1 11 / 1

To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370319964 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9618238

ANGEL ABID GONZALEZ CARILLO

Specialist consult. 04/10/2022 150,000 COP 29,987 COP 24.93 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
24.93 USD.
Prescribed Pharmacy 05/10/2022 470,000 COP 93,978 COP 78.11 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
103.04 USD.

Total reimbursement statement 620,000 COP 123,965 COP 103.04 USD

Amount of our payment 103.04 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 2 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370320097 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9618364

ANGEL ABID GONZALEZ CARILLO

Specialist consult. 09/02/2023 155,000 COP 30,991 COP 25.76 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2023. Level now attained :
25.76 USD.
Prescribed Pharmacy 09/02/2023 103,000 COP 20,584 COP 17.12 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2023. Level now attained :
42.88 USD.

Total reimbursement statement 258,000 COP 51,575 COP 42.88 USD

Amount of our payment 42.88 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 3 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370320539 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9618396

ANGEL ABID GONZALEZ CARILLO

Prescribed Pharmacy 28/02/2023 48,500 COP 9,699 COP 8.06 USD
exceptional reimbursement
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2023. Level now attained :
50.94 USD.

Total reimbursement statement 48,500 COP 9,699 COP 8.06 USD

Amount of our payment 8.06 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 4 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370320687 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9618850

ZAMIR GONZALEZ MALDONADO

Lenses from 22/04/2022 ; number: 2
730,000 COP 0.00 EUR 730,000 COP 0.00 USD
Kindly provide us with the following documents: medical prescription with correction degree (copy)

Total reimbursement statement 730,000 COP 0.00 EUR 730,000 COP 0.00 USD

Amount of our payment 0.00 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 0.94 EUR = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 5 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370320806 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9618977

ALEXA FERNANDA CARRILLO RUIZ

Physiotherapy from 20/02/2023 ; number: 12
720,000 COP 0.00 EUR 720,000 COP 0.00 USD
Kindly provide us with the following documents: invoice with the date of each session (copy)

Total reimbursement statement 720,000 COP 0.00 EUR 720,000 COP 0.00 USD

Amount of our payment 0.00 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 0.94 EUR = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 6 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370321160 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9620737

ALEXA FERNANDA CARRILLO RUIZ

Ultrasound 28/06/2022 110,000 COP 22,000 COP 18.28 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
18.28 USD.

Total reimbursement statement 110,000 COP 22,000 COP 18.28 USD

Amount of our payment 18.28 USD

Reimbursement sent to your company on 20/03/2023
EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 7 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370321286 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9620783

ALEXA FERNANDA CARRILLO RUIZ

Prescribed Pharmacy 27/06/2022 85,700 COP 17,149 COP 14.24 USD
exceptional reimbursement
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
32.52 USD.
Laboratory tests 30/06/2022 60,000 COP 12,004 COP 9.97 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
42.49 USD.

Total reimbursement statement 145,700 COP 29,153 COP 24.21 USD

Amount of our payment 24.21 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 8 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370321496 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9620847

ALEXA FERNANDA CARRILLO RUIZ

Laboratory tests 27/06/2022 80,000 COP 16,022 COP 13.29 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
55.78 USD.
GP consultation 27/06/2022 50,000 COP 9,996 COP 8.31 USD
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
64.09 USD.

Total reimbursement statement 130,000 COP 26,018 COP 21.60 USD

Amount of our payment 21.60 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 9 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370321663 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9620885

ALEXA FERNANDA CARRILLO RUIZ

Laboratory tests 28/06/2022 160,000 COP 31,996 COP 26.59 USD
exceptional reimbursement. please make sure to provide us with an itemized invoice for reimbursement next time
This reimbursement contributes to the limit of 40 000 USD for 1 year(s) from the 01/01/2022. Level now attained :
90.68 USD.

