Chapter I Corporate Identity

Transcription

1 Chapter I Corporate Identity Policyholder COLOMBIA TRIEVENTS S.A.S. City: Bogotá Insured All participating athletes of the IRONMAN Cartagena event to be held on December 4, 2016, shall be insured. Beneficiaries For purposes of this insurance, the beneficiary shall be the Policyholder. In the event that future claims are presented by the beneficiaries to the Insurance Company, in connection to the compensation paid to COLOMBIA TRIEVENTS, the POLICYHOLDER shall take responsibility for all oppositions or claims exonerating ALLIANZ SEGUROS DE VIDA S.A. under any concept. Policy Póliza Number.: <> Insurance Agent Direct Business Subsidiary: Broker Page 2 of 7

2 Chapter II Insurance Purpose and Scope Subject to the exclusions mentioned below, this insurance covers death caused by accident, provided that death occurs within ninety (90) days following the occurrence of the accident. For all purposes of this insurance, it is understood by accident any external, violent, unexpected, sudden and independent event of the insured s will, producing the loss of any limb, organ damage or functional disturbance. Muscle distortions, lacerations, dislocations or fractures occurring upon the insured, are also considered accidents. Chapter III Quotation Particular Conditions 1. INSURANCE INDIVIDUAL TERM. From 06:00 hours of December 4 th, 2016, to 24:00 hours of December 4 th. 2. POLICY TYPE Non-Contributory. 3. COVERAGES AND INDIVIDUAL INSURED VALUES. COVERAGES ACCIDENTAL DEATH DISABILITY AND DISMEMBERMENT DUE TO ACCIDENT MEDICAL EXPENSE DUE TO ACCIDENT FUNERAL EXPENSES DUE TO ACCIDENT INDIVIDUAL PREMIUM VALUE INSURED VALUE COP$ COP$ COP$ COP$ COP$4.150 Page 3 of 7

3 4. ENTRY AND PERMANENT AGES. Entry and permanence ages are unlimited. 5. INFORMATION PRESENTATION. The liability of the Policyholder consisting on informing the Company about the amount of people registered in the event is recorded. 6. DEFINITION OF COVERAGES. ACCIDENTAL DEATH. It covers the insured's death originating from an accident, provided that death occurs within ninety (90) days following the occurrence of the accident and the accident occurs within the term of this policy. 7. EXCLUSIONS OF THE ACCIDENTAL DEATH COVERAGE. 1) Suicide and injuries caused voluntarily by the insured against his own physical integrity. 2) Acts of internal or external war, revolution, rebellion, insurrection, civil commotion, riot, strikes or violent acts motivated by civil commotion or application of martial law. 3) Terrorist acts. 4) Injuries or death caused by another person, with firearm, sharp pointed weapon, explosives or poisoning. 5) Physical or mental illness of the insured, any kind of hernias and varicose veins, medical or surgical treatments that are not necessary within the range of accidents covered by this policy, or psychic or aesthetic effects of any accident or illness. 6) Participation of the insured in military work, in the military, warships, air force or police of any country or international authority, as well as the participation of the insured in groups outside the law. 7) Criminal violations. 8) The insured being voluntarily under the influence of alcohol, narcotics, hallucinogens or toxic or heroic drugs, whose use is not required by medical prescription. 9) Accidents suffered by the insured during surgery or caused by them, or those caused by x-ray medical treatments or electric shock, with the exception they obey healing of injuries produced by a covered accident. 10) Convulsions of any kind. Page 4 of 7

4 11) Fission, nuclear fusion or radioactivity. 12) Accidents occurring prior to the individual coverage validity start, or their aftermath. 8. COLLECTION METHOD AND POLICYHOLDER REPORT. The payment of the premium shall be made IN ADVANCE, once the policy holder reports the number of attendants to the IRONMAN 70.3 Cartagena 2016 event. 9. TERM FOR THE PAYMENT OF PREMIUMS. The policy holder shall pay the premium to Allianz Seguros de Vida S.A. within 30 days counted from the starting date of validity. 10. REVOCATION. This policy may be revoked by the Policy holder at any time. 11. MINIMUN TERMS AND DOCUMENTS REQUIRED FOR PAYMENT OF CLAIMS. Allianz Seguros de Vida S.A. shall make the payment of the claims corresponding within the month following the date on which the Policyholder has credited the occurrence of the claim and amount. The term for the notice of claims of 30 days shall be granted. The minimum documents that shall be provided in case of claim, in original or certified copy, as the case are as follows: In case of death Declaration Form to Demand Payment of a Group and Collective Insurance Death Certification Birth Certificate or Certificate of Citizenship Act of removal of the body and/or necropsy Report of competent authority detailing time, manner and place of events occurred. In any case, Allianz Seguros de Vida S.A. reserves the right to request additional documents, when the claim warrants. 12. COMMUNICABILITY OF CONDITIONS. The obligation of the Policyholder is expressly stated; consistent in providing the policy s general and particular conditions and its annexes to all insured, so that they cannot plead ignorance. Page 5 of 7

5 13. ARBITRATION. Through this clause, the parties agree to submit to the decision of three arbitrators all disputes arising in connection with this offer. The arbitrators shall be appointed by common agreement of the parties and, if this is not possible, the provisions set forth in Decree Law 2279 of 1989 shall apply, as amended by Law 23 of 1991 and other rules which amend or replace it. The judgment shall be in law and the process term will be of six (6) months. WHAT IS NOT PROVIDED IN THIS PROVISIONAL LIQUIDATION, AS WELL AS THE DEFINITION OF PROTECTION NOT DESCRIBED SHALL BE GOVERNED IN ACCORDANCE WITH THE TERMS AND POLICIES OF THE PERSONAL ACCIDENTS INSURANCE POLICY APE053 V7. THIS PROVISIONAL LIQUIDATION DOES NOT IMPLY THE ACCEPTANCE OF RISK, AND THEREFORE DOES NOT PLEDGE ANY OF THE PARTIES; UNTIL THE RESPECTIVE INSURANCE CONTRACT IS NOT CELEBRATED ANT THE INSURANCE COMPANY NOTIFIES IN WRITING THE VALIDITY STARTING DATE. THIS QUOTATION IS MADE BASED ON THE INFORMATION PROVIDED TO THE COMPANY TO THIS PROPOSAL SUBMISSION DATE. IF FOR ANY REASON SUCH INFORMATION DOES NOT MATCH THE ONE SUBMITTED AT THE ISSUING TIME, THE COMPANY SHALL ADJUST THE INITIAL CONDITIONS TO ADAPT THEM TO REAL CONDITIONS. SUBSEQUENT AMENDMENTS OF INITIAL CONDITIONS, WITHOUT THESE BEING INFORMED TO THE COMPANY, MAY CAUSE REVOCATION BY DEFAULT AND INACCURACY (ARTICLE 1058 OF THE COMMERCE CODE). THIS PROVISIONAL LIQUIDATION HAS A VALIDITY OF THIRTY DAYS (30) FROM THE DATE OF THIS COMMUNICATION. I accept the quotation terms, all its terms and conditions. POLICYHOLDER Acceptance signature We accept the agreement in all its terms and conditions ALLIANZ SEGUROS DE VIDA S.A. Acceptance signature Page 6 of 7

6 Allianz Seguros de Vida S.A. NIT No Cra. 13 A No Allianz Business Tower Bogotá, D.C. Phone Number: (57) (57) Page 7 of 7