trip period , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

IMPORTANT: When the insured is younger than 14 year s of age (inclusive), the indemnity shall be solely intended to reimbursement of the bu rial expenses, which shall be evidenced by providing original certification invoices. The i ndemnity shall be limited to the insured capital contracted for this guarantee.

3. EXCLUDED RISKS

3.1 In addition to the risks excluded in item 4 – RISKS EXCLUDED FROM ALL GUARANTEES of the General Conditions, the following risks are exc luded from this coverage:

a) Variations or complications arising out of exams ca rried out, clinical or surgical

treatments, when not arising out of covered persona l accident;

b) Cardiovascular accidents, cerebrovascular accident (CVA), aneurism, syncope, apoplexy, epilepsy and medical accidents, when not arising out of covered accident; and

c) Accidents suffered prior to contracting the insuran ce, even if their sequelae have onset

during the effective period thereof.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the e vent date upon settlement of insurance


Update 051216 33

claims shall be deemed as the accident date.

5. DEDUCTIBLE








c) Insured’s Death Certificate;

d) Police Report, if any;

e) National Driver’s License (CNH), in case the insurance claim involves a vehicle driven by insured.

8. MISCELLANEOUS



Update 051216 34


FULL OR PARTIAL PERMANENT INCAPACITY DUE TO TRIP AC CIDENT

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Full or partial permanent incapacity due to trip accident into the Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity, limited to the amount of the insured capital, in case of definite, full or partial functional loss, reduction or disab ility , of the limbs or organs defined in the Policy, due to an injury suffered by insured, caused due to personal accident occurred during the trip period, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance.

2.2. After treatment conclusion, or depletion of all therapeutic resources available for recovery, after ascertaining and assessing the permanent incapacity upon the definite medical discharge, insurer company shall pay indemnity, in accordance with the percentages set forth below:

2.2.1. IN CASE OF PERMANENT AND TOTAL INCAPACITY

DESCRIPTION Indemnity

of both eyes’ vision 100% of IS

of both upper limbs’ use 100% of IS

of both lower limbs’ use 100% of IS

of hands’ use 100% of IS

of one upper limb’s and one lower limb’s use 100% of IS

of one hand’s and one foot’s use 100% of IS

of both feet’s use 100% of IS

Total and unhealable mental alienation 100% of IS

Two-sided nephrectomy 100% of IS


Update 051216 35

2.2.2. IN CASE OF PERMANENT AND PARTIAL INCAPACITY (MISCEL LANEOUS)


Total loss of one eye’s vision 30% of IS

Total loss of one eye’s vision, when Insured has already lost the other eye’s vision 70% of IS

Total, unhealable deaf of both ears 40% of IS

Total, unhealable deaf of one of the ears 20% of IS

Unhealable dumbness 50% of IS

Non-consolidated fracture of the lower jaw 20% of IS

Immobility of the backbone cervical segment 20% of IS

Immobility of the backbone thoracic-lumbar-sacrum segment

25% of IS

2.2.3. IN CASE OF PERMANENT AND PARTIAL INCAPACITY OF THE UPPER LIMBS


Total Loss of one of the upper limbs 70% of IS

Total Loss of one hand’s use 60% of IS

Non-consolidated fracture of one of the humeri 50% of IS

Non-consolidated fracture of one of the radioulnar segments 30% of IS

Total anchylosis of one of the shoulders 25% of IS

Total anchylosis of one of the elbows 25% of IS

Total anchylosis of one of the wrists 20% of IS

Total loss of one of the thumbs’ use including the metacarpal 25% of IS

Total loss of one of the thumbs’ use excluding the metacarpal

18% of IS

Total loss of the use of thumb’s distal phalanx 9% of IS


Update 051216 36

Total loss of one of the forefingers’ use 15% of IS

Total loss of one of the little fingers’ or one of the middle fingers’ use

12% of IS

Total loss of one of the ring fingers’ use 9% of IS Total loss of any phalanx’s use, excluding those of the thumb

1/3 of the respective

finger value

2.2.4. IN CASE OF PERMANENT AND PARTIAL INCAPACITY OF THE LOWER LIMBS

DESCRIPTION INDEMNITY

Total loss of one of the lower limbs 70% of IS

Total use loss of one of the feet 50% of IS

Non-consolidated fracture of a femur 50% of IS

Non-consolidated fracture of one of the tibial-perineurium segments

25% of IS

Non-consolidated fracture of the patella 20% of IS

Non-consolidated fracture of one foot 20% of IS

Total anchylose of one of the knees 20% of IS

Total anchylose of one of the ankles 20% of IS

Total anchylose of one hip 20% of IS

Partial loss of one of the feet, i.e., loss of all toes and part of the same foot

25% of IS

Amputation of the first (1st) toe 10% of IS

Amputation of any other toe 3% of IS


Update 051216 37

Total loss of the use of a 1st toe phalanx,

indemnity equivalent to

½, and the remaining toes,

equivalent to 1/3 of the respective toe.

SHORTENING OF ONE OF THE LOWER LIMBS:

Five (5) centimeters or more 15%

Four (4) centimeters 10%

Three (3) centimeters 6%

Less than three (3) centimeters No indemnity

2.2.5. IN CASE OF LOSS OR DECREASED FUNCTIONAL STRENGTH OR CAPACITY DEEMED AS THAT NOT RESULTING FROM INJURIES (MISCELLANEOUS).

DESCRIPTION INDEMNITY

JAW

Lower Jaw (maxillary) decreased movements

Minimum degree 5% of IS

Medium degree 10% of IS

Maximum degree 15% of IS

NOSE 20% of IS

Total nose amputation with total smell loss 25%

Total smell loss 7%

Smell loss with taste changes 10%

VISUAL SYSTEM AND ADNEXA OF THE EYE


Update 051216 38

Diplopia Injuries of the tear ducts 15%

One-sided 7%

One-sided with fistulas 15%

Two-Sided 14% 25% Two-Sided with fistulas

Injuries of the eyelid

One-sided Ectropium 3%

Two-Sided Ectropium 6%

One-sided Entropion 7%

Two-sided Entropion 14%

One-sided bad eyelid occlusion 3%

Two-sided bad eyelid occlusion 6%

One-sided eyelid ptosis 5%

Two-sided eyelid ptosis 10%

PHONATION SYSTEM

Word loss (unhealable dumbness) 50%

Substance loss (soft and hard palate) 15%

HEARING SYSTEM

Total amputation of one ear

Total amputation of both ears

8%

SPLEEN LOSS 15%

URINARY TRACT

Chronic urine retention (mandatory catheterizations) 15%

Cystostomy (definite) 30%

Permanent urinary incontinence 30%


Update 051216 39

Loss of a kidney, with remaining kidney

with preserved renal function 30%

Decreased renal function (non-dialytic) 50%

Decreased renal function (dialytic) 75%

Loss of single kidney 75%

GENITAL AND REPRODUCTIVE SYSTEMS

Loss of one testicle 5%

Loss of both testicles 15%

Traumatic penis amputation 40%

Loss of one ovary 5%

Loss of both ovaries 15%

Pre-menopause uterus loss 30%

Post-menopause uterus loss 10%

NECK

Pharynx stenosis with impaired swallowing 15%

Esophagus injury with motor function disorders 15%

Definite tracheostomy 40%

THORAX RESPIRATORY TRACT

Post-traumatic pleural sequelae 10%

Total or par tial resection of one lung (pneumectom y – partial o r total)

with preserved respiratory function 15%

with decreased minimum respiratory function degree 25%

with decreased medium respiratory function degree 50%

with respiratory failure 75%

BREASTS (WOMEN)

One-sided mastectomy 10%


Update 051216 40

Two-sided mastectomy 20%

ABDOMEN (ORGAN AND ENTRAILS)

Subtotal Gastrectomy 20%

Total Gastrectomy 40%

SMALL INTESTINE

Partial resection 20%

Partial resection with malabsorption syndrome or definite ileostomy

40%

LARGE INTESTINE

Partial Colectomy 20%

Total Colectomy 40%

Definite Colostomy 40%

RECTUM AND ANUS

Prolapse-free Fecal Incontinence 30%

Fecal Incontinence with prolapse 50%

Anal retention 10%

LIVER

Hepatic lobectomy w/o functional change 10%

lobectomy with hepatic insufficiency 50%

NEUROLOGICAL SYNDROMES

Post-traumatic epilepsy 20%

Ventriculo-peritoneal bypass (hydrocephaly) 20%

Post-concussion syndrome 5%

2.3. If functions of the injured limb or organ are fully extinguished, indemnity for partial loss is calculated by applying, to the percentage outlined in the plan for total loss thereof, the functional decreased level provided.

