PERSONAL EFFECTS INSURANCE

Name of student:
School / Yeshiva:
Passport #: / Phone #
In Israel:
Address in Israel:
Email address:

Cover: All contents are covered in the dorm/ apartment for theft, fire, water damage, and arson.

All Risks: Specified items (*) are covered both inside & outside the dorm/ apartment up to policy limit ($1,600 or $4,000).

N.B. No cover for cell phones, glasses, cash.

Nocover for items left in a car or bus.

There is also no cover if there is gross negligence (e.g. leaving a laptop unattended on the beach).

Please insure my personal effects for the period ____ to ____
Items: / Approx Value $
Clothing
Books
Musical Instruments
Other Items:
Items to be covered in All- Risks: (cover outside of the dorm) :
* / Photographic equipment
* / Electronic equipment (stereo, laptop, ect)
* / Jewelry/watches: please list any item over $150
* / Tefillin

N.B. It is a good idea to keep receipts of items bought in חו"לin case of a claim

PERSONAL EFFECTS INSURANCE

Continuation

Total Sum Insured:
All Risks (specified items) :

Please cover me for:

1) Maximum cover for specified items (All Risk): Up to $1,600

Maximum total cover: $8,000

Cost:

Approx $70

2) Maximum cover for specified items (All Risk): Up to $4,000

Maximum total cover: $20,000

Cost:

Approx $100

You can fax or e-mail this form together with the attached credit card form to.

Fax: 972-72-244-9916

E-mail:

Credit card details:

Name on credit card: / Passport #
Phone #:
Type of card / Visa Master card American ExpressDiners
Card Number:
Expiration date: / / Signature:

The debit will be to Menorah Insurance Company

Claims:

If you need to make a claim for loss/ theft/ fire, etc we need:

1) A police report (ask your yeshiva / school for nearest police station)

2) Valuation of lost or stolen items.

Claims take approx. 4weeks to settle.

There is a deductible of approx575NIS for each claim, except for I-pods and laptops – double deductible.

**All amounts for cover and prices are approximate according to the current dollar rate**

Policy conditions are according to the full Hebrew policy. (Available upon request)