b) Commencement of Cover

TUNE INSURE AIRASIA RETURN TRAVEL PROTECTION Except for the Trip Cancellation benefit, the "Return" coverage provided to the Insured starts only upon
MASTER POLICY NO: 10·404-4000003-000D0-2014-03 checking-in for departure of a Scheduled Flight provided the premium has been paid prior to travel and a copy of
the AirAsia Insure Travel Protection Certificate has been issued. Coverage will include the time the Insured is inside
SCHEDULE any airport premises lor the purpose of commencement or continuation of the same scheduled Flight.

ForTrip cancellation benefit under a paid Insurance Certificate, the cover starts from the Certificate Issue Date.
a) Schedule of Benefit
(I) Coverage is provided as follows:-
cl Termination of Cover
"'- TRAVEl DISRUPTION BENEFITS
A..l FLIGHT CANCELLATION (Reimbursement lor cost of flight if the Insured cancels the trip for Cover ends upon safe disembarkation of the Insured at the end of the scheduled return flight (either on the
covered reasons) return date, or the date the Insured returns to the termination point of the trip if prior to the planned Return date,
Up to original flight cost or the date the Insured leaves or changes the trip due to unforeseen an unavoidable circumstances covered by
this policy or thirty (30) calendar days from First Departure Date, whichever occurs first.
A..2 FLIGHT INTERRUPTION (Reimbursement lor return flight if the Insured returns home for covered
reasons) In all event, the Policy terminates on the thirty-first (31st) calendar day from First Departure Date even if the
Up to original flight cost return flight has not begun, and all benefits under an Insurance Certifocate will terminate absolutely, effective from
the 31st day after First Departure Date.
A..3 COMMON CARRIER DELAY (Flat payment for every 6 hour period of delay from the original scheduled
departure time) In the event AirAsia reschedules the Scheduled Flight, the Insurers automatically extends the Coverage period for up
lOR 375.000 per 6 hours delay period, up to lOR 2.625.000 to maximum of three (3) clays.

dl Other Limitations
A..4 AI RASIA fLIGHT DELAY
Flat payment for every complete 6 (six) hour period of Flight Delay from original schedule departure (i) Ground cover between destination and departure Is limited to that within the country of arrival only. If the
Insured travels beyond the boundary of the country, cover will exclude the geographical limits beyond the
time.
boundary of that country.
Maximum lOR 750.000 per night for one (1) night for the first complete 6 (six) hours period of delay or lOR
400.000,- in cash per 6 hours delay period, up to lOR 4.000.000 (ii) If the Insured departs on any air Common Carrier to travel outside the country of arrival, insurance cover
will suspend upon the Insured's airline check-in for that out-bound flight, however, cover will resume
upon the Insured's check-out at Immigration upon returning to the original country of arrival, subject to the
A..S LOSS OR DAMAGE FOR MOVEABLE ITEM (Cover loss or damage to moveable Item)
Period Covered, i.e. provided the period is still within thirty (30) days of the First Departure Date of the
Up to lOR 5.000.000,- per Item, IDR 50.000.000,- in aggregate (subject to excess 10% of loss)
Insured's Scheduled Flight.
B. ON TIME GUARANTEE
(Iii) Travel Disruption Benefits coverage for any Air Travel undertaken during the period of ground cover in the
course of the Trip is flmited only to AirAsia flights or, as may be arranged by AirAsia pursuant to flight
Delay of scheduled flight by more than 2 hours from the scheduled time of flight departure caused solely by
reschedule, within the country of arrival.
carrier operator : IDR 800.000

e) Apllmlt
C. MEDICAL AND EVACUATION EXPENSES
Coverage can be purchased under the Return Travel Protection Plan for all AirAsla Guests lor age from 9 days up to
C.1 ACCIDENTAL MEDICAL REIMBURSEMENT (Reimbursement for medical expenses)
age 75 years old.
lOR 50.000.000 (subject to excess of lOR 150.000 anyone claim)
C.2 EMERGENCY MEDICAL EVACUATION & REPATRIATION (In the event of accidental bodily Injury or Under the free coverage extension for infants, the age limits are from 9 days to 2 years old.
death)
lOR 250.000.000

D. 24 HOURS WORLDWIDE TRAVEL ACCIDENT SERVICES

Included

E. Fly Thru (Including Missed Fftght Connectionl-lf applicable

On the condition that there is no onward Scheduled Flight connection available within 6 (six) consecutive hours
from the previously missed Scheduled Flight -lOR 800.000, maximum lOR 1.600.000,-

This Policy shall only pay for any claim either under Section A.4- Flight Delay or Section E - Fly Thru including
Missed Flight Connection.

