Policy information ( www.e-quot.es ) Policy product IHHP EUR Issue date 01 August 2010 Annual Paid and Due Date 01.08

The policy information is specified below. Please be aware that the calculated premium is without potential health loading(s).

Applicant(s) and cover Information Insured person(s) Date of birth Premium EUR Cover Deductible Applicant no. 1 16 September 1943 Hospital Plan+ Module 1 +Module 2 No Deductible 14124 Tax 21 Module 3. Medical evacuation No Deductible 806 Tax 1 Initial premium 14930 Tax for Spain 22 Total premium 14952