2.4. Insured shall have the insurance cancelled after payment of indemnity concerning coverage of total incapacity, upon consequent refund of sums eventually paid after such date,


Update 051216 41

duly adjusted under the specific regulation.

2.5. If there is no accurate provision of the functional decreased level provided, and if such level is rated only as maximum, medium or minimum, the indemnity shall be calculated, based on the 75%, 50% and 25% percentages, respectively.

2.6. In the cases not specified in the plan, the indemnity is established based on insured’s permanent physical capacity decrease, regardless of insured’s profession.

2.7. When incapacity of more than one limb or organ results from the same accident, the indemnity shall be calculated by adding the respective percentages, the total of which may not exceed one hundred percent (100%).

2.8. In case of two or more injuries in a same limb or organ, the sum of the corresponding percentages may not exceed that of the indemnity outlined for total loss thereof.

2.9. For the purposes of indemnity, the loss or greater functional reduction of an already defective limb or organ previously to the accident, shall be deducted from the definite incapacity level.

2.10. Loss of teeth and aesthetic damages shall not entitle to indemnity for permanent incapacity.

3. EXCLUDED RISKS


a) Variations or complications arising out of exams ca rried out, clinical or surgical

treatments, when not arising out of covered persona l accident;

b) Cardiovascular accidents, cerebrovascular accident (CVA), aneurism, syncope, apoplexy, epilepsy and medical accidents, when not arising ou t of covered accident; and

c) Plastic surgeries or aesthetic treatments, except f or the certifiable purpose of repairing a

damage caused by covered personal accident.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the accident date.

5. DEDUCTIBLE


Update 051216 42








c) As the case may be, Police Report;

d) National Driver’s License (CNH), in case the insurance claim involves a vehicle driven by

insured;

e) Report or opinion filled-out by the qualified professional who provided the care service, with the technical, diagnostic specifications required, level and date of incapacity.

8. MISCELLANEOUS



Update 051216 43

SPECIAL CONDITION OF THE ADDITIONAL COVERAGE

LUGGAGE INSURANCE - SUPPLEMENTARY

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of LUGGAGE INSURANCE -

SUPPLEMENTARY into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity in cash , to be solely calculated by the recorded weight, limited to the amount of the insured capital, in case of luggage misplacement , provided that under the liability of the carrier company, attested upon provision of the certifiable PIR - Property Irregularity Report. Indemnity shall be calculated based on the weight of the shipped luggage, considering the amount/kg set-out in the contracted plan, in compliance with the maximum threshold of the coverage insured capital, no matter, on any allegation, the amount of the contents thereof.

3. EXCLUDED RISKS


a) Any damages caused to the luggage contents;

b) Damages to glasses, contact lenses and any mouth de vices;

c) Jewelry, fur, watches, bonds, art works, policies a nd cash (including traveler’s checks);

d) Luggage not previously delivered under the liabilit y of the carrier company and hand

luggage;

e) Any damages to Insured’s luggage prior to delivery to the carrier company;

f) Luggage forfeiture, seizure, damage or destruction by the Customs Authority or any other governmental authority;

g) Luggage belonging to pilots, crew members, employee s or individuals interested in the

carrier company;


Update 051216 44

h) Luggage-specific damages, leakage or liquid spillin g, nibbling, or any other damage, even if total, caused due to bookworm, insect or mold, t he cause of which is not certifiably assignable to accidents or fire with the carrier me ans;

i) Theft and luggage misplacement under insured’s liab ility;

j) Partial theft of the luggage contents;

k) Failure by insured to take the luggage as soon as i t is made available by the carrier

company;

l) Liquids and general beverages, either alcoholic or not, as well as food of any kind, either perishable or not;

m) Any types of animals.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date contained in the PIR - Property Irregularity Report, certifying no luggage recovery.

5. DEDUCTIBLE

5.1. No deductible shall be applied in this coverage



7. DOCUMENTATION IN CASE OF INSURANCE CLAIM



b) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and

signed;


Update 051216 45

c) Voucher copy;

d) PIR - Property Irregularity Report issued by the carrier company in charge, attesting the lost luggage weight in kilograms;

e) Original luggage ticket, containing the luggage weight;

f) Indemnity certificate issued by the carrier company.

8. MISCELLANEOUS

8.1. The remaining General Conditions of the Trip Insurance Plan - Policy which were not revoked by

this Special Condition are hereby ratified.


Update 051216 46


LUGGAGE INSURANCE – COMPLEMENTARY

9. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Luggage insurance into the Trip

Insurance - Policy of QBE Brasil Seguros S.A.

10. COVERED RISKS

10.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity in cash , to be solely calculated by the list of items reported by insured, limited to the amount of the insured capital, in case of luggage misplacement , provided that under the liability of the carrier company, attested upon provision of the certifiable PIR - Property Irregularity Report. Indemnity shall be calculated based on the list of items reported by insured, in compliance with the maximum threshold of the coverage insured capital.

IMPORTANT: Difference between the sum reimbursed by the carrier company and the calculated amount shall lie on Insurer, provided th at the contracted thresholds for this coverage and the verified loss are abided by.

11. EXCLUDED RISKS


n) Any damages caused to the luggage contents;

o) Damages to glasses, contact lenses and any mouth devices;

p) Jewelry, fur, watches, bonds, art works, policie s and cash (including traveler’s checks);

q) Luggage not previously delivered under the liabi lity of the carrier company and hand

luggage;

r) Any damages to Insured’s luggage prior to delive ry to the carrier company;

s) Luggage forfeiture, seizure, damage or destructi on by the Customs Authority or


Update 051216 47

any other governmental authority;

t) Luggage belonging to pilots, crew members, emplo yees or individuals interested in the carrier company;

u) Luggage-specific damages, leakage or liquid spil ling, nibbling, or any other damage, even

if total, caused due to bookworm, insect or mold, t he cause of which is not certifiably assignable to accidents or fire with the carrier me ans;

v) Theft and luggage misplacement under insured’s l iability;

w) Partial theft of the luggage contents;

x) Failure by insured to take the luggage as soon a s it is made available by the carrier

company;

y) Liquids and general beverages, either alcoholic or not, as well as food of any kind, either perishable or not;

z) Any types of animals.

12. EVENT DATE

12.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date contained in the PIR - Property Irregularity Report, certifying no luggage recovery.

13. DEDUCTIBLE







Update 051216 48



c) Voucher copy;

d) PIR - Property Irregularity Report issued by the carrier company in charge

e) Original luggage ticket;

f) List of items contained in the luggage, as well as the values thereof;

g) Indemnity certificate issued by the carrier company.

16. MISCELLANEOUS

16.1. The remaining General Conditions of the Trip Insurance Plan - Policy which were not revoked by

this Special Condition are hereby ratified.


Update 051216 49


INSURED’S RETURN

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Insured’s return into the Trip Insurance - Policy of QBE Brasil Seguros S/A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement , limited to the amount of the insured capital, the expense incurred into of an economic class air ticket for insured’s return to his/her city/State/country of origin, if such insured is prevented from continuing the trip due to a Covered Event, or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and abiding by the remaining items of the General Conditions of the Trip Insurance.

IMPORTANT: This ticket shall only be provided, if using the previously issued air ticket is not possible.