PT ASURANSI DAVIN MITRA Tbk PT ASURANSI DAVIN MITRA Tbk

Geo~tal Insurance General lnsur•nae
 II
TUNE INSURE AIRASIA TRAVEL PROTECTION
RETURN INSURANCE COVERAGE
MASTER POLICY NO: 10-404-4000003-Q0000-2014-03
PT. Asuransi Dayin Mitra Tbk (hereinafter called "Insurer") agrees to Insure the lnsured(s) (name to be noted by
individual certificate) against loss covered by the Master Policy ("Policy") subject to and in accordance with
the exclusions, limitations, provisions and terms contained In the Policy.
COMMENCEMENT AND TERMINAllON OF COVERAGE
A) Commencement of Cover
Except for Flight Cancellation, the insurance coverage provided to the Insured starts only upon checking-in for
departure of a Schedule Fllsht provided the premium has been paid before travel and a copy of Tune Insure Air
Asia Return Travel Protection certificate has been issued, Coverage will include the time the Insured Is inside any
airport premises for the purpose of commencement or continuation of the same scheduled trip.
The insurance coverage here afforded will only be effective for the first thirty (30) calendar days of the trip from
the date of his/her first Flight departure.
For Flight Cancellation benefit under a paid Insurance Certificate, the cover starts from the Certificate Issue Date.
B) Termination of Cover
The coverage will terminate upon safe disembarkation ofthe Insured at the end of the scheduled return flight either
on the return date, or the date the Insured returns to the termination point of the trip if prior to the planned Return
Date, or the date the Insured leaves or changes the trip due to unforeseen and unavoidable circumstances covered
by this policy, or thirty (30) calendar days from First Departure Date, whichever occurs first.
Coverage provided under this Policy is only valid for a maximum period of thirty (30) calendar days from date of
departure of the first Scheduled Flight. Coverage automatically expires on the thirty-first (31st) calendar day from
First Departure Date in the event a travel plan should exceed thirty (30) days.
In the event AirAsia reschedules the Scheduled Flight, the Insurer automatically extends the Coverage period for
up to maximum three (3) days.
[ n - - COVERAGE
(A) TRAVEL DISRUPDQN BENEFITS
Subject to the specified limits of liability:
A.l. FUGifi CAN(EUADON
This coverage which starts on the Certificate Issue Date will reimburse the unused and non-refundable
portion of the A.irAsia Ticket fare due to Trip Cancellation if the insured Is forced to cancel any part of a
planned trip or flight prior to commencement of that trip as a result of the occurrence of one of the
following events :
i) Events connected with the Insured:
• Death; and/or
• Hospitalization not anticipated at the date of flight purchase; and/or
• Serious illness or serious accidental bodily injury sustained by the Insured; and/or
• Serious damage to Insured principal residence due to fire, flood or similar natural disaster (tornado,
earthquake, hurricane, etc.) requiring his/her presence on the premises after the departure date in the
course of The Trip or The Flight as the case may be; and/or
• Serious damage to Insured vehicle within 48 hours of the Departure Oate as substantiated by a police
PT ASURANSI DAVIN MITRA Tbk
Genefal Jnsuranc&
report; and/or
• The Insured being kidnapped, detained, quarantined, required to serve on a jury.
ii) Events connected with those persons whether or not traveling together on the same Flight/Trip as the
Insured whoare considered an Immediate Family Member or a next-of-kin:-
• their death; and/or
• their hospitalization which is not anticipated at the date of flight purchase which requires the
presence of the Insured.
A.2. FUGH! INTERRVP!!ON
This coverage, will refund the unused and non-refundable portion of the AirAsia Ticket fare if the Insured is
forced to curtail his Trip to return home immediately and directly to Indonesia as a result of any one of the
following events:-
(!) Insured requiring repatriation by AA International inc or hospitalization for more than 48 hours.
(ii) If he is required to an Immediate Family Member or a next-of-kin of the same Trip due to hospitalization
for more than 48 hours.
(iii) The unexpected death of an Immediate Family Member in Indonesia.
(lv) The unexpected Sickness or Accident of an Immediate Family Member in Indonesia which may
require hospitalization of more than 48 hours.
This coverage Is subject to no known conditions that may lead to a Trip Interruption.
&r:lusloas App/!cgb/c To Sectloas A.1 qnd A.Z
No benefit will be provided for any loss resulting directly or indirectly (in whole or in part) from:
• criminal acts by the Insured; and/or
• any cancellations resulting from civil or foreign war, riot, popular movements, any pre-existing conditions,
terrorist acts, any effect of a source of radioactivity, endemic, e~s. pollution, natural catastrophes
or climatic events (lack of snow, etc.). •
A.3. COMMON CARRIER DElAY
Provided only for Retum Travel Protection, in the event the scheduled departure of the Common Carrier (which
excludes licensed air travel transport) in which the Insured has arranged to travel is delayed by at least six (6)
hours from the time specified in the itinerary supplied to the Insured, due to inclement weather, equipment
I failure or strike or .l!ii!!:k (other than Aircraft Hijacking) or other Industrial actk,n by the employees of the '
Coii'iii,on cii'iier during the Trip, the Insurer will pay the Insured I~ for the first cg,_mplete six (6)
hour period of delay, followed by the sum of lOR 375.000 for the next complete six (6) hour period of delay
and so on, up to the maximum limit specified in the Schedule of Benefit.
The period of delay will be calculated from the original scheduled departure time of the Common
Carrier until the commencement of the first available alternative transportation offered by the Common
Carrier management. The delay must be verified in writing by operator(s) or their handling agent(s) as well as
the number of hours and the reason for the delay.
A.4. A!RASIA Fl!GH! D£lAY
In the event the scheduled departure of the AirAsia flight in which the Insured has arranged to travel is
delayed for at least six (6) hours at any single location from the time specified in the itinerary supplied to the
Insured due to inclement weather, equipment failure or strike or hijack (other than Aircraft Hijacking) or other
industrial action by any employee of AirAsia during the Flight,
PT ASURANSI DAVIN MITRA Tbk
GonBral lnsuranc~
 the Insurer will pay
II
i) IDR 400.000 for the first complete six (6) hour period of delay, followed by the sum of !DR 400.000 for the
next complete six (6) hour period of delay and so on, up to the maximum limit specified in the Schedule of
Benefit
Or
ii) IDR 750,000 for 1 (one} night hotel accommodation upon complete 6 hours delay. (B) ON TIME GUA8ANIEE

You can claim only either one of payout for any one event
The period of delay being calculated from the original scheduled departure time of AirAsia Fli&ht until the
commencement of the first available alternative transportation offered by AirAsia management. The delay must
be verified in writing by Air Asia or their handling (agents) as well as the number of hours and the reason for the
delay.
Exclusions applicable to Section A.3 and Section A.4 :
No benefit will be payable for any loss:-
1. Arising from the failure of the Insured to check in according to the itinerary supplied to him/her, or to
obtain written confirmation from AirAsia or its handling aaents of the number of hours delayed and the
reason for such delay; and/or
2. Arising from strike or Industrial action of companies/carrier involving other than AirAsia and already in
existence on the date the Trip/ Flight is arranged; and/or
3. Arising from the late arrival of the Insured at an airport (except for late arrival caused by a strike or an
Industrial action).
In the event the scheduled departure of the AirAsia flight in which th~t Insured has arranged to travel is delayed
for at least two {2) hours at any single location from the time specified in the itinerary supplied to the Insured due
to carrier operator, the Insurer will pay the Insured IDR 800.000 for the first complete two (2) hour period of delay.
(C) EMERGENCY MEDICAL ASSISTANCE AND MEDI(AL EXPEN5ES
The following benefits are payable subject to terms:-
1) Accidental Medical Reimbursement
2) Emergency Medical Evacuation & Repatriation
Condition:
In emergencies, the Insured person may directly contact AA International inc a medical emergency assistance
for emergency medical assistance should an accident occur during the trip.

