garanties_crystal_studies_2012_en

[LA MOBILITÉ ]INDIVIDUALS

Crystal Studies

international

Changing the face of insurance.

Insurance solutions for international students

2011-2012

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APRIL International supports

the Foundation for Nature and Mankind

and Handicap International

STUDIES

HOLIDAYS

INTERNSHIPS

AU PAIR

PLACEMENTS

[CRYSTAL STUDIES]

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Crystal Studies,comprehensive insurance for studying abroad!

Crystal Studies is an insurance solution designed for students and schoolchildren living abroad for upto a year for the purposes of travel, language training, au pair placements, internships or studies.

Why take out international insurance?

The cost of healthcare abroad varies greatly from one country to another and can be very expensive. Often, theinsurance cover you are entitled to at home is not valid abroad so, if you have health problems and needtreatment, you have to pay the costs yourself.

Faced with medical expenses? Emergency hospitalisation? Doctor’s appointment?Crystal Studies covers you for both regular and unexpected medical expenses from the 1st euro you spend. There is no excess to pay and we can arrange for your hospital bills to be settled directly. This means you havenothing to pay to the hospital. We'll take care of it!

Need assistance during your trip? Involved in an accident and need to be repatriated straight away? Hospitalised and awaiting the arrival of a relative?APRIL International will organise your repatriation, at any time, day or night, to your home or to the most suitablehospital. We also cover the transport and accommodation costs of a relative coming to stay with you.

Responsible for damage to others? If you damage the equipment you're using during your internship?APRIL International covers you for damage caused to a third party in a private capacity or during your internship.

Your benefits with Crystal Studies

No waiting period or excess on medical expenses

No cash advance if you are hospitalised

Reimbursement of your medical expenses within 48 hours

Cover valid in each country you visit and during short return trips to your country of nationality

Meets requirements for the biggest international universities and the Schengen visa authorities

A translation service and a legal assistance hotline to help you with administrative procedures

FROM

€25PER MONTH

by telephone: +33 (0)1 73 02 93 93 Monday to Thursday from 8.30 to 18.00 (8.30 to 17.30 on Friday) - Paris time

by email: [email protected]

at our offices: 110, avenue de la République - CS 5110875127 Paris Cedex 11 - FRANCE

Our multilingual teams at your service:

Take a look at our healthcarebenefits specially designed fortrips to the USA

In association with our partners, APRIL International has created exclusiveservices:

access to one of thelargest healthcarenetworks in the UnitedStates with nearly 450,000 doctors and more than4,500 hospitals ; using this network means youhave no cash advance to make and we'll settleyour bill for you

a third-party pharmacypayment card: no cashadvance required forpharmacy expenses in the United States

a home consultationservice: no long waits in theemergency room and noneed to pay for the consultation

and our specialhealthcare benefitsin France

A third-party payment card accepted by over 100,000 healthcareprofessional partners.

With this card you no longerneed to make a cash advance for the followingexpenses:

medicines in pharmacies

visits to general practitioners

diagnostic tests

X-rays

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NEW !

[CRYSTAL STUDIES]BenefitsFor periods of 1, 2, 3… 6… or 12 months, get insurance cover designed speciallyfor international students.

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Actual costs: total medical expenses charged to you.

Daily hospital charge: portion of daily hospital costs in Francenot covered by French Social security.

Direct payment of hospital charges: if you are hospitalisedfor more than 24 hours, we can pay your hospital charges onyour behalf: we will contact the hospital to settle your bill andyou have nothing to pay up front.

Reported accident: an accident recorded by a competent authority present at the scene (police, firefighters or paramedics)where a certificate was issued specifying the circumstances ofthe incident, the nature of the injury and the date of the accident.

DEFINITIONS

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Medical or surgical hospitalisation:Transfer by ambulance (if hospitalisation is covered by APRIL International)Accomodation (including daily hospital charge in France)Medical and surgical feesExaminations, tests and medicinesMedical procedures

100% of actual costs

Hospitalisation for the treatment of mental or nervous disorders 80% of actual costs, up to 20 days per year

Direct payment of hospital charges during approved hospitalisation for more than24 hours

provided on request 24 hours a day, if prior agreement has been obtained

(unless a cover as a top‐up to the EHIC has been selected)

Private room up to €50 a day

Examinations and treatment carried out in hospital and lasting less than 24 hours 100% of actual costs

