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			<p style="text-align: center;">&nbsp;<img alt="" src="https://www.mondialcare.eu/wp-content/uploads/2020/01/Asset-2logo-tr.png" style="margin: 10px 20px; width: 308px; height: 47px;" /></p>

			<p style="text-align: center; margin-top:0pt; margin-bottom:5pt; font-size:15pt;"><strong><span style="font-family:Montserrat; color:#ff6600;">ATTESTATION D&#39;ASSURANCE VOYAGE BUSINESS</span></strong><br />
			<strong><span style="font-family:Montserrat; color:#339999;">CERTIFICAT N&deg;[personne--num_client]</span></strong></p>

			<p style="text-align: center; margin-top:0pt; margin-bottom:0pt; font-size:13px;"><strong><span style="font-family:'Myriad Pro'; color:#ff6600;">Certificat en conformit&eacute; avec les exigences internationales pour les s&eacute;jours de 365 jours maximum.</span></strong></p>

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			<p style="font-size: 12px; color:#000000;text-align: justify;"><strong>MONDIALCARE&copy; par AGIS SAS</strong> atteste par la pr&eacute;sente que l&#39;assur&eacute; d&eacute;nomm&eacute; ci-apr&egrave;s est garanti par le contrat GSL <strong>N&deg;ADP20192394 REF GSL-AGISBUSINESSTRIP0819 </strong>suivant les prestations d&eacute;crites dans les conditions g&eacute;n&eacute;rales.</p>

			<p style="font-size: 12px; color:#000000;text-align: justify;">L&#39;assur&eacute;(e) d&eacute;sign&eacute;(e) sur cette attestation d&rsquo;assurance, b&eacute;n&eacute;ficie des garanties d&eacute;finies aux conditions g&eacute;n&eacute;rales valant notice d&rsquo;information jointes en annexe et selon ses options, montants de garanties et de franchises figurant aux tableaux ci-apr&egrave;s.</p>
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<div style="text-align:center; width: 100%;">&nbsp;</div>

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			<p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:12pt;"><strong><span style="font-family:Montserrat; color:#ff6600;">INFORMATIONS DE L&rsquo;ASSURE(E) BENEFICIAIRE DES GARANTIES</span></strong><br />
			<span style="color:#000000;"><span style="font-family:'Myriad Pro'; font-size:10pt;">P&eacute;riode de Garantie : du&nbsp;</span><strong><span style="font-family:'Myriad Pro'; font-size:10pt;">[date-depart]</span></strong><span style="font-family:'Myriad Pro'; font-size:10pt;">&nbsp;au&nbsp;</span><strong><span style="font-family:'Myriad Pro'; font-size:10pt;">[date-fin]&nbsp;</span></strong><span style="font-family:'Myriad Pro'; font-size:10pt;">inclus &ndash; soit&nbsp;</span><strong><span style="font-family:'Myriad Pro'; font-size:10pt;">[resultatDuree]</span></strong><span style="font-family:'Myriad Pro'; font-size:10pt;">&nbsp;jours</span><br />
			<span style="font-family:'Myriad Pro'; font-size:10pt;">Pays de Provenance</span><span style="font-family:'Myriad Pro'; font-size:10pt;">&nbsp;</span><span style="font-family:'Myriad Pro'; font-size:10pt;">:&nbsp;</span><strong><span style="font-family:'Myriad Pro'; font-size:10pt;">[provenance_pays]</span></strong><span style="font-family:'Myriad Pro'; font-size:10pt;">&nbsp;&ndash; Pays de Destination:&nbsp;</span><strong><span style="font-family:'Myriad Pro'; font-size:10pt;">[destination_pays]</span></strong></span></p>
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			<p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10pt;"><strong><span style="font-family:Montserrat; color:#ffffff;">Identit&eacute; de l&#39;assur&eacute;(e)</span></strong></p>
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			<p style="margin-top:0pt; margin-bottom:0pt; text-align:center; font-size:10pt;"><strong><span style="font-family:Montserrat; color:#ffffff;">Coordonn&eacute;es de l&#39;assur&eacute;(e)</span></strong></p>
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			<p style="margin-top:0pt; margin-bottom:0pt; font-size:10pt;"><span style="color:#000000;"><span style="font-family:'Myriad Pro';">Nom :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[personne--nom]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Pr&eacute;nom(s) :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[personne--prenom]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Date de Naissance :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[personne--date-naiss]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Adresse de r&eacute;sidence :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[adresse-payeur]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Pays de r&eacute;sidence :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[pays-payeur]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Ville de r&eacute;sidence :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[ville-payeur]</span></strong></span></p>
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			<p style="margin-top:0pt; margin-bottom:0pt; font-size:10pt;"><span style="color:#000000;"><span style="font-family:'Myriad Pro';">T&eacute;l Fixe :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">+[ind_fix-payeur][telephone_fix-payeur]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Mobile :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">+[ind_mobile-payeur][telephone_mobile-payeur]</span></strong><br />
			<span style="font-family:'Myriad Pro';">Adresse E-mail :&nbsp;</span><strong><span style="font-family:'Myriad Pro';">[email-payeur]</span></strong></span></p>
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<p style="margin-top: 14pt; margin-bottom: 14pt; font-size: 10pt; text-align: center;"><span style="color:#000000;"><strong><span style="font-family:'Myriad Pro';">Pour toutes demandes d&rsquo;Assistance</span></strong><span style="font-family:'Myriad Pro';">, l&rsquo;Assur&eacute;(e) (ou toute personne agissant en son nom)<br />
doit contacter GROUPAMA ASSISTANCE au <strong><span style="font-family:'Myriad Pro';">+33 1 55 98 57 35 </span></strong>(joignable 7 jours sur 7, 24h sur 24)</span><br />
<span style="font-family:'Myriad Pro';">en rappelant la r&eacute;f&eacute;rence du contrat <strong>GSL N&deg; ADP20192394 REF GSL-AGISBUSINESSTRIP0819.</strong></span></span></p>