A.S. LOSS OR QAMAGE FOR MOVEABLE !JEM

(Applicable during the flight)

The Insurer will reimburse the Insured up to the Benefit Amount subject to an excess of 10% of loss per
occurrence and a limit of IDR 5.000.000 per item, max. IDR 50.000.000,- in aggregate per Insured and per
booking code (PNR), in consequence of or loss or damage to the Insured's personal goods directly caused by
the AirAsia Common Carrier, up to the limit stated in Schedui?'li.Jjj~I$K....U:IAJII!Ilill!:!ILG!liUJ»>""'-ll:a...,....,'l
carried on with the Insured durin bin). ersonal goods means portable photographic
- ;andycam, computer or telephone equipment; equipmen or the recording of sound or pictures and it
ssories.
The basis of settlement will be either the lesser of the cash value equal to the original cash value less
allowance of wear and tear and depreciation or the cost of replacement of a similar make & model, or the
cost of repair, as determined by the Insurer. The Insurer's liability shall be limited to any one article in a pair,
or a set. In case of loss to a pair or set, the Insurer may elect to either repair or replace any part, to restore
the pair or set to Its value before the loss; or pay the difference between the cash value of the property
before and after the loss.
The ~ximum sum payab.k.Jor Medical Expenses Incurred In Indonesia Is equivalent to 10% of the
maximumbenelits stailid in the ~hedule of Benefit. This amount is a sub-limit of the aggregate total payable
Benefit Amount under the Schedule of Benefit for Accidental Medical Reimbursement.
Medical expenses covered are medical services and medical supplies which are recommended by the attending
Physician for the treatment of the injury, and they include:
• The services of a Physician;
• Hospital confinement and use of operating room;
• Anesthetics (includin& administration), x-ray examinations or treatments, and laboratory tests;
• Ambulance service;
• Drugs, medicines, and therapeutic services and supplies.
• Physiotherapy treatment by a western qualified physiotherapist.

Exclyslons applicable to Section A.S: 2) Medical Evacuation or Repatriation:

The following Items are excluded from cover: a) Medical Evacuation:
• Equipment for professional use; and/or In the event where the Insured medically requires evacuation in a medical emergency due to an
• Antique and/or collectible Item; and/or Accident occurring during the Trip, AA International Inc will organize emersency medical transport to the
• Loss of or damage to property Insured under any other Insurance policy or otherwise nearest medical facility where appropriate medical care is available. The type of transportation will depend
reimbursed/replaced by the carrier; and/or on the availability and the gravity of the Insured condition.
• Contraband or illegal goods. In the event medical repatriation is necessary, AA International inc will repatriate the Insured back to either
his/her home or habitual residence.
lite following risks are not covered:- Alternatively, AA International Inc will arrange for the resumption of the Insured Interrupted journey as far
• Wear and tear or gradual deterioration; and/or as it is practical to do so, subject to the cost of the direct return journey to the Insured's home, and
• Insects or vermin; and/or subject to the limit stated in the Schedule of Benefit.
• Inherent vice or damage; and/or
• Confiscation or expropriation by order of any government or public authority; and/or