Consultations, visits and procedures carried out by GPs or specialists

100% of actual costs(limited to €130/year for eye care consultations andto 80% of actual costs and 5 sessions/year for the

treatment of mental or nervous disorders)

Diagnostic tests, laboratory tests, x‐rays and drugs 100% of actual costs

Procedures carried out by medical auxiliaries (following a reported accident) 100% of actual costs

Emergency dental treatment up to €400 per year

Cost of dentures (following a reported accident) up to €600 per year

Prostheses excluding dentures (following a reported accident)Eye care: lenses, contact lenses and frames (following a reported accident)

up to €500 per year

Contraceptives (condoms) up to €20 per year

1 - MEDICAL EXPENSES Up to €200,000 per insurance year

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NO UPFRONT PAYMENTIF YOU ARE HOSPITALISED

APRILREIMBURSES YOU WITHIN

48 HOURS

The European Health Insurance Card provides proof of entitlement to healthcare insurance formembers of the European Union. It allows you to access the public healthcare system while on atemporary stay in another Member State in accordance with local legislation and formalities. It isvalid for 12 months.

The card can be used in the following countries: Austria, Belgium, Bulgaria, Cyprus, the CzechRepublic, Denmark, Estonia, Finland, France (including Guadeloupe, Martinique, French Guyana and

Reunion Island), Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lichtenstein, Lithuania, Luxemburg,Malta, the Netherlands, Norway, Poland, Portugal (including Madeira and the Azores), Romania, Slovakia, Slovenia,Spain (including the Balearic and Canary Islands), Sweden, Switzerland and the United Kingdom (includingEngland, Scotland, Wales, Northern Ireland and Gibraltar).

SOME USEFUL TIPS BEFORE YOU LEAVE:Ë Scan or photocopy all your important documents: visa(s), identity papers (passport,...), as well as your airline tickets or

international driving licence; this will make it easier to make a claim if they are lost or stolen,

Ë Check the expiry date on your credit or debit card, if you are taking it with you,

Ë Keep receipts or invoices for your valuables (camera, laptop etc.). This will be helpful if you need to make a baggage claim,

Ë Don’t forget your insurance card or APRIL International client reference number so that you can reach us quickly if problemsarise.

THE EUROPEAN HEALTH

INSURANCE CARD

(EHIC)

2 If you opted for a cover as a top-up to the EHIC

See a healthcareprofessional

Send your medicalbills to Social

Security in eitheryour host or home

country

Your reimbursement is based on the Social Security rates in your

home country

You then sendyour Social

Securitystatement to

APRILInternational

Your top-upreimbursement

is processed within 48 hours

(excluding postaldelivery and bank processing times).

+

> > > > >OR

How to claim reimbursement of your medical expenses

1 If you opted a cover from the 1st euro spent

international

Your reimbursement is processed within 48 hours

(excluding postal delivery and bank processing times)

>Send your medical bills to APRIL International

>See a healthcare

professional

>Your reimbursement is based on the Social Security rates in your

host country

international

[CRYSTAL STUDIES]

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Benefits (continuation)For periods of 1, 2, 3… 6… or 12 months, get insurance cover designed speciallyfor international students.

2 - REPATRIATION ASSISTANCEMedical evacuation and repatriation covered

Presence of a family member for hospitalisation of more than6 days return ticket and €80 per night, maximum 10 nights

Early return home in case of death or hospitalisation of a familymember covered

Early return home due to a terrorist attack or natural disaster reimbursement of your travel costs

Procurement and shipment of medication not available locally covered

Search and rescue costs up to €5,000

Return of remains costs covered

Provision of coffin up to €1,000

Advance payment of bail abroad up to €15,000

Passing on urgent messages covered

Travel assistance if personal items are lost or stolen up to €1,000 (advance)

Enforced stay abroad €80 per night, maximum 5 nights(accommodation and food)

Translation of legal and administrative documents up to €500 per year

3 - LEGAL ASSISTANCELegal information and safety advice by phone covered

4- COUNSELLINGExchanges with a clinical psychologist telephone calls or exchanges of email

5 - PERSONAL LIABILITY private capacity, interships and tenant's liabilityBodily injury up to €4,500,000

Material and consequential damage to a third party up to €460,000, including €92,000 for consequential damage, excess €75

Material damage caused to manager during internships up to €12,000, excess €75

Legal cover - recourse up to €3,100, for costs over €228

6 - PERSONAL ACCIDENTAccidental death €10,000, or funeral expenses for the under 16’s

Accidental disability up to €40,000 , proportional excess 20%

7- BAGGAGE COVERLuggage which is lost, stolen or destroyed in an explosion or fireor by water during the outward or return trip or during the stay

up to €1,600, excess of €15 per claim, benefit limited to 50% for valuables, i.e. up to €800

8 - DELAYED DEPARTUREReimbursement of fees charged by airline company for changeof outward flight up to €100, airline tickets only

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ENFORCED STAY ABROADIf a "force majeure" event prevents you returning to your home country as planned, we will cover your additional accommodation costs and extend your policy until you get home.