2.1.1. Early Return shall be covered due to the following events:

� Fire or theft on insured’s customary residence;

� Sudden disease, accident or death of insured him/he rself, his/her trip companion or any insured’s or his/her trip companion’s family member .

IMPORTANT: For this coverage, family members shall be construed as the relatives with a 1st kinship degree and resident in Brazil.

3. EXCLUDED RISKS



Update 051216 50

a) Insured’s return due to events not described in item 2.1.1.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date contained in the document attesting to insured’s early return due to a Covered Event.

5. DEDUCTIBLE





7.1. In complement to item 17 – DOCUMENTATION REQUIRED I N CASE OF INSURANCE CLAIM of the General Conditions hereof, for analysis of i nsurance claim of this coverage the following documents shall be delivered to Insurer, in original or certified copies:

a) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and

signed;

b) Same documents required for Settlement of the Covered Event Insurance Claim;

c) Individual Taxpayers’ Register (CPF), ID Card (RG) and residence certificate;

d) Certificate of payment of the new ticket bought, as well as the tickets and/or internet purchase certificates and prior tickets;

e) Police Report and Fire Brigade Report, in case of insurance claim occurred due to fire or theft on

the residence;

f) Medical report indicating the clinical condition shown by insured or companion or relative, as well as recommendation to return to Brazil, in case of insurance claim occurred for disease.


Update 051216 51

8. MISCELLANEOUS

8.1. The remaining General Conditions of the Trip Insurance Plan of QBE Brasil Seguros S.A. not revoked by this Special Condition are hereby ratified.


Update 051216 52


LEGAL COUNSEL

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Legal Counsel into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of the insured capital, the expenses with attorney’s fees if insured suffers any sort of accident in which insured is held liable and requires legal counsel during the trip period, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as a date contained in the documents attesting to the requirement of the covered expenses.

5. DEDUCTIBLE



6.1. No elimination period shall be applied in this coverage



Update 051216 53




c) Copy of the Occurrence issued by the respective local authority, attesting to occurrence of the Accident;

d) Copies of the defense documents issued or hearings in which the hired attorney took part;

e) Original receipts of the attorney’s fees, containing professional’s identification to exercise the duty;

8. MISCELLANEOUS



Update 051216 54


GUARANTEE AND LEGAL EXPENSES

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Guarantee and legal expenses into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of the insured capital, the legal expenses incurred into to insured or Benefici ary(ies) as well as guarantee costs , due to the order of arrest or undue imprisonment by any government or foreign authority during the trip period, or provision of the corresponding service, when outlined in the plan’s contractual conditions unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

3. EXCLUDED RISKS


4. EVENT DATE


5. DEDUCTIBLE



6.1. No elimination period shall be applied in this coverage.


Update 051216 55



a) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and signed;

b) Copy of the Occurrence issued by the respective local authority, attesting to the undue arrest or imprisonment;

c) Original certificates of guarantee or procedural cost payments; d) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS

8.1. The remaining General Conditions of the Trip Insurance - Policy of QBE Brasil Seguros S.A. which were not revoked by this Special Condition, are hereby ratified.


Update 051216 56


FLIGHT DELAY

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Flight delay into the Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with indemnity for reimbursement limited to the amount of the insured capital, the expenses related to lodging and food incurred into due to flight delay/ cancellation , if insured’s flight delays six (6) hours or more , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

Delays due to the following events shall be covered by this coverage:

a) Any severe climatic condition delaying a scheduled flight arrival or departure;

b) Any labor-related issue interfering with a flight arrival or departure (employee strike);

c) Any sudden, unforeseen damage to the aircraft of good standing air company.

IMPORTANT: reimbursement is limited to payment of food and lod ging expenses not previously paid by the regular air company, while t he delay lasts. This coverage solely refers to regular air companies’ flights, not comprising, therefore, chartered flights .

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date of flight delay.


Update 051216 57

5. DEDUCTIBLE

5.1. A 6-hour Deductible shall apply to this coverage.






b) Air ticket and shipping card copy;

c) Original food and lodging expense certificates;

d) Air company statement, except that deriving from a publicly known fact, confirming the delay and number of hours;

e) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS



Update 051216 58


CANCELLATION/INTERRUPTION PLUS REASON OR

TRIP CHANGE

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Cancellation/Interruption Plus Reason into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of contracted insured capital for this coverage, in case of unrepairable losses with deposits and/or expenses early paid in reference to his/her trip, due to cancellation, interruption or trip change , if insured is prevented from beginning or continuing the trip, and provided that the tourism operator/agency fails to reimburse him/her , during the trip period, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

2.1.1. Cancellation/Interruption Plus Reason due to the fo llowing shall be covered: a) Death, severe disease or severe bodily accidents of:

� Insured; � First kinship degree relative; � The individual appointed for tutoring minors or handicapped people; � The professional replacement.

b) Death of the relative of up to third kinship degree; c) Severe losses on insured’s residence or work place; d) Insured’s labor dismissal; e) Incorporation to a new job function, in a different company, with a labor agreement; f) Letter for cancellation of vacations issued by insured’s company; g) Call-up as party or witness to a court or jury member; h) Provision of evidence for competitive civil-service examination; i) Appointment for a function as a civil servant; j) Call-up as member of the polls; k) Legal requirement prior to beginning the trip (irrefutable call-up/service); l) Cancellation by a companion for any covered cause (ensures payment


Update 051216 59

of the individual supplement and individual expenses for disappearance of the minimum group);

m) Documentation or luggage theft, preventing insured from beginning his/her trip; n) Visa denied for destinations where it is issued upon entering the country; o) No acceptance of passenger/visa issued in Brazil, i.e., refusal notice issued by the

destination country; p) Damage or accident to the vehicle owned by insured or his/her spouse, preventing

insured from beginning his/her trip; q) Extension of the labor agreement; r) Forced work transfer, with transportation lasting over three months; s) Unexpected call for surgical intervention; t) Insured’s marriage cancellation; u) Insured’s separation/divorce; v) Pregnancy contracted after the trip acquisition date; w) Complication in pregnancy or abortion. x) Rejection of school subjects of insured or first kinship degree relative; y) Compensation for change to dates of tests, works, presentations of insured or first

kinship degree relative.

If such reimbursement is partial, insurer shall onl y be entitled to the difference between the amount reimbursed by the operator and the total amo unt of expenditures, provided that in compliance with the thresholds contracted for this coverage. Insurer shall be immediately notified after the trip cancellation and be informe d of the reason.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the e vent date upon settlement of insurance claims shall be deemed as the trip cancellation dat e.

5. DEDUCTIBLE



Update 051216 60






b) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and

signed;

c) Document attesting to the family relationship of insured to the damaged person (individual who suffered the death or hospitalization), being: • If insured’s parentes or children: copy of the ID Card (RG) or Birth Certificate and

Individual Taxpayers’ Register (CPF). • If insured’s spouse: copy of the ID Card (RG) and Individual Taxpayers’ Register (CPF).

Up-to-date marriage certificate (taken from the registry office after the event occurs). If issuing the up-to-date certificate is not possible, send the Marriage Certificate and the Private Certificate of Stable Union. In case the person does not own a Marriage Certificate, send up-to-date Public Certificate of Stable Union (drafted before a registry office).

• If insured’s sibling: copy of the ID Card (RG) and Individual Taxpayers’ Register (CPF) of sibling and parents.

d) Letter reporting the amount of the fine collected due to cancellation, being: • Maritime Trip: document issued by the maritime company; • Air + Land Trip: copy of the agreement with description of the acquired pack and amount of

the trip and letter from the trip agency in a letterhead document and with signature of the party in charge informing amount of the fine, as well as confirmations by suppliers on the fine applied (emails).