PT ASURANSI DAVIN MITRA Tbk PT ASURANSI DAVIN MITRA Tbk

Genoral lnsuraflce- General lost;rance
 b) Body Repatriation:
If during the period of Insurance, whilst the Insured is on a trip, the Insured dies as a result an Accident
occurring during The Trip, AA International Inc will organize the repatriation of his/her corpse to his/her
habitual residence subject to the limit stated in the Schedule of Benefit. The process of burial, embalming,
casket and ceremonies are not covered in the repatriation coverage unless this is mandated by legislation or
regulation.
El<duslons apphcable to Section C:
i) The Insurer will only pay costs for medical care that is prescribed by a ~ensed Phy~n or which is ~y a
rcglini,ed Hospilel: Benefits will not be proyjded for any loss which is directly or Indirectly, in whole or in part,
due to: - --- -;:::=..
Ovll or Foreign war whether declared or not; and/or
The effect of drugs, medication or treatment not prescribed by a Physician; and/or
The influence of alcohol characterized by a blood alcohol level of the Insured equal to or superior to that fixed
by the laws; and/or
Suicide, attempted suicide or intentionaUy self-Inflicted Injury; and/or
~ation in ~g the use of a motorized land, water, or air vehicle;
and/or
The Insured's participation In any professional sports; and/or
The Insured riding or driving a m ment over 125 em 3; and/or
The Insured's flying whether as a fare-paying passenger or not, in or on any aircraft that does not ong to an
airline Insurer or which is not duly registered or licensed for the transportation of fare-paying passengers on
regular and published scheduled routes; and/or
The Insured 's active service in any of the armed forces of any nation; and/or
The participation or involvement of the Insured in a criminal act; and/or
The Insured's ~ractice or ~n, either as Q!!Qt.Qr passenger, of a ULM, ~ hand slider, P!rasail,
parachute, hot air balloon, and the like, or engaging in any aerial flight other than that as previously expressed.
ii) Benefits will not be provided for expenses incurred as a consequence of:
Medical care Incurred in the country of residence except as provided in the Medical Expenses described
above; and/or
Pre-Existing Conditions; and/or
Precnancy and its consequences; and/or
Mental or emotional disorders; and/or
Sexually transmitted diseases, HIV infections and AIDS related infections; and/or
Experimental or investigative procedures; and/or
Cosmetic surgery, apart from reconstructive surgery in consequence of a covered Accident; and/or
Follow up non-medical treatment of any kind resulting from an Accident or Sickness, psychoanalytical
treatment, stays in rest homes, physiotherapy and detoxification; and/or
Ophthalmological care, eye glasses, contact lenses, hearing aids, dental care and dentures, unless they are
the direct consequence an injury from a covered Accident, which makes usaae medically necessary; and/or
care provided by a chiropractor, osteopath, herbalist, acupuncturist or any other practitioner of alternative
medicine; and/or
Non-emergency medical check-ups; and/or
Vaccinations and their complications.
(0)24 HOURS WORlDWIDE TRAVEl ACCIDENT SERVICES
Included
(E) By Thru l!ndudlng Missed FOght Connectlanl -If appHcable
In the event the covered Scheduled Flight during a Flight is missed at the transfer point due to the late arrival of the
Insured Person's incoming connecting Scheduled Flight and no onward Scheduled Flight is available or made available
to the Insured Person within at least 6 (six) consecutive hours from the scheduled time of connecting departure, the
Company will pay the Insured Person lOR 800.000 for every full six (6) consecutive hours of delay, maximum lOR
1.600.000,-.
Spedql ExdrJs/goS IJDD!!cob/« to Scctlqq D -Fly 1'l!n! llndudfnq M/swl Flight Cqonect/on/;
The Company shall not be liable for any loss caused by:-
(a) voluntary cancellation of a Scheduled Flight by the Insured Person;
(b) the Insured Person ·s f'!iliiP' to ch•<k in acmrdinl! to the itinerary supplied to him/her prior to the Scheduled
~;
PROVIDED ALWAYS THAT:·
This Policy shall only pay for any claim either under Section A.4- Flight Delay or Section E- Fly Thru including Missed
Flight Connection.
I GENERALEXCWSIONS ~-]
This insurance excludes anyone of the following events or situations:-
1. The Insured is below the age of 9 days or over the age of 75 (last birthday).
2. The Insured acting as members of the Armed Forces while on duty or while enaaging in or taking part in Naval,
Military, or Air Force service or operations of participating In operations of an Offensive nature planned or
conducted by the Civil or Military Authorities against bandits, terrorists or other elements, whether full time
service or as a volunteer
3. A willful or intentional act of the Insured whether sane or insane, self-inflicted Injury, suicide pact or agreements
or any attempt threat, provoked homicide or assault.
4. During air travel (except as a fare paying passenger in any properly licensed private and/or commercial aircraft
operated by Insured).
5. Any violation or attempt of violation of the law or resistance to arrest.
6. Treatment of alcoholism, or drug abuse or any other complications arising therefrom or any drug Accident.
7. Pregnancy, miscarriage or childbirth, or any treatment relating to birth control or treatment pertaining to
infertility or any other complication arising therefrom.
8. Psychosis, mental or nervous disorders or sleep disturbance disorders.
9. Cosmetic or plastic surgery or any elective surgery.
10. Any form of dental care or surgery unless necessitated by injury caused by an accident to sound and natural
teeth.
11. Any congenital defect which has manifested or was diagnosed before the Policy efft!ctlve date.
12. Routine health checks, any investigation(s) not directly related to admission diagnosis, illness or injury, or any
treatment.
13. Investigation which Is not medically necessary, or convalescence, custodial or rest care.
14. Any condition, which is or results from or is a complication of infection with Human Deficiency Syndrome (tilV),
any variance including Acquired Immune Deficiency Syndrome and AIDS related Complication (ARC), or any
opportunistic and/or malignant neoplasm (tumor) found in the presence of HIV, AIDS or ARC.
15. Driving or riding in any kind of race Involving motorized vehicles.
16. Engaging, practlcin& or participating in a sport in a professional capacity or when a Insured would or could earn
income or remuneration from engaging in such sport.
17. Any pre-existing physical or mental defect or infirmity before Policy effective date.
18. Any serious physical injury or Disability resultin& directly or indirectly from, attributed to, or accelerated by the
use, release or escape of nuclear materials that directly or indirectly results In nuclear reaction or radiation or
radioactive contamination; or the dispersal or application of pathogenic or poisonous biological or chemical
materials; or the release of pathogenic or poisonous biological or chemical materials.
For the purposes of this exclusion, serious physical injury means physical injury that involves a substantial risk
of death; and/or protracted and obvious physical disfigurement; and/or protracted loss of or impairment of the
function of a bodily member or of an organ.
19. Death or Injury directly or Indirectly occasioned by war, invasion, act of forelgn enemy, hostilities or warlike
operation (whether war be declared or not) mutiny, civil war, rebellion, revolution, insurrection, conspiracy,

PT ASURANSI DAVIN MITRA Tbk PT ASURANSI DAVIN MITRA Tbk

Genero;~-1 tnsuranca G~Soeral Insurance
 military or usurped power, martial law, or state of siege, of any of the events or causes which determine the
proclamation or maintenance of martial law, or state of siege, seizure, quarantine, or customs regulations or
nationalization by or under the order of any government or public or local authority.
20. The Insurer will not pay under any section of this Policy where such payment would violate a government
prohibition or regulation.
21. Delay, seizure, confiscation, destruction, requisition, retention or detention by Customs or any other Government
or Public Authority or Official.
22. Late arrival of the Insured at the airport after the official check-in time required by AirAsia.
23. Beyond thirty (30) calendar days from the flight departure date in respect of coverage duration applicable for
each Air Asia Insure Return Travel Protection Certificate issued
24. Any loss, injury, damage or legal liability;
a) Arising directly or indirectly from travel in, to or through Afghanistan, Cuba, Democratic Republic of Congo,
Iran, Iraq, Uberia, Sudan or Syria; and
b) Suffered or sustained directly or indirectly by an insured person if that insured person Is:
(i) a terrorist;
(ii) a member of a terrorist oiJanlzation;
(IIi) a narcotics trafficker; or
(iv) a purveyor of nuclear, chemical or biological weapons
6. Payment of a covered claim under this Policy will be made subject to Clause 19 of the Applicable Terms &
Conditions below.
7. Payment of any claim covered under this Policy shall be made in Indonesian currency or its equivalent in any other
currency at the prevailing rate of exchange as at the time of effecting payment if so required by the Insured or
his legal personal representative.
8. If any claim under this Polley shall be fraudulent or if any fraudulent means or devices shall be used by the
Insured, their legal personal representative(s), any claimant or anyone acting for and on behalf of any of them to
obtain any benefit under this Policy, the Insurer shall be under no liability for such claim.
9. No claim shall be payable for any loss or expenses that has been reimbursed by or is recoverable from AirAsia
or from any other source.
\ DEFINITIONS I
AirAsia Common carrier: shall mean any mechanically propelled air conveyance operated by AirAsia or its successor.