EXCLUSIVE!

You’re going to work as an au pair in France. Everything goesperfectly to plan, you are warmly welcomed by the family and thetwo children are making good progress thanks to your Englishlessons. At the end of your third week, you trip and accidentallyknock over a very old and very expensive piece of sculpture.

Ë With your personal liability cover, your host family will receivecompensation to replace the sculpture and you can continue yourstay under the best possible conditions!

At the end of your study year in Canada, you decide to take sometime out to explore the Rocky Mountains. As you make the finaldescent, you slip on damp ground , break your leg and sufferextensive bruising.

Ë With Crystal Studies, you will be flown by emergencyhelicopter to the nearest hospital and, if you need to stay longerin hospital, we will arrange for a family member to be with you.

You’ve just arrived in France for an exchange year and are a bitlost with all the paperwork waiting for you.

Ë You call the APRIL International legal and administrativehotline; our consultants will tell you all you need to know aboutopening a bank account in France, getting a work permit,understanding the rental agreement for your apartment andassisting you with your visa application etc.

On an internship in Brazil you lose your backpack during a visit toRio. Everything is gone: your laptop, camera and, most importantly,your passport and wallet.

Ë APRIL International will advise on how to get your documentsreplaced and offer you a cash advance until you get a new bankcard. You will also receive compensation for your stolenbelongings.

How can we help you?

[CRYSTAL STUDIES]Examplesof reimbursements

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€15.10Social security

reimbursement

€44.90APRIL International

reimbursement

While I was in the States, I was rushed into hospital withappendicitis. Cost of 2 days'hospitalisation: $15,200.APRIL International settled mybill directly with the hospital and I had nothing to pay.I am insured under a CrystalStudies 1st euro policy.

Paola, Spanish au pair in Atlanta,USA

I saw a GP for back pain. Cost of the consultation: €40.I am insured under a CrystalStudies 1st euro policy.

Juan, Brazilian student in Lyon, France

With Crystal Studies international cover, you're protected from anything that might threaten to disrupt your time abroad.

US$ 15.200APRIL International

reimbursement

US$ 0You pay

By simply showingmy third-party

payment card to mydoctor, I had nothing

to pay.

€0You pay

I saw a specialist for an ear, nose and throat infection. Cost of the consultation: €60.I am insured under a Crystal StudiesEHIC top-up policy.

Paul, French exchange studentin Rome, Italy

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Monthly premiums (all taxes included)

For policies taken out before 01/10/2012.A fee of €3 per month will apply if you are paying in monthly instalments and will be added to your premium.Payment in monthly instalments is not available if your stay includes a half month.

EHIC top-up cover is available to children and students who are covered by the statutory Social Security scheme of one of the EUcountries. To qualify, you must apply for a European Health Insurance Card from your Social Security centre before leaving. Youshould then show the card to the medical authorities in your host country. In this case, APRIL International will only providetop-up reimbursements if you can provide evidence of having received medical care under the statutory scheme.

Unlike the Complete option, the Mini option does not provide cover for all eventualities arising during a trip abroad. It providesbasic cover but APRIL International recommends the Complete option.

Level of cover Type of cover LengthAge band

0-30 31-40

Complete option: Benefits 1 to 8

Cover from the 1st euro spent15 days €29 €49

1 month €40 €69

Cover as a top-up to the EHIC

15 days €22 €37

1 month €32 €54

Mini option:Benefits 1 and 2 only

Cover from the 1st euro spent15 days €25 €40

1 month €33 €53

Cover as a top-up to the EHIC

15 days €18 €29

1 month €25 €39

SPECIALLY DESIGNED FOR YOUNG PEOPLE ABROAD, EXCLUSIVE BENEFITS!

Having trouble understanding a document in a foreign language?A tenancy agreement in German, an employment contract in English or a certificate from your host university in Chinese?Simply ask us for a translation of the administrative or legal documents you need.