7.2. In addition to the aforementioned documents, send in case of:

a) Cancellation for death of insured, first degree relative or professional replacement:

•••• Copy of the death certificate.

b) Cancellation for hospitalization of insured, first degree relative or professional replacement:


Update 051216 61

•••• Hospitalization report, with hospitalization date, medical discharge date, ICD – International Classification of Diseases and patient information;

•••• Medical report, informing the period required for resting.

c) Cancellation for Judicial notice of Insured: •••• Copy of the judicial notice;

d) Cancellation for Insured’s Quarantine:

•••• Certificate issued by the sanitary authority reporting that insured must remain in quarantine, as well as informing the disease that put him/her to such situation.

e) Death of the relative of up to third kinship degree;

•••• Copy of the death certificate; •••• Documentation attesting to kinship degree.

f) Severe losses to insured’s residence or work place;

•••• Copy of the police report with occurrence description.

g) Insured’s labor dismissal; •••• Copy of the labor termination informing dismissal date.

h) Incorporation into new job function, in a different company, with labor agreement;

•••• Original company certificate stating incorporation date.

i) Letter for cancellation of vacations issued by insured’s company; •••• Original company certificate stating cancellation of the vacations.

j) Call-up as party or witness to a court or jury member;

•••• Copy of the service of process received by the court, containing name and date for attendance.

k) Attendance to competitive civil-service examination;

•••• Test date certificate

l) Appointment for civil service assignment; •••• Copy of the Brazilian Official Gazette with the appointment for the assignment.

m) Call-up as poll member;


Update 051216 62

•••• Certificate of the Brazilian Regional Electoral Court (TER) call-up.

n) Legal requirement prior to beginning the trip (irrefutable call-up/notification); •••• Legal requirement certificate.

o) Cancellation by a companion for any covered cause (assures payment of the individual

supplement and individual expenses for disappearance of the minimum group); •••• Letter clarifying the reason for companion’s cancellation.

p) Documentation or luggage theft, preventing insured from beginning his/her trip;

•••• Copy of the police report describing the facts.

q) No acceptance of passenger/visa requested in Brazil, i.e., refusal notice issued by the country of destination;

•••• Copy of the passport with the denied visa.

r) Damage or accident to the vehicle owned by insured or his/her spouse, preventing insured from beginning his/her trip;

•••• Letter reporting the occurrence; •••• Copy of the vehicle document in the name of insured or spouse; •••• Certificate of the damage to the vehicle which prevented arrival to the airport (car fixing

record); •••• In case of vehicle owned by the spouse, send copy of the marriage certificate; •••• Copy of the police report describing the facts in case of traffic accident;

s) Labor agreement extension;

•••• Original company certificate stating the labor agreement extension.

t) Forced labor transfer, with transportation lasting longer than three months; •••• Original company certificate stating on forced transfer.

u) Unexpected call for surgical intervention.

•••• Report issued by insured’s assistant physician informing diagnosis and reason for urgent surgery.

v) Insured’s marriage cancellation;

•••• Certificate of marriage cancellation issued by the registry office.

w) Insured’s separation/divorce;


Update 051216 63

•••• Marriage certificate containing divorce registration.

x) Pregnancy contracted after the trip acquisition date; •••• Exam to attest to pregnancy after purchasing the trip.

y) Complication in pregnancy or abortion.

•••• Report issued by insured’s obstetrician informing on the complication in pregnancy/abortion

z) Rejection of school subjects of insured or first kinship degree relative;

•••• Certificate issued by the college/university confirming rejection.

aa)Compensation for change to exam, work, presentation dates of insured or first kinship degree relative.

•••• Certificate issued by the college/university/company, confirming change to the exams/ works or presentations.

bb) Trip change

•••• Certificate of the request for reschedule the trip date; •••• Certificate of the trip rescheduling fine; •••• Certificate of the new trip purchase.

8. MISCELLANEOUS



Update 051216 64


PHYSIOTHERAPY

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Physiotherapy into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of the indemnity, for reimbursement, limited to the amount of the insured capital of Physiotherapy Expenses made by insured for his/her treatment, under medical guidance, deriving from personal accident or sudden, acute disease occurred during the trip period , when outlined in the plan’s contractual conditions unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

Insured may choose service providers at his/her fre e choice, provided that these are legally qualified, being reimbursed for the expenses incurr ed into up to the maximum threshold of the contracted insured capital.

3. EXCLUDED RISKS


a) rejuvenator or aesthetic treatments;

b) prosthesis and orthosis purchases;

c) congenital disorders and the resulting conditions thereof;

d) pediatric care services and of healthy individuals , including routine, school, university exams and immunizations (vaccines);

e) medical services and supplies generated out of the trip effective period;

f) losses, damages, costs or expenditures of any natu re, directly or indirectly caused for, resulting from, or related to any terrorism act, ev en when there is any other cause or occurrence contributing towards the event;


Update 051216 65

g) any physiotherapy treatment not strictly medically required;

h) drug purchases;

i) convalescence states (after medical discharge) and companions’ expenses;

j) Devices related to orthosis of any nature and to p ermanent prosthesis, except for the prostheses for the loss of natural teeth;

k) services, supplies or treatments, including any ho spitalization period, not prescribed, approved and certified as strictly necessary by the physician;

l) physical, laboratorial or radiographic routine and /or preventive exams not strictly necessary and not being a direct consequence of a d isease or accident covered by the insurance.

m) dental services and supplies in insured’s country of residence (in case of international coverage) or in the city where insured resides (in case of national insurance);

n) restoring, plastic surgery or one which was not abs olutely essential and necessary, except as a result of insured’s injury occurred dur ing the trip and covered by this insurance.

o) septum deviation;

p) organ transplantation;

q) psychiatric disorders (mental, nervous or emotiona l);

r) participation in quarrels or fights;

s) kidnapping or intention thereof;

t) losses, damages, costs or expenditures of any natu re, directly or indirectly caused for, resulting from, or related to any terrorism act, ev en when there is any other cause or occurrence contributing towards the event;

u) learning operations to operate any aircraft or act ivities as crew member on such aircraft;

v) any routine treatment, dental treatments not relat ed to the covered accident;

w) expenditures in purchase, arrangement or replaceme nt of prostheses, although arising out of an injury;


Update 051216 66

x) dental services and supplies occurred out of the t rip effective period;

y) drug purchases.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date contained in the documents attesting to the requirement of the covered expenses.

5. DEDUCTIBLE







b) Reports by the assistant physician and exams related to the covered injury and need for physiotherapy, provided for Insured’s emergency care;

c) Original expense certificates;

d) Copy of Insured’s identification documents: ID Card (RG), Individual Taxpayers’ Register (CPF), Birth or Marriage Certificate and evidence certificate of address (water, electric power, gas or fixed phone utilities bills, with maximum term of 90 days);

e) Police Report, if any;

f) Insured’s National Driver’s License, in case of accident with vehicle being driven by insured;


Update 051216 67

8. MISCELLANEOUS



Update 051216 68


PHARMACEUTICAL EXPENSES

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Pharmaceutical Expenses into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of the indemnity, for reimbursement , limited to the amount of the insured capital of expenses with required drug purchases (due to medical or dental care covered by this insurance) prescribed for the condition corresponding to that of the medical guidance provided, provided that insured has been treated during the trip period , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

3. EXCLUDED RISKS


a) Ongoing use drugs

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date when the expenses were incurred into.

5. DEDUCTIBLE





Update 051216 69



a) INSURANCE CLAIM NOTICE Form, duly filled-out and signed by insured;

b) Reports by the assistant physician and exams related to the covered injury, provided for Insured’s emergency care;

c) Original certificates of expenses with drugs;

d) Copy of Insured’s identification documents: ID Card (RG), Individual Taxpayers’ Register (CPF), Birth or Marriage Certificate and evidence certificate of address (water, electric power, gas or fixed phone utilities bills, with maximum term of 90 days);

e) Police Report, if any;

f) Insured’s National Driver’s License, in case of accident with vehicle being driven by insured;

8. MISCELLANEOUS



Update 051216 70


HOTEL STAY EXTENSION

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Hotel stay extension into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of the insured capital, the hotel daily fees, if the medical team from the place where insured is located and the medical team appointed by insurer determine the required extension of the stay period, due to the disease or accident occurred during the trip period , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of determining the insured capital, event date is deemed as the date contained in the documents attesting to the requirement of the covered expenses.