l ClAIM PROCEDURE I Air Ticket: Also known as seats purchased under AirAsia's e-ticketing system, shall mean any air ticket(s) arranged for
a particular journey of the Insured issued by AirAsia. Such journey must Include but not necessarily originate
from Indonesia. Operationally, an electronic acknowledgment response is generated upon an internet purchase, which
Is titled "Passenger Name Record" or PNR. The PNR is recognized as an Air Ticket.
1. On the happening of any event which may give rise to a claim, the Insured shall:-
a) notify the Insurer in writing as soon as possible, but not later than 30 days after the event giving rise to such
Civil War: Armed opposition between two or more parties belonging to the same country where the opposing parties
claim in the form provided;
are of different ethnic, religious, or ideological groups. Included in this definition are armed rebellion, revolution,
b) fumish to the Insurer in writing at his own expense any evidence, proof, information, particulars, accounts,
sedition, insurrection, coup d•etat, and the consequences of martial law.
original receipts, invoices, Insured statements, reports and any other documents as the Insurer may require
and shall be in such form and of such nature as the Insurer may prescribe. Common carrier: This is to mean any land, water or air conveyance operated under a license for the regular
transportation of fare-paying passengers, and any fiXed-wing aircraft provided and operated by a properly
2. The following information and documents shall be furnished to the lnsurer:- licensed commercial airline Insurer for the recular transportation of fare-payin& passengers operating over fixed
a) copies of the record charge forms verifying the relevant Scheduled flight air tickets charged to the Insured ; scheduled flying routes between established licensed commercial airports, which is either arranged or booked for the
b) he Property Irregularity Report obtained from AirAsla in respect of the lost luggage; Insured.
c) details of the Scheduled Flight;
d) details of the delay or loss incurred. Return Travel Protection: This insurance pian is offered In conjunction with a return flight and it is detailed in
Appendix A Section (1) which forms part and parcel of the policy. This Plan Is only available to a Guest between the
3. Any circumstance that may require Emergency medical Evacuation or body repatriation must be notified ages of 9 days to seventy-five (75) years old.
immediately to the AA International inc to obtain advance approved and to make transportation arrangements.
Country of Arrival: The country where the Insured's Scheduled Flight is destined to depart to.
4. All reasonable measures to protect, safeguard and recover such luggage shall be undertaken by the Insured.
Any delay or non-delivery of such luggage shall be reported to an authorized official of AirAsia immediately it is Insured: Refers to an AirAsia Guest for whom an Air Ticket has been purchased on-line and who has been issued with
discovered that such luggage checked In at the airport of departure has not arrived at the intended airport of a Tune Insure AirAsia Travel Protection Certificate for that scheduled flight(s).
destination.
First Departure Date: Refers to the date the Insured is booked on a departure flight on an Insured Scheduled Flight.
5. All notifications of claim to the Insurer shall be addressed to :- This date is concurrent with the Insurance Policy Start Date stated in the Insurance Certificate.
Claims Department
PT Asuransi Dayln Mitra Tbk Foreign war: Armed opposition, whether declared or not between two countries.
Wisma Sudlrman Annex
JIJend Sudirman Kav. 34, Jakarta 10220 Hospital: Means a legally constituted establishment operated pursuant to the laws of the country in which it is based,
Indonesia which holds a license as a hospital (If licensing Is required in the state or government jurisdiction) and meets
Telp. 6221-5708989 (Hunting) the following requirements:
Fax. 6221-5709274 {i) Operates primarily for the reception, care and medicare and treatment of sick, ailing or injured persons as in-
patients
(ii) Provides full-time nursing service by and under the supervision of a staff of Nurses; (Iii) has a staff of one or more