Questions about visas, work permits? How to open a bank account abroad?Our multilingual hotline is available to answer all your practical and legal questions, Monday to Saturday from 9 am to 8 pm.

Your washing machine leaks and causes water damage to the apartment below yours? With your tenant's liability cover, we will pay for any damage to your neighbour's apartment.

You cause damage to property during your end-of-studies internship?With the extension of your liability cover to internships, you're covered if you cause damage to equipment used during yourinternship.

[CRYSTAL STUDIES]How the policy operatesUseful information before you apply

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WHO IS THE POLICY DESIGNED FOR?

- any student, school pupil or au pair under the age of 41, living abroad,- for the purposes of travel, language courses, au pair placements, internships or studies.

WHAT IS THE MAXIMUM PERIOD OF COVER?

The Crystal Studies policy is available for a minimum period of one month and a maximum of 12 months. It is renewable with the insurers' agreement on condition that you remain in full-time education or that your au pairplacement continues.

WHAT HAPPENS IF I CHANGE OR CANCEL MY TRIP?

If you cancel your trip, we will refund your premium if you let us know in writing before the effective date of your policyand you return the original of your Membership certificate and your APRIL International card, if you have one. If you decide to cut short your stay and return permanently to your country of nationality, you should send us aregistered letter with proof of receipt enclosing documented evidence of your return home (receipt for payment ofelectricity, gas or telephone bill, etc). We will then cancel your policy and refund any premium due.

HOW TO APPLY

Fill in and sign the attached Application form

Enclose a photocopy of your student card or school attendance certificate (if you are going abroad to work as anau pair, please enclose a copy of your contract with the host family along with your application form)

If you are paying in full:- enclose a cheque in € payable to APRIL International Expat orprovide your credit/debit card details on the Application formIf you are paying in monthly instalments from your French bank account:- fill in the attached direct debit authorisation formenclose details of your bank account

Send your application to: APRIL International Expat - Service Adhésions Individuelles - 110, avenue de la République CS 51108 - 75127 Paris Cedex 11 - FRANCE

WHERE AM I COVERED?

You are covered anywhere in the world (including in your country of nationality during short return visits).If you selected an EHIC top-up policy, you are covered in all EU countries as well as Switzerland, Norway, Icelandand Liechtenstein (and during short visits to your country of nationality).Certain countries may be excluded from the policy as a result of heightened tension there. The list of excludedcountries is available on request by calling +33 (0)1 73 02 93 93.

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Servicesto support you throughout your stay abroad

… ONLINEIf you are insured, you can view:

your reimbursement advice notes, details of cover and the general conditions that apply,your personal and bank details.

If you are the member, you can:view your personal details and those of yourinsurance consultant,check your premium payments and paymentmethod, pay your premiums online using a bank card.

If you are hospitalised for more than 24hours, we can pay your hospital chargeson your behalf: we will contact the hospitalto settle your bill and you have nothing topay up front. This service is subject tomedical approval.

(unless you selected EHIC top-up cover)

YOUR

PERSONAL

SPACEDIRECT PAYMENT

OF YOUR HOSPITAL

CHARGES

INCLUDING EMERGENCY CONTACT NUMBERS,AVAILABLE 24/7 FOR:

direct payment of hospital charges if you arehospitalised for more than 24 hours (unless youselected EHIC top-up cover),requesting emergency assistance,contacting the counselling service.

The card facilitates your admission to a medicalcentre in the event of emergency hospitalisation, for more than 24 hours. To simplify procedures, the card contains your personal details: name, first name(s) and policy number.

YOUR

INSURANCE

CARD

✚Mr MARINI Christophe

N° de contrat / Policy number: 1815236

Date de couverture / Period of cover: 01/10/2011 - 31/05/2012

The above person benefits from the direct payment of hospital fees. Kindly facilitate

hospital admission calling one of the numbers noted on the other side of this card.

Information

www.april-international.fr

Tél : +33 (0)1 73 02 93 93

Crystal Studies

international

APRIL INTERNATIONAL CARES As part of our commitment to protecting the environment and improving the living conditions of disadvantagedpopulations worldwide, APRIL International is proud to support the Foundation for Nature and Mankind andHandicap International.

You can contribute to one of these associations by donating:

- an additional €5, €8 or €12 when paying your premium or,- the cents from your healthcare reimbursements.

GOING TO THE UNITED STATES? STAYING IN FRANCE FOR MORE THAN 6 MONTHS?

Take advantage of exclusive services speciallydesigned to simplify procedures while respectingyour budget!

