INFORMATION AND ADVICE SHEET

(Document provided in application of Articles L521-2, L521-4 and R-521-1 of the French Insurance Code)

1 LEGAL INFORMATION ABOUT THE BROKER

MSH International is a French insurance brokerage company, a simplified joint stock company with a capital of 2,500,000 euros, whose
head office is located at 39 rue Mstislav Rostropovitch, 75815 Paris Cedex 17, France.

MSH International is registered with ORIAS under number 07 002 751 and with the Paris Trade and Companies register under number
352 807 549. These registrations can be verified on the website www.orias.fr and www.infogreffe.fr respectively.

MSH International operates under the supervision of the French Prudential Supervision and Resolution Authority (ACPR), 4 Place de
Budapest CS 92459, 75436 Paris, FRANCE.

In application of Article L521-2-II-b of the French Insurance Code, we would inform you that the insurers with whom we work to cover
the risks identified in your application for insurance are listed in annex 1.

2 INFORMATION ABOUT YOU

• Title : Mr
• Last name : Sostene
• First name : Iraha
• Country : Sweden Tel : +46760053474
• Email : [email protected]
• Country of nationality : Burundi

3 COMPLAINTS / MEDIATION

If you wish to make a complaint, we recommend getting in touch with your usual point of contact in our company. You can also write to
our Complaints Department at 23, Allées de l'Europe, 92587 Clichy Cedex, France.

If the response you are given does not resolve the dispute, you have the option of contacting the French Insurance Ombudsman
(Médiation de l'Assurance): TSA 50110 75441 Paris cedex 09 / www.mediation-assurance.org.

4 INFORMATION ON HOW THE BROKER IS REMUNERATED

The broker is remunerated on a commission basis.

MSH INTERNATIONAL – a French insurance brokerage company, a simplified joint stock company with a capital of 2,500,000 euros, whose head
office is located at Immeuble Season - 39 rue Mstislav Rostropovitch, 75815 Paris Cedex 17, France. Registered in the Paris Trade and
Companies Register under number 352 807 549. Registered with ORIAS under number 07 002 751 Intra-Community VAT number: FR 78 352 807 Page 1/5
549
5 YOUR HEALTH INSURANCE NEEDS AND ANY DEMANDS YOU MAY HAVE

You have told us about the following needs :

• Requested duration of coverage : 1 mois

• Requested start date of coverage : 05/06/2023

• Country of expatriation : Serbia

You have stated the particular demands set out below :

• Type of plan : 1st euro top-up to CFE benefits

• Type of plan : fixed term automatic renewal

• Combination of benefits required :

Package of essential emergency benefits

Hospitalization, Routine healthcare

Hospitalization, Routine healthcare, Vision/Dental

Hospitalization, Routine healthcare, Vision/Dental, Maternity

6 FROM

To meet your needs and any demands listed above, we recommend purchasing the following plan: Start'Expat whose main features
are described below: :

1. Benefits

250 000 € Upper limit of Healthcare benefits

Hospitalization + Routine healthcare in case of emergency

Legal assistance + Personal third party liability

Extensive Assistance/Repatriation

Life & disability

2. Deductible

No deductible €350 / $500 €750 / $1,000 €2,000 / $2,500 €4,000 / $5,000

3. Main exclusions

Below are some of the exclusions from the plan. This list is not exhaustive and full details of all the exclusions can be found in the
Information Booklet serving as General Terms and Conditions.

MSH INTERNATIONAL – a French insurance brokerage company, a simplified joint stock company with a capital of 2,500,000 euros, whose head
office is located at Immeuble Season - 39 rue Mstislav Rostropovitch, 75815 Paris Cedex 17, France. Registered in the Paris Trade and
Companies Register under number 352 807 549. Registered with ORIAS under number 07 002 751 Intra-Community VAT number: FR 78 352 807 Page 2/5
549
 • pre-existing medical conditions: any illness, disorder or injury or associated symptoms which developed before the date of
enrollment in the plan, of which the member or their dependents were aware, or of which they could reasonably have been aware,
and which we have not expressly agreed to cover;
• non-prescription drugs;
• the cost of cosmetic, esthetic or reconstruction treatments performed by a plastic surgeon to improve or transform the appearance
- even for psychological reasons - unless this treatment is linked to the restoration of a physical feature or function following a
disfiguring accident or surgery related to the treatment of cancer occurring during the period of insurance coverage;
• expenses deemed to be excessive, unreasonable or unusual considering the country in which they were incurred. Therefore, only
usual and reasonable costs will be covered and reimbursed under the plan, i.e. reasonable medical expenses which are commonly
charged in the relevant country for the specific treatment received, according to standard medical and generally accepted
procedures;
• the care, treatment and all consequences of attempted suicide or self-inflicted injuries or illnesses, or the use of narcotics without
a medical prescription;
• the cost of voluntary termination of pregnancy;
• costs which were paid by another insurance provider, person, organization or state program.
•

The consequences of participating in any sporting competitions and training for these competitions as well as the practice of any sports
in a club or federation, or the practice of sports in a professional capacity, or the practice of the sports listed below: :
• Extreme sports (see list in the members’ guide)
• Mountain sports (see list in the members’ guide)
• Air sports: aerobatics, gliding, parachuting, microlighting, hang gliding, paragliding and skysurfing
• Water sports: scuba diving as part of a sporting competition or for leisure purposes, riverboarding and kite surfing
• Competitive self-defense and combat sports
• Motor sports: motor racing, motorcycle racing or kart racing.