PT ASURANSI DAVIN MITRA Tbk PT ASURANSI DAVIN MITRA Tbk

Ge:n(lt"at lnsuranct) General Insurance
 Physicians available at all times;
(iv) Maintains organized facilities for the medical diagnosis and treatment of such persons, and provides (where
appropriate) facilities for major surgery within the confines of the establishment or in facilities controlled by
established; and
(v) Is not primarily a clinic, nursing, rest or convalescent home or similar establishment and Is other than a place for
alcoholic or drug addicts.
And Hospital shall not include the following:
(1) A mental Institution; and Institution confined primarily to the treatment of psychiatric disease including sub-
normally; the psychiatric department of a hospital.
(2) A place for the aged; a rest home; a place for drug addicts or alcoholics.
(3) A health hydro or nature cure clinic; a special unit of a hospital used primarily as a place for drug addicts or
alcoholics, or nursing, convalescent, rehabilitation, extended-care facility or rest home.
Immediate Family Member: This is to mean a Insured's legal spouse; children; children-in-law; siblings; siblings in law;
parents; parents-in-law; grandparents; grandchildren; legal guardian, ward; step or adopted children; step-
parents; aunts, undes, nieces, and nephews, and who resides in that Insured's principal country of residence.
Insurance Certificate: This is the Confirmation of insurance travel protection which is electronically generated upon the
on-line purchase of the Tune Insure AirAsia Travel Protection.
Physician : Means a legally licensed physician or surgeon duly registered and practicing with the scope of his license
pursuant to the law of the country in which such practice is maintained.
Pre-Exlstlns Condition : Means any medical condition of the Insured or an Immediate Family Member of the
Insured which in the 90 day period preceding purchase of air tlcket(s); (a) first manifested itself, worsened,
became acute or exhibited symptoms which would have caused an ordinarily prudent person to seek diagnosis, care
or treatment; or, (b) required the taking of prescribed drugs or medicine; or, (c) is under treatment by a Physician or
where treatment has already been recommended by a Physician.
Reasonable and Customary Charces: This is to mean an expense which is charged for medical/Hospital treatment,
supplies or services medically necessary to treat the Insured; it should not exceed the usual level of charges for similar
treatment, supplies or medical services in the locality where the expense is incurred; and should not Include charges
that would not have been made if no insurance was procured.
Scheduled Fhsht: This refers to commercial flights scheduled by AirAsia, it being always understood that AirAsia has at
all times the requisite and valid licenses or similar authorizations for scheduled air transportation and landing rights
for fare-paying passengers as issued by the relevant authorities in the country in which it operates, and that in
accordance with such authorization, maintain and publish schedules and tariffs for passenger service between
named airports. Furthermore, Scheduled Flights shall comply with the ABC World Airways Guide. In addition,
departure times, transfers and destination points shall be established by reference to the Insured's Scheduled Flight
ticket.
Serious Illness: Whenever applied to the Insured or Immediate Family Member, it shall mean Sickness certified as
being life threatening and requiring Immediate treatment by a Physician and which results In the Insured or
his/her Immediate Family Member being certified by that Physician as unfit to travel or to continue with his/her
original Flight or Trip.
Sickness/Illness: Any noticeable change in the physical health of an Insured that requires the care of a Physician
acting within the scope of his/her license to treat the Sickness for which the claim is made, and the nature of the illness
is not excluded from this present policy.
Under Return Travel Protection, this change must occur between the date of purchase of Air Ticket and
Departure Oates In respect of Cancellation benefit.
The Insurer: PT Asuransi Oayin Mitra Tbk.
PT ASURANSI DAVIN MITRA Tbk
Gen-eral fnsurance
The Trip: The period between the departure date and return date.
Time: Any reference to a time or a date in the policy context or in the context of a coverage period is that referable
to Indonesian time.
I ----· APPUCABLETERMS&<:O::.::-· I
1. ENTIRE CONTRACT-cHANGES IN POLICY: This Master Policy contains all the terms of the Insurance.
2. ALTERATIONS: The Insurer reserves the right to amend the terms and provisions of the Master Policy and may at
the amendment. No alteration in the Master Policy shall be valid unless approved by an authorized
representative of the Insurer and such approval be endorsed herein.
3. CURRENCY OF PAYMENT: All amounts payable either to or by the Insurer shall be payable in the currency stated
on the Schedule of Benefits.
4. COMPENSATION LIMIT: The Compensation limit is that expressed in the Compensation Table.
5. METHOD OF PREMIUM PAYMENT: paid by credit card.
6. GRACE PERIOD: Premium shall be paid In full before the effective date of the Policy. Grace period for payment of
premium is inapplicable to this Policy.
7. ADMmED PERIOD AS OF WHEN THE PREMIUM PAYMENT IS RECEIVED, IF PAYMENT CONDUCTED WITH
THE FOLLOWING METHOD: By credit card in favor of AirAsia, then the premium payment will be admitted on the
date such credit had been able to be received on the AirAsia's account.
8. AGE LIMITS FOR PERSONS INSURED UNDER THIS POLICY: Within 9 days to eighty (75) years.
9. MIS-STATEMENT OF AGE: All ages referred to in this Policy shall be the age of the Insured at his last birthday.
10. NOTICE OF CLAIM: Written notice of claim must be &iven to the Insurer within thirty (30) days after the date of
loss. In the event of accidental death, immediate notice thereof must be given to the Insurer. The Insured
hereunder shall produce for the Insurer's examination pertinent documents at such reasonable times and shall
co-operate with the Insurer in all matters pertaining to any loss and/or claims. Failure to comply with this
condition may prejudice the claim. (Refer "Claims Procedure" below)
11. OBSERVANCE OF INSURANCE TERMS AND CONDITIONS: The due observance of this Insurance Certificate
shall be binding upon the Insured, and shall serve as conditions precedent to the admission of any claim
lodged under this Policy.
12. EFFECT OF FRAUD: Any fraud, misstatement or concealment in respect of this Insurance or any claim hereunder
shall render the Certificate of Insurance null and void and Benefit due hereunder shall be or become forfeited.
13. OFAC CLAUSE: The Insurer is not liable to make any payments for liability under any coverage sections <>f this
Policy or make any payments under any extensions: For any loss or claim arising in, or where the Insured or
any beneficiary under the Policy is a citizen or instrumentality of the government of, any country(ies) against
which any laws and/or regulations governing this Policy and/or the Insurer, its parent company or Its ultimate
controlling entity have established an embargo or other form of economic sanction which have the effect of
prohibiting the Insurer to provide insurance coverage, transacting business with or otherwise offering economic
benefits to the Insured or any other beneficiary under the Policy. It Is further understood and agreed that no
benefits or payments will be made to any beneficiary who is/are declared unable to receive economic
benefrts under the laws and/or regulations governing this Policy and/or the Insurer, its parent company or its
ultimate controlling entity.
14. PROOF OF LOSS: Written proof of loss must be furnished to the Insurer at Its said office within ninety (90) days
after the date of loss. Failure to furnish such proof within the time required shall not Invalidate nor reduce any
claim If it was not reasonably possible to give proof within such time provided such proof is furnished as soon as
possible and In no event, except in the absence of legal capacity, later than one (1) year from the time proof
is otherwise required.
15. MIS-REPRESENTATION IN APPLICATION: The benefits shall not be payable and the Policy shall be considered
voidable at the option of the Insurer In the event that (a) there has been a failure to disclose or there has been
any misrepresentation of any fact with respect to the Insured or Insured that is material to the insurance
provided hereunder which Is required to be furnished as evidence of Insurability; and/or (b) in all cases of
fraud.
PT ASURANSI DAVIN MITRA Tbk
General Insurance
16. COMPUANCE WITH POLICY PROVISIONS: Failure to comply with any of the provisions contained in the
Certificate of Insurance shall invalidate all claims hereunder.
17. DISPUTE RESOLUTION: Any dispute arising out of or in relation to the interpretation and/or implementation of
this Policy shall be settled amicably within 60 (sixty) days from the date on which the dispute is brought by the
Insured to the Insurer's attention. The dispute shall be deemed to arise commencing from the date of the written