For all your routine healthcare costs (pharmacy,consultations, diagnostic tests and x-rays) withpartner medical service providers, you havenothing to pay; we'll settle your bill for you!

EXTENSIVE THIRD

PARTY PAYMENT

SERVICES


FOR MORE INFORMATION, CONTACT YOUR INSURANCE CONSULTANT

international expat

Our promise:Top quality management of your insurance choices: applications processed within 24 hours and reimbursement of medical expenses within 48 hoursMultilingual teams at your serviceClear and easy to understand products supported by a range of services

For every expatriate situation, an international insurance solutionWhether you're a student, on an internship, planning a working holiday, in work or retired, travelling alone or withyour family, APRIL International will support you during your time abroad with a range of comprehensive and flexibleinsurance solutions suitable for all kinds of expatriates and all budgets.

APRIL, changing the face of insurance

From our beginnings in 1988, APRIL has been committed to changing the face of the insurance industry by ensuring that the client is always at the heart of our business.

Today, more than 3 million people know they can count on our 3,750 employees and 50 companies to protect their goods and families day after day.

APRIL has earned that trust by providing insurance products that combine a fair price with a reassuringlevel of cover and quality service; proof indeed that insurance is not what it used to be.

APRIL International, specialising in international insurance for more than 35 years

APRIL INTERNATIONAL EXPAT A MEMBER OF APRIL

Headquarters: 110, avenue de la République - CS 51108 - 75127 Paris Cedex 11 - FRANCETel.: +33 (0)1 73 02 93 93 - Fax: +33 (0)1 73 02 93 90Email: [email protected] - www.april-international.fr

Public limited company with capital of €200,000 - Registered with Companies House in Paris under number 309 707 727Insurance broker - Registered with ORIAS (Organisation for the registration of insurance brokers) under number 07008 000 (ww.orias.fr) - Prudential Supervision Authority - 61, rue Taitbout - 75436 Paris Cedex 09 - FRANCE.

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WORLDWIDEPRESENCE IN 34 COUNTRIES

international



Crystal StudiesApplication form 2011-2012




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Crystal Studies application formPLEASE WRITE IN CAPITAL LETTERS Insurance consultant reference number:0000000

INSURED Person to be insured

Title: Mrs Miss Mr Date of birth:00/00/0000(upper age limit of 40)

Surname: 0000000000000000000000000000000000First names: 0000000000000000000000000000000000Country of nationality:0000000000000000000000000000000000Country of destination:0000000000000000000000000000000000Email: 0000000000000000000000000000000000(Providing an email address will allow you to receive information on your reimbursements)

Reason for trip: Study Leisure Training Language course Au pair placement

School or organisation which the insured attends:0000000000000000000000000000000000000000000000000000000000000000000Address for delivery of correspondence:0000000000000000000000000000000000000000000000000000000000000000000000Postcode:00000 City:0000000000000000000000000000000State/Region/Land/County: 00000000000000000000000000000000Country: 000000000000000 Telephone:00/00/00/00/00/00if outside

I would like to receive my correspondence in: French English Spanish German

PERIOD AND LEVEL OF COVER

Period of cover required: from00/00/0000 to 00/00/0000for a duration of:00.0months (minimum 1 month, maximum 12 months)

Are you renewing an existing policy? Yes No

Client reference number: 0000000Type of cover selected: Complete cover or Mini cover

1st euro or EHIC top-up

MEMBER = The insured is paying the premium (in this case, the address below is not required)PERSON PAYING THE PREMIUM Someone else is paying the premium

Title: Mrs Miss Mr Date of birth:00/00/0000Surname: 0000000000000000000000000000000000000First names:0000000000000000000000000000000000000Address: 000000000000000000000000000000000000000000000000000000000000000000000000000000 Postcode:00000 City:0000000000000000000000000000000State/Region/Land/County: 0000000000000000000000000000000Country: 0000000000000000000000000000000000000Telephone: 00/00/00/00/00/00if outside France

Email: 0000000000000000000000000000000000000(Providing an email address will allow you to receive information on your policy)

I would like to receive my correspondence in: French English Spanish German

Please note: you must send us a photocopy of your

student card or current school attendance certificate

before your policy can take effect.

If you are going abroad to work as an au pair, please

send us a copy of your contract with the host family

along with your application form.

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France

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During your period of insurance you can update your contact details at www.april-international.fr (Individuals).