<p style="margin-top: 14pt; margin-bottom: 14pt; font-size: 11pt; text-align: center;"><span style="color:#000000;"><strong><span style="font-family:'Myriad Pro'; font-size:10pt;">Pour tout autre renseignement et demande de remboursement FRAIS M&Eacute;DICAUX-HOSPITALISATION :</span></strong><br />
<span style="font-family:'Myriad Pro'; font-size:10pt;">Contacter <strong>MONDIALCARE&copy;</strong> par l&#39;intermediaire de AGIS SAS - 33 Avenue Victor Hugo 75784 Paris Cedex 16</span></span><br />
<span style="font-size:14px;"><span style="color:#000000;"><span style="font-family: &quot;Myriad Pro&quot;;">T&eacute;l&eacute;phone : +33182835626&nbsp;</span><span style="font-family: &quot;Myriad Pro&quot;;">ou par E-mail :&nbsp;</span> </span><a href="mailto:contact@mondialcare.eu" style="text-decoration:none;"><span style="color:#000000;"><u><span style="font-family: &quot;Myriad Pro&quot;;">contact@mondialcare.eu</span></u></span></a></span></p>

<p><span style="color:#000000;font-family:'Myriad Pro';">Ce contrat pr&eacute;voit notamment les garanties suivantes (voir le Tableau de Garanties pour plus de d&eacute;tails):</span></p>