disagreement notice from the insured to the Insurer. If the dispute cannot be settled amicably, the Company
provides the Insured with a freedom to select either one of the dispute settlement procedures as provided
below. The settlement dispute resolution selection Is final and irrevocable. The insured shall notify the Company
of his/her selection by recistered letter, telegram, telex, facsimile, e-mail or by courier.
a. Any dispute arising out of or In relation to the interpretation and/or implementation of this Policy shall be
settled by the Indonesian National Arbitration Agency or Badan Arbitrase Nasional indonesia ("BANI") based
on BANI's proceeding regulations, which has a final and binding decision.
b. Court of lawAny dispute arising out of or in relation to the interpretation and/or implementation of this
Polley will be settled through district court based on the provisions of the indonesian legal proceeding law.
18. COUNTRY OF FLIGHT ORIGIN: Coverage of the Insured is subject to either their residence in indonesia or for non-
residents, to their travel through Indonesia or to their transit throuah a Indonesian airport.
19. TO WHOM INDEMNITY IS PAYABLE: Indemnity for loss of life in respect of the Insured is payable to the
beneficiary elected by the insured or to the Insured's Estate. Indemnity for all other benefits will be paid to
the Insured. The process of claim including settlement will be handled directly between the Insurer and the
Insured or his/her Estate as the case maybe, whose sole discharge will constitute full and final discharge of the
claim lodaed.
20. CANCELLATION:
- The Insured is able to cancel the Policy by submitting a written notification addressed to AirAsia when
the Scheduled Flight Is cancelled by AirAsia. The cancellation must be done prior to the departure date and
before using any of the benefits afforded in the Policy.
The Insurer refunds the premium when AirAsla grants full refund for the Air Ttcket.
21. AI RASIA: Any issues, matters or claims related In whole or part to insurance provided under this Policy shall be the
sole responsibility of the Insurer, and shall not in onyway involve AirAsia.
22. PREVAILING LANGUAGE: For all intents and purposes where there Is a conflict or ambiguity as to the meaning in
the English provisions or the Bahasa Indonesia provisions,it Is hereby agreed that the Indonesian version shall
prevail
PT ASURANSI DAVIN MITRA Tbk
Geoet.l!l insurance
ON TIME GUARANTEE (OTG} EXTENSION
WHEREAS the Insured Person by a proposal and declaration which shall be the basis of this contract and is deemed to
be incorporated herein has applied to PT. Asuransi Dayin Mitra, Tbk (the Company) for the insurance hereinafter
contained and has paid the premium in respect of such insurance.
NOW THIS POLICY WITHESSETH that in the event that the Occurrence described hereunder shall occur during the
Period of Insurance and subject to the limitations exceptions and conditions contained herein or endorsed hereon
(hereinafter collectively referred to as the Terms of this Policy), the Company will compensate the Insured Person the
Compensation hereinafter described.
PROVIDED ALWAYS that the due observance and fulfillment of the terms conditions and endorsements of this Policy
in so far as they relate to anything to be done or complied with by the Insured Person shall be conditions precedent to
any liability of the Company to make any payment under this Policy.
OCCURRENCE
Delay of scheduled flight by more than 2 hours from the scheduled time of flight departure caused solely by carrier
operator.
COMPENSAnON
The actual Airfare and charges for the particular flight subject to maximum lOR 800.000,- of per Insured Person.
PERIOD OF INSURANCE
The insurance coverage commences upon the check in on the Departure Date for a Scheduled Flight which will include
the time the Insured Person is inside any airport premises for the purpose of commencement or continuation of the
Schedule Flight, and will be in Ioree until the Policy Is terminated in accordance with General Conditions of the Policy.
POLICY DEFINITIONS
Insured Person Refers to an Insured AlrAsia Guest whom an Air Ttcket has been purchased and !
who has been issued with an AirAsia Insure Travel Protection Plan Certificate of
Insurance for that scheduled flight(s).
Delay Shall mean the scheduled aircraft In which the Insured Person has booked to
travel is delayed caused solely by carrier operator.
Carrier Operator Shall mean .PT. AirAsia Indonesia
Scheduled Flight Shall mean commercial flights scheduled by PT. AirAsia Indonesia, it being
always understood that PT. AirAsia Indonesia has at all times the requisite and
valid licenses or similar authorizations for scheduled air transportation and
landing rights for fare-paying passengers as issued by the relevant authorities in
the country in which it operates, and that in accordance with such
authorization, maintain and publish schedules and tariffs for passenger service
between named airports. Furthermore, Scheduled Flights shall comply with the
ABC World Airways Guide. In addition, Departure Times, transfers and
destination points shall be established by reference to the Insured Person's
Scheduled Flight ticket.
Schedule Time Shall means:
(I) The time printed in the Insured Person itinerary;
(il) Any new departure time which PT. AirAsia Indonesia have advised the
Insured Person not less than 24 hours from the original schedule time of
flight departure on the fli;ht itinerary.
Qualifies Medical Practitioner Shall mean any person qualified by a degree in western medicine and legally
licensed and authorized to practice medicine and sureerv.
PT ASURANSI DAVIN MITRA Tbk
Gene-ral Insurance
EXCWSIONS
II
The Company will not pay for loss directly or Indirectly arising as a result of:-
1) Any illegal or unlawful intention act by the Insured Person.
2) Any breach of government re&ulatlon or any failure by the Insured Person to take reasonable precautions to avoid
a claim under the Polley following the warning of any intended strike, riot or civil commotion through or by
general mass media.
3) The failure of the Insured Person to check in according to the Itinerary supplied to him/her.
4) Strike or industrial action existing on the date the flight Is arranged.
5) Any prohibition or resulations by any covernment.
6) The Insured Person Is not fit to travel or is travelling against the medical advice of a Qualified Medical
Practitioner.
7) Delay caused by circumstances which beyond PT. AlrAsia Indonesia control such as bad weather, air traffic
control, airport closure, strikes and acts of Gods.
GENERAL CONDITIONS
PROVISO
a) The benefits under this extension mentioned herein shall be offered to passenger(s) who has/have purchased
AirAsie Insure Travel insurance Protection and with an additional premium paid.
b) Compensation in respect of the benefits mentioned herein shall be payable only when the claim has been proven
to the satisfaction of the Company.
COMMUNICATION
Every notice or communication to be given or made under this Policy by the Insured Person and/or his legal Personal
representative and/or PT. AirAsia Indonesia shall be delivered in writing to the Head Office of the Company.
FORMS FOR PROOF OF LOSS
The Company, upon receipt of a notice of claim will furnish to The Insured such claim forms which are usually
furnished by the Company for filing proofs of loss. Such claims forms must be returned by The Insured with full
particulars within 15 days after the receipt of such claims forms from the Company. PT. AlrAsla Indonesia shalt notify
The Company in any event of any delay, the circumstances and the extent of the loss for which the claim Is made.
ARBITRATION
a) Any dispute, difference or question which may arise at any time hereafter between the Company and PT. AlrAsla
Indonesia In relation to the true construction of the Polley or the rights or liabilities of the parties hereto shall be
referred to arbitration In Indonesia and the Indonesian law shall apply hereto.
b) The arbitration shall be heard by a single arbitrator to be agreed by the parties hereto within fourteen (14) days
of the commencement of the arbitration. In default of agreement, the arbitrator shall be appointed in accordance
with and subject to the provisions of any Arbitration Act of Indonesia or any statutory modification or the re-
enactment thereof for the time being in force. Arbitration proceedings shall be conducted in accordance with the
Rules of any Indonesia Arbitration Centre.
ENllRE CONTRACT
The Policy, Schedule, Endorsements, Certificate of Insurance, Application Form, Declaration and attached papers
together with other statement in writing shall be read together as one contract. Any word or expression to which a
specific meaning has been ascribed in any part of the Schedule attached shall bear specific meaning wherever it may
appear. in the event of a conflict, the terms, conditions or provisions of the Schedule attached shall prevail. No
statement made by the applicant for insurance coverage not included herein shall void the insurance cover or be used
in any legal proceeding hereunder. No Agent shall be valid unless approved by an executive officer of the Company
and such approval be endorsed hereon.