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d d m m y y y y d d m m y y y y

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FOR MEDICAL EXPENSES, YOU CAN BE REIMBURSED BY:

cheque in euros

bank transfer to a bank account in France. In this case, please send us details of your bank account.

bank transfer to an account in the USA. International bank details are required including the IBAN number, SWIFT code, your bank'saddress, sort code and an ABA routing number.

bank transfer to an account in other countries. International bank details are required including the IBAN number, SWIFT code, yourbank's address.

Bank charges will be deducted from any payment over the equivalent of €75. Bank charges are shared for all transfers (of any amount) carriedout within the Euro zone.

Your reimbursement statements are available by email or on your insurance website. If you would also like to receive a paper version, pleasetick this box:

OTHER INFORMATION FOR THE COMPLETE OPTION

In the event of death I name as beneficiary:

My surviving spouse on condition that we were not legally separated when the lump sum became payable, second, equally, my childrenliving, unborn or represented as such; third, equally my ascendants and fourth my other heirs.

Other beneficiary:

Surname: 0000000000000000000000000000000000000First names:0000000000000000000000000000000000000Date of birth: 00/00/0000Place of birth: 00000000000000000000000000000000000

CALCULATION OF PREMIUM

Minimum period of cover: 1 month; maximum period of cover: 12 months.

Depending on your age band, the choice of cover (1st euro or EHIC top-up) and the payment method selected (full payment on application ormonthly instalments), go to page 9 of the brochure to calculate your premium.

Monthly premium (all taxes included) for your level of cover: €00Number of months required: 00.0 Total premium (all taxes included): €000

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SELECTION OF PAYMENT METHOD

Full payment at time of application by cheque or debit/credit card:

by cheque, please make them payable to APRIL International Expat

by credit/debit card, please enter your card details below:

Only Eurocard-Mastercard and Visa cards are accepted: Eurocard-Mastercard Visa

Card number: 0000/0000/0000/0000 Expiry date:00/00The last three digits of the security number printed on the reverse side of your card: 000Cardholder: 0000000000000000000000000000000000

Payment in monthly instalments from a French bank account:

Complete the direct debit authorisation and enclose bank details.

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HEALTH STATEMENT

Insured’s surname and first name(s): 00000000000000000000000000Deadline for signature of the Health statement: 6 months.If you would like your policy to start on 01/07/2012, you can sign this Health statement between 01/01/2012 and 30/06/2012.

I declare that I am in good health and do not suffer from any disability or illness for which I am currently receiving treatment andwhich is likely to reoccur or develop. I declare that I have not undergone any medical treatment lasting more than one month duringthe last three years and do not plan to undergo any therapy, treatment or surgery in the country I will be visiting during the periodof insurance cover.

I declare that I do not expect to be hospitalised within 12 months of the effective date of my policy for any reason whatsoever(removal of tonsils or cysts, knee surgery, childbirth etc.).

I authorise the Medical Examiner to request any information he considers necessary from the doctors who have treated me orwhom I have consulted. I authorise these doctors to pass on the information, within the bounds of patient confidentiality, to theMedical Examiner.

I confirm that I have answered all of the questions accurately and honestly and have neither included or omitted anything whichcould mislead the insurers of the present policy.

THE INSURER'S MEDICAL EXAMINERS RESERVE THE RIGHT TO REQUEST FURTHER MEDICAL EXAMINATIONS.

Any non-disclosure, intentional misrepresentation or inaccuracy altering the nature of the risk or influencing the insurersto reduce the risk will result in the cancellation of all cover under the policy. In such circumstances the premium will notbe refunded (art. L113-8 of the French Insurance Code).

If you cannot sign the health statement, please give us the reasons why:

Signed in (city) Date00/00/0000

Signature of the insured preceded by the words « I have read, understoodand accepted the policy document »:

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I would like to make a donation to:

Handicap International The Foundation for Nature and Mankind

To make my contribution:

I will make a donation of: €5 €8 €12 (to be added to my premium payment)

and/or

I will donate the cents from my healthcare reimbursements (available to beneficiaries only)

If you are a French taxpayer, part of your donation is tax-deductible. For Handicap International, you can claim 75% of your donation up to€510 and 66% for higher amounts (capped at 20% of your net taxable income). For the Foundation for Nature and Mankind, you can claim66% of your donation (capped at 20% of your net taxable income). You will automatically receive a tax receipt for any donation over €8.

On behalf of our sponsored associations, APRIL International invites you to support the protection of the environment or the improvement of livingconditions of disadvantaged populations worldwide.