We recommend purchasing this plan because it presents the following advantages which meet your requirements :
• The level of benefits provided is suited to your country of expatriation;
• The combination of benefits and the deductible are in line with the needs you have expressed;
• The type of coverage we provide is in line with your expectations.

7 WARNING

Our analysis and proposals are based on the information, needs and demands you have told us about and expressed during our
discussions. It should be noted that the quality and accuracy of the information you have provided to us, particularly with regard to
costs and the purpose of the insurance, directly affect the quality and appropriateness of our proposal.

Although the information and advice you have been given is as specific as possible, it is very important to carefully read the
insurance documents issued to you as well as the information booklet or insurance plan provided with this information and
advice sheet. The information booklet or insurance plan forms the legal document which states the rights and obligations of
the insured and the insurer.

In particular, we would draw your attention to the paragraphs in your information booklet or insurance plan setting out the risks which
are excluded from the insurance, the duration of your membership or enrollment in your plan, changes in the amount of the premium,
the waiting period (period during which any costs incurred are payable by the insured), definitions of the benefits (as well as their
purpose and expiration date) and the penalties for providing inaccurate or incomplete information.

The information contained in this information and advice sheet is binding and governs the proposal and the enrollment in the insurance
plan.

MSH INTERNATIONAL – a French insurance brokerage company, a simplified joint stock company with a capital of 2,500,000 euros, whose head
office is located at Immeuble Season - 39 rue Mstislav Rostropovitch, 75815 Paris Cedex 17, France. Registered in the Paris Trade and
Companies Register under number 352 807 549. Registered with ORIAS under number 07 002 751 Intra-Community VAT number: FR 78 352 807 Page 3/5
549
8 PROTECTION OF PERSONAL DATA

MSH International, with its head office located in Season, 39 rue Mstislav Rostropovitch 75815 Paris cedex 17, France, conducts
personal data processing actions required for your formal identification to access a secure area, for the issue of an insurance offering
or policy, its management and monitoring, for compliance with regulatory requirements in the field of anti-money laundering and
terrorist financing and for the provision of exceptional and temporary information related to crisis events or cases of force majeure
(health or political crisis, etc.). In this respect, all of the data collected is mandatory.

The recipients of your personal data are: the risk carrier (insurer), the different entities making up MSH International and the service
providers involved in the administration of the insurance policy across the world. In this context, your data may be transferred to third
countries outside the European Union guaranteeing an appropriate level of protection or subject to the use of adapted safeguards such
as the signature of standard data protection clauses adopted by the European Commission, or based on the derogations provided for
in Article 49 of Regulation 2016/679, known as General Data Protection Regulation.

Your personal data will be stored for the length of time required by the administration service, as provided for by the applicable laws.

At all times you benefit from a right of access, rectification, or erasure, or restriction or opposition and portability of your personal data
as well as the right to organize instructions upon your death. To exercise your rights, please contact the Data Protection Officer by mail
at the abovementioned address or by email at [email protected].

You benefit from the right to file a complaint with a supervisory authority in charge of personal data protection.

You can access our full Policy on the Protection of Personal Data by clicking on LEGAL NOTICES, Privacy and personal data
protection.

Signed in ,

On 13/05/2023,

In duplicate with one copy to be returned to the potential policyholder or member.

You acknowledge that you have read and understood the contents of this document before entering into the insurance plan being
proposed above.

Signature of Client Signature of Broker

MSH INTERNATIONAL – a French insurance brokerage company, a simplified joint stock company with a capital of 2,500,000 euros, whose head
office is located at Immeuble Season - 39 rue Mstislav Rostropovitch, 75815 Paris Cedex 17, France. Registered in the Paris Trade and
Companies Register under number 352 807 549. Registered with ORIAS under number 07 002 751 Intra-Community VAT number: FR 78 352 807 Page 4/5
549
 Annex 1 : In application of article L521-2-II-b of the French Insurance Code, information on the insurers with whom MSH International
works to cover the risks identified in your application for insurance.

For the benefits: Healthcare

For the benefits: Assistance/Repatriation

MSH INTERNATIONAL – a French insurance brokerage company, a simplified joint stock company with a capital of 2,500,000 euros, whose head
office is located at Immeuble Season - 39 rue Mstislav Rostropovitch, 75815 Paris Cedex 17, France. Registered in the Paris Trade and
Companies Register under number 352 807 549. Registered with ORIAS under number 07 002 751 Intra-Community VAT number: FR 78 352 807 Page 5/5
549
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