5. DEDUCTIBLE






Update 051216 71



b) Medical Reports indicating the clinical condition shown by insured as well as the reasons that prevented return to Brazil;

c) Original invoices of the lodging expenses;

d) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS



Update 051216 72


COMPANION IN CASE OF EXTENDED HOSPITALIZATION

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Companion in case of extended hospitalization into the Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at ensuring payment of indemnity for reimbursement, limited to the amount of the insured capital, the expenses with Roundtrip air ticket, economic class, to an individual appointed by insured, when insured is traveling alone and the physicians, deem as required insured’s hospitalization for a period of over forty-eight (48) hours , or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

2.2. If insured cannot appoint a companion, that appointed by him/her for notifications in emergency events shall be deemed. In absence thereof, the spouse or any first degree relative, of age.

IMPORTANT: the individual appointed to follow insur ed shall necessarily reside in Brazil.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of coverage and determining the insured capital, event date is deemed as the sudden accident/disease date.

5. DEDUCTIBLE



Update 051216 73






b) Original Air Tickets with the respective payment certificates;

c) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS



Update 051216 74


COMPANION LODGING

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Companion Lodging into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at ensuring payment of the indemnity for reimbursement , limited to the amount of the insured capital, the expenses with hotel daily fee, with Insured’s Companion Lodging , when insured is traveling alone and the physicians deem as required his/her hospitalization for periods of over forty-eight (48) hours , or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy

3. EXCLUDED RISKS


4. EVENT DATE


5. DEDUCTIBLE






Update 051216 75



b) Medical Reports indicating the clinical condition shown by insured as well as as well as the reasons that prevented return to Brazil;

c) Original invoices of the lodging expenses;

d) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS



Update 051216 76


DAMAGE TO THE LUGGAGE

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Damage to the luggage into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement , limited to the amount of the insured capital, in case of damage to the luggage of insured, provided that under the liability of the carrier company, as duly evidenced by provision of the evidence damage report, registered with the Maritime or Air Company, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance.

2.2. Insurer shall indemnify insured for the cost of replacement or repair of the damaged luggage. Being certain that, in case repair is not possible, insured shall acquire new luggage, provide the invoice and then be entitled to reimbursement.

3. EXCLUDED RISKS

3.1. In addition to the exclusions contained in item 4 - RISKS EXCLUDED FROM ALL GUARANTEES of the General Conditions hereof the fol lowing items are also expressly excluded from this coverage:

a) Damages caused to the luggage content;

b) Damages to glasses, contact lenses and any mouthpi ece;

c) Jewels, fur, watches, bonds, policies and cash (in cluding traveler’s checks);

d) Luggage not delivered under the carrier company’s liability and hand luggage;


Update 051216 77

e) Pre-existing damages to the luggage and previously known to Insured prior to delivery to the carrier company;

f) Luggage forfeiture, seizure, damage or destruction by the Customs Authority or any other governmental authority;

g) Luggage belonging to pilots, crew members, employe es or individuals interested in the carrier company.

h) Luggage-specific damages, leakage or liquid spilli ng, nibbling, or any other damage, even if total, caused due to bookworm, insect or mo ld, the cause of which is not certifiably assignable to accidents or fire with the carrier me ans;

i) Theft or aggravated theft and luggage misplacement ;

j) Any object stolen from inside the luggage;

k) Failure by insured to take the luggage as soon as it is made available by the carrier company;

l) Events not notified to the carrier company, by fil ling out the discrepancy report, prior to leaving the landing place.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date contained in the document notifying the carrier company of such damage.

5. DEDUCTIBLE







Update 051216 78


b) Air ticket or ticket of the transportation means of the section where the luggage was damaged;

c) Original luggage tickets related to all shipped volumes, (in case of air companies with the respective weights recorded);

d) P.I.R – Property Irregularity Report, for occurrences with air companies, stating the luggage damage;

e) Irregularity Report by the carrier company for maritime, land and railway transportations;

f) Copy of Insured’s identification documents: ID Card (RG), Individual Taxpayers’ Register (CPF), Birth or Marriage Certificate and evidence certificate of address (water, electric power, gas or fixed phone utilities bills, with maximum term of 90 days);

g) Original invoice of luggage repair or new luggage purchase.

8. MISCELLANEOUS



Update 051216 79


COMPANION RETURN

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Companion Return into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at ensuring payment of the indemnity for reimbursement , limited to the amount of the insured capital, the expense incurred into with Air tickets, economic class, or any other public transportation means authorized for return of the companions to the domicile, when insured is traveling with companions and has to be removed or hospitalized to the city/State/country of origin, preventing his/her companions from returning by the transportation means initially determined, or provision of the corresponding service, when outlined in the plan’s contractual conditions, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance.

2.1.1. The number of companions to return upon this covera ge is limited and shall be defined in the insurance policy.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the event indemnity upon settlement of insurance claims, shall be deemed as the accident occurrence date.

5. DEDUCTIBLE




Update 051216 80





b) Hospital background record and report by the assistant physician attesting to the disease or injury of the individual whose hospitalization has caused return of the companions to the domicile, when insured is traveling with companions;

c) Documents attesting to other events that have caused return of insured’s companion, such as judicial notification, Police Report, Fire Brigade Report, labor agreement termination, labor agreement (in case of new job), information on strikes or any other acts of a company involved in the trip, etc.;

d) Copy of the companion’s identification documents: ID Card (RG), Individual Taxpayers’ Register (CPF), Birth or Marriage Certificate and evidence certificate of address (water, electric power, gas or fixed phone utilities bills, with maximum term of 90 days).

e) Certificate of the tickets purchased as well as the prior ones;

f) Service provision agreement

8. MISCELLANEOUS



Update 051216 81


THEFT OR AGGRAVATED THEFT OF ELECTRONIC DEVICES

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of THEFT OR AGGRAVATED THEFT OF ELECTRONIC DEVICES into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement up to the amount of the insured asset , limited to the amount of the insured capital, in case of THEFT OR AGGRAVATED THEFT OF ELECTRONIC DEVICES belonging to insured during the trip , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

2.1.1. Only the following electronic devices listed in the Insurance Policy shall be covered: Portable PC, Laptop, Tablet, Notebook Computer, Music Player , Smartphones, Photographic Camera, GPS and Video Camera.

3. EXCLUDED RISKS


a) Forfeiture, seizure, damage or destruction of the a ssets by the Customs Authority or any other governmental authority;

b) Assets from smuggling;

c) Assets left unattended;

d) Theft of the assets.

4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date of Theft/Robbery of the electronic device.

5. DEDUCTIBLE


Update 051216 82








c) Description of the assets;

d) Police report;

e) Invoice of the subtracted asset.

8. MISCELLANEOUS



Update 051216 83


LUGGAGE DELAY

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Luggage Delay into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of the insured capital, in case of Luggage Delay , provided that under the air or maritime company’s liability, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

2.1.1. In case of Luggage Delay, the amount to be indemnified shall agree to the invoices of the essential items, limited to the amount of the Insured capital, acquired after six (6) hours of recording the complaint form issued by the Air or Maritime Company. After locating the luggage, nothing else shall be indemnified. Expense reimbursement shall only occur in the going section (air trips).

Essential items are construed as those related to p ersonal hygiene and clothing for use until the luggage is located.

3. EXCLUDED RISKS


a) Damages to the luggage content;

b) Damages to glasses, contact lenses and any mouthpie ce;

c) Jewels, fur, watches, bonds, policies and cash (inc luding traveler’s checks).

4. EVENT DATE

For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date of the occurrence which originated the insurance claim.