FITNESS FOR TRAVEL INTEREST

At the time of travelling the Insured Person must be medically fit to travel and not be aware of any circumstances No indemnity from the Company shall accrue any interest.
which could lead to cancellation or disruption of the flight, otherwise any claim is not payable.
GOVERNING lAW
CURRENCY This Policy shall be governed by and interpreted in accordance with Indonesia law. The indonesia courts shall have
All amounts shown are in Rupiah Indonesia. exclusive jurisdiction.

CANCELLATION CONTRACTS (RIGHTS OF THIRD PARTIES)

This Extension once issued is not cancelable or refundable. A person who Is not a party to this Policy contract shall have no right under the Contracts (Rights of Third Parties) Act
and any subsequent revision or amendment thereof enforce any of its terms. For avoidance of doubt, the application
COMPUANCE WITH POUCY PROVISIONS of the aid Act is expressly excluded insofar as the Polley contract is concerned.
Failure to comply with any of the provisions contained in thi• Policy shall invalidate all claims hereunder.

NOTICE AND PROCEDURES OF CLAIMS

Upon the happening of any event which may give rise to a claim, the Insured Person shall:-
(i) I notify the Company in writing as soon as possible but not later than thirty (30) days after any event which may
give rise to such claim by filline up the claim form as provided by the Company;
(ii) Furnish to the Company in writing, at the Insured Person's own costs and expenses, any evidence and proof
includtng but not limited to information, partk:ulars, accounts, original receipt, invoices, Insured Person ·s
statements, reports and any other documents as the Company may require and shall be in such form and of such
nature as the Company may prescribe.
(iii) Produce for the Company's examination pertinent documents at such reasonable times and shall co-operate with
the Company in all matters pertaining to any loss and/or claims. Failure to comply with this condition may
prejudice the claim.

The following information and documents shall be furnished to the Company under any circumstances in matters of
claims:-
(!) Copies of the record and/or charge forms verifying the relevant Scheduled Flight Air Tickets charged to the
Insured Person's credit card account.

PT ASURANSI DAVIN MITRA Tbk PT ASURANSI DAVIN MITRA Tbk

General fnsurance General Insurance
IMPORTANT NOTICE
1. Under the prudential framework of Corporate Government, the following avenues have been set up to handle
customer grievances:·

PT. Asuransi Dayin Mitra, Tbk

Wisma Sudirman Annex
Jl. Jend. Sudirrnan Kav. 34
Jakarta 10220
Indonesia

(a) Marketing Department

Tel : +6221 570 8989
Fax : +6221570 9276/78

(b) Claim Department

Tel : +6221 570 8989
Fax : +6221570 9274

Any policyholder who Is not satisfied with the decision of an Insurance Company may write to the Mediator, giving
details of the dispute, the name of the Insurance Company and the Polley Number. Copies of the correspondence
exchanged between the Policyholder and the Company must be submitted to facilitate matter.

Badan Mediasi Asuransi Indonesia (BMAI)

Jl. H.R. Rasuna Said Kav. B-9
Menara Outa lantai 7 Wing A
Jakarta Selatan 12910
Indonesia

Tel: +6221527 4145

Fax: + 6221 527 4146

Any policyholder who is not satisfied with the conduct of an insurance company may write to Badan Mediasi Asuransi
Indonesia (BMAI), siving details of the complaint, the name of the insurance company and the policy number or the
claim number together with supporting documents.

Badan Medlasi Asuransllndonesia (BMAI)

Jl. H.R. Rasuna Said Kav. B-9
Menara Duta lantal 7 Wing A
Jakarta Selatan 12910
Indonesia

Tel: +6221527 4145

Fax: + 6221 527 4146

2. By virtue of the Undang- Undang Nomor 25 tahun 2003 (Undang- Undang Tindak Pi dana Pencucian Uang), any
"Suspicious Transaction~~ as classified by the law is required to be reported to Pusat Pelaporan dan Analisis
Transaksi Keuangan (PPATK).

Pusat Pefaporan dan Anallsis Transaksi Keuangan (PPATK)

Jl. lr. H. Juanda No. 35
Jakarta 10120
Indonesia
Tel: +6221 385 0455/3922
Fax: + 6221 385 6809/6826

PT ASURANSI DAVIN MITRA Tbk

Gen&ral losurance