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MAKING A DIFFERENCE WITH APRIL International

If the person to be insured is a minor, a parent or legal guardian mustsign on his or her behalf:

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Your Insurance consultant + APRIL International Expat Code:

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SIGNING YOUR APPLICATION FOR INSURANCE

I hereby apply for membership of the Association of APRIL Mobilité Insured under their agreements with Groupama Gan Vie and ACE Europe. I have read theAssociation's statutes and regulations.

I understand that, by choosing Personal liability (private capacity) cover and Legal assistance (included under the Complete Option), I am applying for insurance withGan Eurocourtage and Solucia PJ.I have read the General conditions and booklet CS 2012 outlining the details of my insurance cover. I am aware of my right to cancel the insurance and accept the termsand conditions. I have retained a copy of these. I also understand the terms and conditions of APRIL International Expat’s handling of my insurance cover. If my insurancecover is subsequently amended, I accept that the General conditions applied will be those outlined above.

I have been informed that the information requested is required in order to process my application and that these details will be held electronically by APRIL InternationalExpat, the insurer or their agent for the requirements of my insurance cover.

Under the French Act of 6th January 1978 (amended), I have the right to access and, if necessary, rectify any personal information held on file by writing to APRILInternational Expat, 110 avenue de la République, CS 51108, 75127 Paris Cedex 11, FRANCE. APRIL International Expat has the right to use certain administrativeinformation and to share it with associated businesses who may use it to make me aware of new products or services. A list of these companies is available on request. Under the French Act of 6th January 1978 (amended), I have the right to prevent my details being passed on in this way by writing to APRIL International Expat at theabove address. Postal charges will be refunded.

I understand that telephone calls to APRIL International Expat may be recorded for administrative purposes and that I may have access to recordings made of my callsby writing to APRIL International Expat at the above address. I understand that each recording is kept for a maximum of 2 months.

I understand that cover under the present policy does not exempt me from paying contributions to any state scheme to which I may belong.

I agree to pay APRIL International Expat any reimbursements made to me by Social Security or any private healthcare insurer (unless an EHIC top-up cover has beenselected).

I confirm that I have answered all of the questions accurately and honestly and have neither included or omitted anything which could mislead the insurers of the presentpolicy.

Signed in (city) Date00/00/0000Signature of the insured preceded by the words « I have read, understoodand accepted the policy document »:

Signature of the member (if different from the insured) preceded by thewords « I have read, understood and accepted the policy document »:

d d m m y y y y

d d m m y y y y

DIRECT DEBIT AUTHORISATION FORM (to be completed if you are paying by direct debit)

I hereby authorise my bank to effect transfers from my account, if adequate funds are available, on the instructions of the organisation namedbelow. In the event of a disputed transaction I have the right to cancel the order by instructing my bank to do so. I will then settle the outstandingamount with the creditor.

Name and address of the creditor: APRIL International Expat - 110, avenue de la République - CS 51108 - 75127 Paris Cedex 11 - FRANCE

National Issuer Number 004082

Surname, first names and address of account holder:

Surname of account holder: 0000000000000000000000000000First names of account holder: 0000000000000000000000000000Street number: 000 Street type (ave., st., blvd,…): 000000000000000Street name: 0000000000000000000000000000000Postcode: 00000 City:0000000000000000000000Country: 0000000000000000000000000000000

Account to be debited:

Sort code: 00000 Branch code:00000Account number: 000000000000000 Transaction code:00

Name and address of the bank to be debited:

Name: 0000000000000000000000000000000Street number: 000 Street type (ave., st., blvd,…):000000000000000000Street name: 0000000000000000000000000000000Postcode: 00000 City:0000000000000000000000Country: 0000000000000000000000000000000

Date:00/00/0000 Signature:Please send this form to APRIL International Expat enclosing details of your bank, savings, or Post Office account.

F R A N C E

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Please send your completed application to:

APRIL International ExpatService Adhésions Individuelles

110, avenue de la République - CS 5110875127 Paris Cedex 11 - FRANCE

7

To cancel your policy, please use the tear-off slip below and send it to APRIL International Expat - 110, avenue de la République - CS 51108 - 75127 Paris Cedex 11 - FRANCE

CANCELLATION OF DOOR-TO-DOOR CONTRACT OF SALEArticle L.112-9 of the French insurance code

Any person who is canvassed at their home or residence or place of work, even if this visit was at their own request, and who signs an insuranceproposal or contract for a purpose which is not related to their commercial or professional activity, may cancel this agreement by sending a letterby recorded delivery with proof of receipt during a period of 14 days from the day of signature of the agreement without requiring to specify thereason for the cancellation or being subject to penalties.