Update 051216 84

5. DEDUCTIBLE






a) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and

signed by insured; b) Air ticket or ticket of the transportation means of the section where misplacement occurred; c) Original Luggage Tickets related to all shipped volumes, (in case of air companies with the

respective weights recorded); d) Evidence of the occurrence communication to the respective authorities; e) Original P.I.R – Property Irregularity Report, for occurrences with air companies, attesting to

the luggage weight; f) Irregularity Report by the carrier company for maritime, land and railway transportations; g) Copy of Insured’s identification documents: ID Card (RG), Individual Taxpayers’ Register (CPF),

Birth or Marriage Certificate and evidence certificate of address (water, electric power, gas or fixed phone utilities bills, with maximum term of 90 days);

h) Original evidence of the expenses with essential items and personal hygiene objects, deemed as necessary.

8. MISCELLANEOUS



Update 051216 85


LOSS OF CONTRACTED SERVICES (CLASS REIMBURSEMENT)

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Loss of Contracted Services (Class Reimbursement) into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement , limited to the amount of the insured capital, of the amount proportional to the contracted servic es (classes) , when formalizing the reservation with the provider, and not used , if insured interrupts his trip in advance , unless otherwise deriving from excluded risks and abiding by the remaining items of the General Conditions of the Trip Insurance-Policy.

2.1.1. Loss of the contracted services shall only be cover ed, if the trip interruption occurs solely and exclusively due to the following:

a) Death or hospitalization for over twelve (12) hours, suddenly and acutely reported, of insured, spouse, parents, siblings or children, preventing from continuing his/her trip;

b) Receipt of non-postponable judicial notification for insured to attend to court, provided that receipt of such notification is after contracting the trip and/or touristic services;

c) Statement by competent sanitary authority leaving insured in quarantine, provided that the statement is after contracting the trip and/or touristic services;

d) Infectious-contagious diseases, contracted within up to twenty (20) days prior to the trip, with evidence through medical report and certificate.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date of the document attesting to the reason for Trip Interruption.


Update 051216 86

5. DEDUCTIBLE







b) Complete medical report or death certificate; c) Certificates of the amount of fine(s) withheld in case of cancellation; d) Service provision agreement of the trip arrangers, to provide for the fines in case of

cancellation, as determined by EMBRATUR; e) In case of trip cancellation due to insured’s trip companion, documents attesting that the

individual was actually insured’s trip companion shall be required. f) Medical Reports indicating the clinical condition shown by insured as well as recommendation

to return to Brazil; g) Original Air Tickets with the respective payment certificates; h) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS



Update 051216 87


COMPANION FOR MINOR/ELDERLY RETURN

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Companion for Minor/Elderly Return into the Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment or reimbursement limited to the insured capital contracted for this coverage the expense incurred into with air ticket, economic class, roundtrip, for an adult individual, appointed by insured’s family, to follow the minors/elderly in return to the domicile, provided that previously requested through the Service Central, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance.

IMPORTANT: This coverage only applies when insured is following minors under 14 years of age or people over 70 years of age and due to accident, disease or death of insured, and such minors/elders are left alone.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the date contained in the document attesting to insured’s return due to the Covered Event.

5. DEDUCTIBLE




Update 051216 88



7.1. In complement to item 17 – DOCUMENTATION REQUIRED I N CASE OF INSURANCE CLAIM of the General Conditions hereof, for analysis of insu rance claim of this coverage the following documents shall be delivered to Insurer, in origina l or certified copies :

a) INSURANCE CLAIM NOTICE Form or Letter, duly filled-out and signed by insured or his/her representative, in case of insured’s death or medical impossibility;

b) Insured’s Death Certificate whose death has given rise to the minor(s)’ return;

c) Hospital background record and report by the assistant physician attesting to the disease or injury of insured whose hospitalization has caused the minor(s)’ return;

d) Copy of the identification documents belonging to the adult individual, appointed by insured’s family: ID Card (RG), Individual Taxpayers’ Register (CPF), Birth or Marriage Certificate and evidence certificate of address (water, electric power, gas or fixed phone utilities bills, with maximum term of 90 days);

e) Service provision agreement and voucher;

f) Certificate of the purchased tickets, as well as certificate of their values.

8. MISCELLANEOUS



Update 051216 89

SPECIAL CONDITION OF THE ADDITIONAL COVERAGE MEDICA L

AND/OR HOSPITAL EXPENSES FOR PREGNANT WOMEN

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Medical and/or Hospital Expenses for Pregnant Women into the Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment or reimbursement limited to the insured capital contracted for this coverage in case of Medical and/or Hospital Expenses incurred into by insured for her treatment, under medical guidance, caused for complications arising out of pregnancy, such as medical and hospital expenses incurred into in the emergency ca re of pregnant insureds up to the 32 nd pregnancy week, occurred during the trip period , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance.

2.1.1. As of the 33rd pregnancy week, the medical care services solely deriving from covered personal accident shall be insured.

2.1.2. The pregnant insured’s pregnancy week shall be stated in the insurance policy.

Insurer shall indicate the service providers to be used. If insurer does not have service providers to indicate, insured shall freely choose medical, hospital and dental service providers, provided that these are legally qualifie d.

EXCLUDED RISKS

2.2. In addition to the risks excluded in item 4 – RISKS EXCLUDED FROM ALL GUARANTEES of the General Conditions, the following risks are excluded from this coverage:

a) Deliveries occurred after the 32 nd pregnancy week (to be construed as vaginal, surgic al, induced and other deliveries), including eventual c omplications, when not deriving from covered personal accident;

b) convalescence states (after medical discharge) and companions’ expenses;


Update 051216 90

c) Devices related to orthosis of any nature and to pe rmanent prosthesis, except for the prostheses for the loss of natural teeth;

d) Services, supplies or treatments, including any hos pitalization period, not prescribed, approved and certified as strictly necessary by the physician;

e) Physical, laboratorial, or radiographic routine and /or preventive exams not strictly necessary and not directly resulting from a disease or accident covered by the policy;

f) dental services and supplies in insured’s country o f residence (in case of international coverage) or in the city where insured resides (in case of national insurance);

g) restoring, plastic surgery or one which was not abs olutely essential and necessary, except as a result of insured’s injury occurred dur ing the trip and covered by this policy;

h) rejuvenator or aesthetic treatments;

i) prosthesis and orthosis purchases;

j) congenital disorders and the resulting conditions t hereof;

k) assistance related to fragile, deformed or flat foo t, corns or toenails;

l) acne diagnosis and treatment;

m) septum deviation;

n) organ transplantation;

o) pediatric care services and of healthy individuals, including routine, school, university exams and immunizations (vaccines);

p) psychiatric disorders (mental, nervous or emotional );

q) medical services and supplies generated out of the trip effective period;

r) participation in quarrels or fights;

s) kidnapping or intention thereof;

t) losses, damages, costs or expenditures of any natur e, directly or indirectly caused for, resulting from, or related to any terrorism act, ev en when there is any other cause or occurrence contributing towards the event;

u) learning operations to operate any aircraft or acti vities as crew member on such aircraft;


Update 051216 91

v) any routine treatment;

w) dental treatments not related to the covered accide nt;

x) expenditures in purchase, arrangement or replacemen t of prostheses, although arising out of an injury;

y) dental services and supplies occurred out of the tr ip effective period;

z) drug purchases.

3. EVENT DATE

3.1. For the purpose of determining the insured capital, event date is deemed as the accident date or the date when the sudden, acute disease is noticed (as the case may be).

4. DEDUCTIBLE










e) Report or opinion filled-out by the qualified professional who provided the care service, with the technical and diagnostic specifications required.


Update 051216 92

7. MISCELLANEOUS



TRIP CANCELLATION/INTERRUPTION – STANDARD

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Trip Cancellation/Interruption – Standard into the Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity limited to the insured capital contracted for this coverage in case of unrepairable losses with deposits and/or expenses paid in advance in reference to his/her trip, whenever Cancellation/Interruption is necessary and/or unavoidable, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Comprehensive Trip Insurance.