Total reimbursement statement 160,000 COP 31,996 COP 26.59 USD

Amount of our payment 26.59 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 10 11 / 1
To contact us:
MR ZAMIR GONZALEZ MALDONADO
Client Services Team no. UG 28 CARRERA 7 NO. 74-21 PISO 7
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL EDIFICIO SEGUROS AURORA
33431 BOCA RATON , UNITED STATES OF AMERICA
00000 BOGOTA
T 001 561 322 4261 COLOMBIA
F 001 561 368 5972
[email protected]

References below to be mentioned in all

correspondence:
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

EXPLANATION OF BENEFITS (EOB)

Statement issued on 17/03/2023 for the period from 17/03/2023 to 17/03/2023
Dates indicated in international format DD/MM/YYYY

PRIMARY YOUR PAID BY THE

EXPENSES
COVER CO-PAYMENT PLAN

Reimbursement statement no. 370321816 on 17/03/2023 by Elizabeth MWIKALI PAUL following your reimbursement
request 9621043

ALEXA FERNANDA CARRILLO RUIZ

Lenses from 13/06/2022 ; number: 2
650,000 COP 0.00 EUR 650,000 COP 0.00 USD
Kindly provide us with the following documents: itemized invoice (copy), medical prescription with correction
degree (copy)

Total reimbursement statement 650,000 COP 0.00 EUR 650,000 COP 0.00 USD

Amount of our payment 0.00 USD

Reimbursement sent to your company on 20/03/2023

EXCHANGE RATE
on 17/03/2023: 1 USD = 0.94 EUR = 4,814.00 COP

International transfer delays may vary between 2 to 10 days according to the country and currency of payment. Please
contact your Client Services Team if a transfer is not received within this standard timeframe.

To allow us to quickly respond to your requests, please always indicate the

following information :
Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client Services Team: UG 28
Client contract : WFP
 11 11 / 1
To contact us: MR ZAMIR GONZALEZ MALDONADO
CARRERA 7 NO. 74-21 PISO 7
Client Services Team no. UG 28
EDIFICIO SEGUROS AURORA
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL 33431
00000 BOGOTA
BOCA RATON , UNITED STATES OF AMERICA
COLOMBIA
T 001 561 322 4261
F 001 561 368 5972
[email protected]

References below to be mentioned in all correspondence:

Member: 08846240 - Mr Zamir Gonzalez Maldonado
Client contract: WFP

Boca Raton, 17 March 2023

Subject : Missing information for your pending claim

Dear Sir,

Please be informed that some of your claims are pending further to additional information that we have requested.
To enable us to review your pending claims, we would be grateful if you could provide us with the following missing
information/documents:

REIMBURSEMENT TREATMENT
BENEFICIARY TREATMENT AMOUNT MISSING INFORMATION
STATEMENT DATE*

370320687 Zamir Gonzalez Lenses 730,000.00 COP 22/04/2022 Ø medical prescription

Maldonado with correction
degree (copy)
370320806 Alexa Fernanda Carrillo Physiotherapy 720,000.00 COP 20/02/2023 Ø invoice with the
Ruiz date of each
session (copy)
370321816 Alexa Fernanda Carrillo Lenses 650,000.00 COP 13/06/2022 Ø itemized invoice
Ruiz (copy)
continuation
 REIMBURSEMENT TREATMENT
BENEFICIARY TREATMENT AMOUNT MISSING INFORMATION
STATEMENT DATE*

Ø medical prescription
with correction
degree (copy)

* Dates indicated in international format DD/MM/YYYY

Please disregard this message if you have already provided us with the requested information.

We thank you in advance for your kind assistance. Please feel free to contact us should you require any further information.

Elizabeth MWIKALI PAUL

HENNER
2424 NORTH FEDERAL HIGHWAY, SUITE #314 , FL 33431 BOCA RATON , UNITED STATES OF AMERICA
T. 001 561 322 4261
F. 001 561 368 5972
[email protected]

12 11 / 1