Conditions: If you wish to cancel your insurance policy, please fill in and sign this tear-off slip. You should then send it in a sealed envelope byregistered letter with proof of receipt to the above address. It must be sent no later than 14 days on the day following signature of your applicationor, where the deadline expires on a Saturday, Sunday or a bank holiday or other non-working day, on the next working day.

I, the undersigned, wish to cancel my application for insurance under the following policy:

Policy name: Crystal Studies Ref/ CS 2012

Date of signature of application: 00/00/0000Member’s surname: 00000000000000000000000000000Member’s first name: 00000000000000000000000000000Date of birth: 00/00/0000Member’s address: 00000000000000000000000000000Postcode: 00000 City:000000000000000000000Country: 00000000000000000000000000000Telephone: 00/00/00/00/00/00if outside France

Name of insurance consultant: 0000000000000000000000000000Address of insurance consultant:0000000000000000000000000000Postcode: 00000 City:000000000000000000000Country: 00000000000000000000000000000Telephone number: 00/00/00/00/00/00if outside France

Date and member’s signature: Reserved for APRIL International Expat

00/00/0000 Client reference number0000000C

d d m m y y y y

d d m m y y y y

d d m m y y y y

Your application step by step:

Your application is processed within

24 hours.

Fill in your application form and send it to APRILInternational Expat.

If you need help, read the tipson the next page or contact us.

> >✚

Mr MARINI Christophe

The above person benefits from the direct payment of hospital fees. Kindly facilitatehospital admission calling one of the numbers noted on the other side of this card.

Informationwww.april-international.frTél : +33 (0)1 73 02 93 93

Crystal Studies



Crystal StudiesApplication form 2011-2012




You will be sent:

- your membership certificate serving as your insurance certificate,

- the general conditions showing how your policy operates,

- your insurance card containing emergency contact numbersfor requesting assistance services or before admission tohospital.


APRIL INTERNATIONAL EXPAT A MEMBER OF APRIL Headquarters: 110, avenue de la République - CS 51108 - 75127 Paris Cedex 11 - FRANCETel.: +33 (0)1 73 02 93 93 - Fax: +33 (0)1 73 02 93 90Email: [email protected] - Internet: www.april-international.fr

Public limited company with capital of €200,000Registered with Companies House in Paris under number 309 707 727Insurance broker - Registered with ORIAS (Organisation for the registration of insurance brokers) under number 07 008 000 (www.orias.fr)Prudential Supervision Authority - 61, rue Taitbout - 75436 Paris Cedex 09 - FRANCE

TAKING OUT THE INSURANCE[CRYSTAL STUDIES]

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11.

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A. Fill in your personal details (surname, first name, address…) and .

B. Select the period and level of cover .

C. Choose how you want to receive your healthcare reimbursements .

D. If you are applying for the Crystal Studies "Complete" option, please designate a beneficiary in the event of death .

E. Depending on your age band and your choice of cover (1st euro or EHIC top-up) and the selected method for paying the premium(full payment on application or monthly instalments), refer to page 9 of the brochure to calculate the amount of your premiumand fill it in .

F. Select the payment type (full or monthly) and the payment method .

G. If you would like to make a donation to one of our sponsored associations, fill in part .

H. Complete, date and sign the Health statement .

I. Date and sign the application form .

J. Enclose with your application: a photocopy of your current student card or school attendance certificate (if you are going abroad to work as an au pair, please send us a copy of your contract with the host family)

If you are paying in full:enclose a cheque in € made payable to APRIL International Expat orprovide your credit/debit card details on the application form

If you are paying in monthly instalments:fill in the attached direct debit authorisation formenclose details of your bank account

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WHAT HAPPENS NEXT?

Your application is processed within 24 hours, as soon as we receive your application form and supporting documents.

Your insurance is evidence by the issue of a Membership certificate (serving as your insurance certificate) showing details of thecover you have selected and the effective date of your policy.

Your policy will start on the date shown on the Membership certificate and, at the earliest, on the day following receipt of yourapplication form and supporting documents.

Send to APRIL International Expat - Service Adhésions Individuelles110, avenue de la République - CS 51108 - 75127 Paris Cedex 11 - FRANCE

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international expat

garanties_crystal_studies_2012_en

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