2.2. The Trip Cancellation/Interruption shall only be covered solely and exclusively due to:

a) Death, acute disease or severe accident, suddenly reported and acute of insured, spouse, parents, siblings or children, preventing beginning/continuity of the trip. For trip cancellation, hospitalization should occur up to the thirty (30) days prior to beginning of the Voucher effective period. For cancellation for death of insured or first degree relative, it should have occurred within up to sixty (60) days prior to beginning of the trip;

EXCLUDED RISKS

2.3. In addition to the exclusions contained in item 4 - RISKS EXCLUDED FROM ALL GUARANTEES of the General Conditions hereof the fol lowing items are also expressly excluded from this coverage :


Update 051216 93

a) Plastic surgeries and the consequences thereof, inc luding those derived from congenital issues. Restoring plastic surgeries aris ing out of covered personal accident occurred in the insurance coverage period are cover ed;

b) Aesthetic and obesity treatment in any modalities, as well as surgeries and convalescence periods related thereto;

c) Hospitalizations for routine physical exams or any other exam without affecting the normal health;

d) Hospitalizations when the patient is not under the cares of legally qualified physicians;

e) Chronic and/or pre-existing diseases prior to contr acting the insurance not reported in the proposal card, when such is required, known to insured, as well as aggravation, consequences and sequelae.

2.4. Hospitalizations in institutions of the kind listed below are excluded from the coverage of this guarantee:

a) Institution for assistance of mentally ill individu als, i.e., institution essentially dedicated to treat psychiatric disorders, including subnormal ities or the psychiatric department of a hospital;

b) Place for elderly, retirement houses, refuge and th e like;

c) Clinics or places for alcohol and drug addicted rec overy;

d) Hydrotherapeutic health institutions or natural hea ling method clinic; healthcare home for convalescents; hospital special unit essentiall y used as a place for drug or alcohol addicted people or as a healthcare home for convale scents or for rehabilitation; weight-loss clinics and SPA.

3. EVENT DATE

3.1. For the purpose of coverage and determining the insured capital, event date is deemed as the cancellation date.

4. DEDUCTIBLE




Update 051216 94





b) INSURANCE CLAIM NOTICE Form, with insured’s banking information, duly filled-out and signed by insured;

c) Trip cancellation request documents;

d) Document attesting to insured’s family relationship to the damaged person (individual who suffered the death or hospitalization):

• If parents or children of insured : copy of the ID Card (RG) or Birth Certificate and Individual Taxpayers’ Register (CPF);

• If insured’s spouse : copy of the ID Card (RG) and Individual Taxpayers’ Register (CPF) of spouse. Up-to-date marriage certificate (taken from the registry office after the event occurs). If issuing the up-to-date certificate is not possible, send the Marriage Certificate and the Private Certificate of Stable Union. In case the person does not own a Marriage Certificate, send up-to-date Public Certificate of Stable Union;

• If insured’s sibling : copy of the ID Card (RG) and Individual Taxpayers’ Register (CPF) of sibling and parents.

e) Letter reporting the amount of the fine collected due to cancellation, being:

• Maritime Trip: document issued by the maritime company;

• Air + Land Trip: copy of the agreement with description of the acquired pack and amount of the trip and letter from the trip agency in a letterhead document and with signature of the party in charge informing amount of the fine.

f) Cancellation for Insured’s , parents’, spouse’s, children’s or siblings’ (first degree relative) death , send:

• Copy of the death certificate.

g) Cancellation for Hospitalization of insured, parents, spouse, children or siblings (first degree relative), send:

• Hospitalization report containing: hospitalization date (medical record), discharge date (medical discharge), ICD – International Classification of Disease and Patient information);

• Medical report, informing the period required for resting.


Update 051216 95

7. MISCELLANEOUS

7.1. The remaining General Conditions of the Comprehensive Trip Insurance of QBE Brasil Seguros S.A. which were not revoked by this Special Condition, are hereby ratified.


LODGING EXTENSION FOR FLIGHT CANCELLATION

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Lodging Extension for Flight Cancellation into the Trip Insurance - Policy of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity for reimbursement, limited to the amount of the insured capital, in case of expenses arising out of Lodging Extension for Fligh t Cancellation if insured’s flight is cancelled for any severe climatic condition , unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

3. EXCLUDED RISKS


4. EVENT DATE

4.1. For the purpose of calculating the indemnity, the event date upon settlement of insurance claims shall be deemed as the flight cancellation date.


Update 051216 96

5. DEDUCTIBLE







b) Copy of the air ticket and the shipping card;

c) Original certificates of lodging expenses;

d) Air company statement confirming flight cancellation;

e) Copy of Insured’s Individual Taxpayers’ Register (CPF), ID Card (RG) and Residence Certificate;

8. MISCELLANEOUS



Update 051216 97


EXTRAORDINARY EXPENSES FOR FORCED PERMANENCE

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Extraordinary Expenses for Forced Permanence in the Comprehensive Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity or reimbursement limited to the insured capital contracted for this coverage of Extraordinary Expenses for Forced Permanence preventing insured from returning to his/her country of origin, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Comprehensive Trip Insurance.

2.2. Only the forced permanence as a sole and exclusive result of the following shall be covered:

a) Insured’s or trip companion’s death;

b) Disease requiring hospitalization where the passenger is not authorized to return to the country of origin;

c) Insured or trip companion is confined into compulsory quarantine;

d) Loss/Theft of passport or essential documents to return to the country of origin.

e) Lodging expenses deriving from: flight delay for over 12h or flight cancellation caused by: a) any severe climatic condition delaying a flight schedule; b) any sudden failure, not foreseen, of regular aircraft. The indemnity shall be limited to payment of expenses not paid by the regular air company while the delay or cancellation lasts.

3. EXCLUDED RISKS


4. INSURED CAPITAL

4.1. For the purpose of coverage and determining the Insured capital, event date is construed as


Update 051216 98

the occurrence date which originated the insurance claim.

5. DEDUCTIBLE








c) In case of insured’s or trip companion’s death: Death Certificate;

d) In case of insured’s hospitalization: hospitalization report with ICD;

e) In case of natural disasters: News on the disaster with details (place, date and description);

f) In case of compulsory quarantine: medical report;

g) In case of passport loss/theft: copy of the police report.

8. MISCELLANEOUS



Update 051216 99


TRIP CANCELLATION/INTERRUPTION – TOTAL

1. PURPOSE

1.1. This Special Condition is aimed at including the coverage of Trip Cancellation/Interruption – Total in the Comprehensive Trip Insurance of QBE Brasil Seguros S.A.

2. COVERED RISKS

2.1. This Special Condition, provided that contracted and the premium is paid, is aimed at assuring insured with payment of indemnity limited to the insured capital contracted for this coverage in case of unrepairable losses with deposits and/or expenses paid in advance in reference to his/her trip, whenever Cancellation/Interruption is necessary and/or unavoidable, unless otherwise deriving from excluded risks and in compliance with the remaining items of this Special Condition and the General Conditions of the Trip Insurance - Policy.

IMPORTANT: this coverage shall only be valid if contracted upon confirming the reservation, or up to five (5) days of confirming the reservation, only.

