By completing this purchase, I acknowledge the following: If paying by credit card, I authorize Trawick Travel GMBH. to debit my Discover, VISA, MasterCard or American Express account for the amount specified above. Coverage purchased by credit card is subject to validation and acceptance by the credit card company. I understand my payment information will be stored by a PCI-DSS compliant payment gateway. Total payment for the initial term of coverage requested must be entirely paid in U.S. dollars at time of application or prior to the Effective Date of Coverage. I read and understand the cancellation/refund provision for the plan.  

I consent to receive insurance-related documents and communications, including but not limited to, policy documents, disclosures, notices, explanation of benefits (EOB), claims documentation, as well as termination and cancellation or non-renewal notices, electronically to the email address you provide to us through the online application process instead of receiving these records in a paper format from us. I understand this insurance contains a Pre-existing Condition exclusion, and other restrictions and exclusions.

I understand that the information contained herein is a summary of the certificate and that I will receive my certificate upon acceptance by Trawick. I understand that Zurich Insurance Europe AG, Belgian branch, as underwriter of the plan, is solely liable for the coverage and benefits provided under the insurance. I understand and agree that the agent/ broker/representative, if any, assisting with this application is a representative of the Applicant. If signed by a representative of the Applicant, the undersigned warrants his/her capacity to so act. If signed as guardian or proxy of the Applicant, the undersigned warrants his/her capacity to so act. By acceptance of coverage and/or submission of any claim for benefits, the Applicant ratifies the authority of the signer to so act and bind the Applicant. I hereby apply for membership in the AMD Global Trust and for the insurance provided to me by Zurich Insurance Europe AG, Belgian branch. I understand the insurance applied for is not a general health insurance policy but is intended for use in the event of a sudden or unexpected event while traveling outside my Home Country as declared on my application.

SUBSCRIPTION AGREEMENT I hereby apply to be a Covered Person of the AMD Global Trust established in the Cayman Islands (the "Trust") and to participate in the insurance coverage extended by Zurich Insurance Europe AG, Belgian branch (the "Insurer") to Covered Persons under the Trust (the "Coverage"). I understand that the Coverage is not a general health insurance product but is intended for use in the event of a sudden and unexpected event while traveling outside my Home Country (for purposes of this Agreement, Home Country means the Country of Residence is the country in which the Covered Person maintains their current primary residence or usual place of abode and any country to which the Covered Person pays income taxes based upon employment in that country. In the event there is more than one Country of Residence under the above-listed criteria, the Country of Residence is the country meeting the above-listed criteria and listed by the Covered Person as their Country of Residence on the Application). I understand that the Coverage extended to me will terminate upon my return to my Home Country unless I qualify for a Benefit Period or Home Country coverage. I understand that the liability of the Insurer as underwriter of the Coverage is as provided in the Certificate of Coverage. By acceptance of Coverage and/or submission of any claim for benefits, the Covered Person ratifies the authority of the undersigned to so act and bind the Covered Person. The Covered Person undertakes to make all Premium payments as they fall due in respect of the Coverage extended. AMD Global Trust (the Trustee ) shall not be responsible for the administration of such payments. If the Covered Person fails to make any premium payment due in respect of the Coverage extended, subject to the discretion of the Insurer, such Coverage will lapse. The Covered Person hereby confirms the accuracy of all information and validity of all representations and warranties provided to the Trustee in connection with its participation in the Plan and/or the subscription for the insurance coverage, howsoever provided, including the terms of this Subscription Agreement, (together "Representations & Warranties"). The Covered Person acknowledges that certain of such information will be relied upon by the Insurer as Provider of the Coverage and that any inaccuracy therein may result in the invalidity of such Coverage as it relates to the Covered Person, the loss of Coverage and all monies paid in relation thereto. The Covered Person hereby undertakes to inform the Trustee of any change to any matter that forms the subject of any of the Representations & Warranties. The Covered Person hereby undertakes to indemnify and hold harmless the Trustee against any loss or damage (including attorney's fees) occasioned by any inaccuracy in any Representations & Warranties or failure to advise the Trustee of any change in any matter that forms the subject of any of the Representations & Warranties. The Covered Person agrees that the Trustee shall be entitled to rely on and to act in accordance with any written instruction purported to be provided by the Covered Person and the Covered Person hereby undertakes to indemnify and hold harmless the Trustee against any loss or damage (including attorney's fees) occasioned by the Trustee acting in accordance with any such instruction. Payments under the terms of the Coverage shall be paid by the Insurer to the Covered Person or directly to a Provider if assignment of benefits has been authorized. The Trustee shall not be responsible for the administration of such payments. I confirm that I have satisfied myself in that the Coverage is appropriate for me and that I meet the Eligibility criteria.