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			<th style="text-align: left;font-size:10pt;background-color: rgb(255, 102, 0);"><span style="font-family:Montserrat; color:#ffffff;">Montants TTC Maximum</span></th>
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			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">Frais m&eacute;dicaux, chirurgicaux, pharmaceutiques et d&#39;hospitalisation</span></td>
			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">Jusqu&#39;&agrave; 2 000 000&euro;</span></td>
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			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Assistance m&eacute;dicale compl&egrave;te</span></td>
			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Frais R&eacute;els</span></td>
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			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Rapatriement du corps en cas de d&eacute;c&egrave;s</span></td>
			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Frais R&eacute;els</span></td>
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			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Capital D&eacute;c&egrave;s accidentel et Invalidit&eacute; Permanente</span></td>
			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Jusqu&#39;&agrave; [personne--optfm]</span></td>
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			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Forfait Individuel ou Famille ?</span></td>
			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">[personne--indivfam]</span></td>
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			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Assurance des Bagages et Effets Personnels</span></td>
			<td style="text-align: left;font-size:14px;"><span style="color:#000000;font-family:'Myriad Pro';">Jusqu&#39;&agrave; 2 000&euro;</span></td>
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			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">Assurance Retard, Annulation billetterie, D&eacute;tournement a&eacute;rien</span></td>
			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">Jusqu&#39;&agrave; 5 000&euro;</span></td>
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			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">L&#39;assur&eacute; b&eacute;n&eacute;ficie des Garanties en option suivantes ?</span></td>
			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">[multitrip]</span></td>
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			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">Responsabilit&eacute; Civile Vie Priv&eacute;e</span></td>
			<td style="text-align: left;font-size:14px; background: #FDFDFD;"><span style="color:#000000;font-family:'Myriad Pro';">Jusqu&#39;&agrave; 5 000&euro;</span></td>
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<p style="font-size:10px;text-align: justify;"><span style="color:#000000;">L&#39;assur&eacute; reconna&icirc;t avoir pris connaissance de l&#39;ensemble des informations figurant sur son contrat et les conditions g&eacute;n&eacute;rales. Ce contrat est &eacute;tabli selon ses d&eacute;clarations; le code des assurances pr&eacute;voit express&eacute;ment la nullit&eacute; du contrat (article L113.8 du Code des assurances) en cas de fausse d&eacute;claration ou de d&eacute;claration incompl&egrave;te.&nbsp; L&#39;assur&eacute; autorise son assureur &agrave; communiquer les informations relatives &agrave; son contrat &agrave; toute personne qui pourrait en avoir besoin en raison de sa gestion ou de son ex&eacute;cution. L&#39;assur&eacute; dispose d&#39;un droit d&#39;acc&egrave;s et de rectification pour toute information le concernant, qu&#39;il pourra exercer aupr&egrave;s de notre si&egrave;ge ou contactez DPO EXPERT au 01 4227 7349 &agrave; dpo@agis-group.com</span></p>

<p style="text-align:justify; font-size:10px;"><span style="color:#000000;"><strong>MONDIALCARE &copy; par AGIS SAS - 33 Avenue Victor Hugo 75116 Paris - T&eacute;l : +33 9 70 46 66 10 ou +33 1 82 83 56 26 </strong>RCS Paris B 524 120409 Garantie Financi&egrave;re et responsabilit&eacute; civile professionnelle conformes &agrave; la loi Immatriculation sous le num&eacute;ro 10057380 au registre des Interm&eacute;diaires d&#39;Assurances Orias - 1 rue Jules Lef&egrave;vre - 75311 Paris Cedex 9 - Activit&eacute; exerc&eacute;e sous le contr&ocirc;le de l&#39;ACPR - 4 Place de Budapest - CS 92459&nbsp; 75436 Paris</span></p>

<p style="text-align:justify; font-size:10px;"><strong><span style="font-family:Montserrat; color:#ff6600;">INFORMATIONS DU CONJOINT</span></strong></p>

<p style="text-align:justify; font-size:10px;"><span style="color:#000000;"><strong><span style="font-family:'Myriad Pro';">NOM: [personne--conjoint-nom]</span></strong></span></p>

<p style="text-align:justify; font-size:10px;"><span style="color:#000000;"><strong><span style="font-family:'Myriad Pro';">Prenom: [personne--conjoint-prenom]</span></strong></span></p>

<p style="text-align:justify; font-size:10px;"><span style="color:#000000;"><strong><span style="font-family:'Myriad Pro';">Date de naissance: [personne--conjoint-datenais]</span></strong></span></p>

<p style="text-align:justify; font-size:10px;"><strong><span style="font-family:Montserrat; color:#ff6600;">Liste des enfants</span></strong></p>

<p style="text-align:justify; font-size:10px;">[personne--enfants]</p>
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