2.2. Only trip cancellation as sole and exclusive conseq uence of the following shall be covered:

a) Insured’s death;

b) Total or partial incapacity for insured’s clinically reported accident or disease;

c) Total or partial death or incapacity, or total or permanent clinically reported incapacity for acute disease or severe accident of the following family members: parents, children, spouses/companions, siblings, children, stepchildren, father-in-law, mother-in-law, son-in-law, daughter-in-law, grandparents, and grandchildren (if the grandchild is minor);

d) Total or partial death or incapacity, or total or permanent clinically reported incapacity for acute disease or severe accident of the trip companion or partner;

e) Emergency care for delivery of insured, spouse and/or permanent insured’s companion;

f) Emergency care for abortion of insured, spouse and/or permanent insured’s companion;

g) Scheduled delivery of pregnancy contracted after the trip acquisition date;


Update 051216 100

h) Natural disasters such as quake, earthquake, volcanic eruption, seaquake or tsunami, hurricane, cyclone, tornado, flood, or strong wind occurring inside insured’s home town or destination city preventing insured from traveling and/or preventing any commercial flight from getting to destination and/or taking off the respective affected city; IMPORTANT: For the purpose of this guarantee, when cancellation is due to supplier’s incapacity (Agent, Operator, Hotel, Air Company, Maritime Company, etc.) to meet the trip contracted, this coverage shall not apply and insured shall not be entitled to indemnity.

i) Having been appointed as jury or to attend to court on the trip date;

j) Legal requirement prior to beginning the trip;

k) If, within the 15 days prior to taking off or connections of the schedule, insured or his/her companion has lost the documents preventing the beginning or continuance of the scheduled trip;

l) Visa denied for destinations where it is issued upon entering the Country;

m) No acceptance of passenger/visa issued in Brazil;

n) If, inside insured’s house or company, as a result of the acts described below, requires insured’s intervention: during fire and/or lightning, explosion, floods, damages caused by water, willful acts of others, including terrorism acts, riots, civil or popular commotion and/or strike, hail, strong wind, aircraft crash or parts arising out of them or car crash and smoke;

o) Cancellation of insured’s marriage;

p) Damage or accident to the car owned by insured or his/her spouse, preventing insured from beginning or continuing the trip;

q) Insured’s separation/divorce;

r) Insured’s dismissal;

s) Sudden call or rescheduling of dates for public service exams and university admission tests; or poll member

t) Appointment for a public servant office;

u) Cancellation of insured’s vacations;

v) Job change by insured;

w) Rejection in (school) subjects;

x) Compensation for change to dates of tests, works, presentations.

y) Change to meeting for documented reasons;

z) Cancellation of meeting for documented reasons.


Update 051216 101

aa) extension of labor agreement;

bb)Forced work transfer, with transportation of over three months; cc)Other Reasons (including desistance***) – when trip cancellation is due to a reason other than those listed above, a deductible shall be deducted from the sum payable of insured.

The deductible shall be applied over the non-recoverable loss of the deposits spent and paid in advance for the trip, in accordance with the General Conditions of the insurance subscribed by insured with the trip agency and/or touristic operator. The deductible percentage shall be reported in the insurance policy.

*** For the purpose of this guarantee, only the can cellation requests formalized at least 48 hours prior to shipping shall be accepted, with no exceptions whatsoever. If such term is not complied with, insured shall lose right to indemnit y.

Insured shall inform to insurer, immediately and wi thin 24 hours, occurrence of the fact which originated the trip cancellation, under penalty of losing right to indemnity.

This guarantee shall not apply to trips to snow sea son destinations.

IMPORTANT: Insurer reserves the right to make evidentiary medical investigation. If this reimbursement is partial, insurer shall only indemnify the difference between the amount reimbursed by the operator/agency and the full pack price, provided that abiding by the thresholds contracted for this coverage.

3. EXCLUDED RISKS


a) Events not reported within up to twenty-four (24) h ours after occurrence of the event which caused cancellation;

b) Use of drugs, drug addiction or use of drugs with n o medical prescription;

c) Cases in which lack of visa for entrance to the des tination country is a requirement for immigration, which visa shall have been issued prio r to occurrence of the event which caused cancellation;

d) When cancellation results from cancelled chartered flight;

e) Cancellation and/or changes to dates of professiona l and sports events, or private events (such as weddings), for groups (over 3 individuals) , where cancellation / change is due to the provider (Operator / Agency etc.);


Update 051216 102

f) Fees, fines and tariff differences arising out of n ew issuance/rescheduling of tickets, lodging, sea shipments and remaining trip items sha ll not be covered by this insurance, except in the cases where applied to prevent/avoid total c ancellation of the trip and provided that the accruing values are lower than the values outlined in the agreement for the respective cancellation.

g) Rental of real property for vacations

h) Trip cancellation due to changes to dates and/or de stinations caused by the Trip Agency / Operator.

4. INSURED CAPITAL

4.1. For the purpose of coverage and determining the insured capital, event date is deemed as the cancellation date.

5. DEDUCTIBLE

5.1. The deductible shall be informed in the insurance policies.




7.1. In complement to item 19 – DOCUMENTATION REQUIRED I N CASE OF INSURANCE CLAIM of the General Conditions hereof, for analysi s of insurance claim of this coverage the following documents shall be delivered to Insurer, in original or certified copies:



c) Trip cancellation request document;

d) Document attesting to insured’s family relationship to the damaged individual (individual who suffered the death or hospitalization), being:

• If parents or children of insured: copy of the ID Card (RG) or Birth Certificate and Individual Taxpayers’ Register (CPF).


Update 051216 103

• If insured’s spouse: copy of the ID Card (RG) and Individual Taxpayers’ Register (CPF). Up-to-date marriage certificate (taken from the registry office after the event occurs). If issuing the up-to-date certificate is not possible, send the Marriage Certificate and the Private Certificate of Stable Union. In case the person does not own a Marriage Certificate, send up-to-date Public Certificate of Stable Union.

• If sibling of insured: copy of the ID Card (RG) and Individual Taxpayers’ Register (CPF) of sibling and parents.

e) Letter reporting the amount of the fine collected due to cancellation, being:

• Maritime Trip: document issued by the maritime company;

• Air + Land Trip: copy of the agreement with description of the acquired pack and amount of the trip and letter from the trip agency in a letterhead document and with signature of the party in charge informing amount of the fine.

f) Cancellation for death of Insured , parents, spouse, children or siblings, grandparents, companion, daughter-in-law, son-in-law, father/mother-in-law, uncle/aunt, brother/sister-in-law, nephew/niece, trip companion, professional replacement, send:

• Copy of the death certificate.

g) Cancellation for Hospitalization of insured, parents, spouse, children or siblings, grandparents, companion, daughter-in-law, son-in-law, father/mother-in-law, uncle/aunt, brother/sister-in-law, nephew/niece, trip companion, professional replacement, send:

• Hospitalization report containing: hospitalization date (medical record), discharge date (medical discharge), ICD – International Classification of Disease and Patient information);

• Medical report, informing the period required for resting.

h) Cancellation for Total ou Partial Medical Incapacity for Accident or Disease of insured clinically reported inhibiting locomotion or generating prostration, complication in pregnancy or abortion of insured, spouse or permanent companion:

• Detailed medical report of the disease/accident, informing the required resting period.

i) Cancellation for Judicial notice of insured:

• Copy of the judicial notice.

j) Cancellation for Notification for Competitive civil-service examinat ion of insured:

• Copy of the notification/invitation of the competitive civil-service examination.

k) Cancellation for Dismissal, Cancellation of Vacations, Change of Emp loyment, Labor Agreement Extension, Forced Professional Transfer a nd Over three (3) months of insured or professional replacement:

• Original company’s letterhead letter signed by the hierarchical head or person in charge of the company informing the reason.


Update 051216 104

l) Cancellation for Quarantine of insured:

• Certificate issued by the sanitary authority report ing that insured must remain in quarantine, as well as informing the disease that p ut him/her to such situation.

m) Cancellation due to Marriage Cancellation, Annulment, Separation or Div orce of insured:

• Petition and documents certifying the fact.

n) Cancellation for Residential Insurance Claim:

• Police / Fire Brigade Report;

• Letter handwritten by insured describing the occurrence.

o) Cancellation due to Trip Companion’s or Partner’s Trip Cancellation or Interruption:

• Documents evidencing the reason for cancellation of the trip companion’s or partner’s trip;

• Evidence of company’s relationship (copy of the Articles of Association).

p) Cancellation for Loss and Theft of Documents or Luggage preventing or interrupting the trip:

• Police Report;


q) Cancellation for Damage or Accident in Vehicle of insured or spouse preventing or interrupting the trip:

• Police report;


r) Cancellation for Natural Disasters:

• News on the disaster with details (place, date, description).

8. MISCELLANEOUS
