Premium Car Rental Protection Enrollment

Added protection for you and your passengers.

I request coverage in Premium Car Rental Protection under Master Policy

AX0610 issued by AMEX Assurance Company. I have read, understand and
agree to the Summary of Terms and Conditions of Policy AX0610 explained in
this enrollment packet. I understand that coverage is effective when American
Express receives and validates this enrollment request. I understand that the
premium will be charged to my Card account whenever I pay for a car rental
using my enrolled American Express Card, until my enrollment is terminated.
Any person who knowingly and with intent to defraud any insurance
company or other person files an application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a
fraudulent insurance act, which is a crime, and shall also be subject to a civil
penalty not to exceed five thousand dollars and the stated value of the claims for
each such violation.
PCRP-EF 06/05
Enrollment:
When you enroll your eligible American Express Card Account in the optional
Premium Car Rental Protection plan, you automatically enroll all of your other
eligible American Express Card Accounts as detailed below.
If you enroll a Card Account for which you are the basic Card Member,
eligible Card Accounts will be automatically enrolled. This includes 1. Any other
eligible Card Account for which you are the basic Card Member; 2. Eligible Card
Accounts that you apply for in the future as the basic Card Member; and 3.
Additional Cards issued under your enrolled Card Accounts. The only Card
Accounts that are not automatically enrolled are Corporate Cards, any Card
Account issued by a third-party bank partner of American Express, and any
Additional Card issued under your eligible Card Accounts which is already
enrolled in this product.
Separately, if you have an Additional Card under someone elses basic Card

Account, that Additional Card will not be automatically enrolled.

If you enroll an Additional Card on a Card Account for which you are not
the basic Card Member only that Additional Card will be enrolled.
Covered Persons:
When the Card Member enrolls, Covered Persons under the Plan include you,
the Card Member, and any Passenger, including any Authorized Driver,
Boarding, sitting in, riding in, or Alighting from the Rental Car.
Coverage:
Premium Car Rental Protection can provide coverage for 1) reimbursement for
Damage to or Theft of the Rental Auto and Personal Property, and 2) medical
expense and Accidental Death and Dismemberment benefits resulting from a
covered Accident. The vehicle must be rented from a Rental Company, which is
a commercial rental agency whose primary business is renting passenger type
motor vehicles. It does not include a company whose primary business is
something other than renting cars, such as an auto body shop, truck rental
company, or a moving van company. Coverage is not available for ride-sharing
companies that allow individuals to rent out their personal vehicle.
The Plan can cover an eligible Rental Car for the first 42 consecutive days of a
rental (30 consecutive days for Washington State Card Members) as long as the
Card Member remains in Possession of the Rental Car. Coverage is provided
anywhere in the world except in Australia, Ireland, Israel, Italy, Jamaica, New
Zealand or in any instance where coverage would be in violation of U.S.
economic or trade sanctions. This product does not include coverage for Liability,
Uninsured or Underinsured Motorist, or Disability. Enrollment is generally
available to Consumer and Small Business Card Members residing in the 50
United States of America, District of Columbia, Puerto Rico or US Virgin Islands.
This product may not be available to residents of certain states.
This coverage provides benefits in addition to those that may be available to you
at no additional charge when you use your American Express Card. When
buying insurance its always a good idea to review other insurance available to
you, including insurance available on your credit card and at the rental counter to
see how the products may work together.
Limits of Plan Coverage:
Option 1
The $100,000 coverage level with a premium of $24.95 ($15.25 for Florida

Residents and $17.95 for California Residents) covers:

Up to $100,000 of primary damage and theft coverage for the rental car.
Up to $100,000 of Accidental Death and Dismemberment (AD&D) coverage
($250,000 for California Residents).
Up to $10,000 of AD&D coverage per passenger ($40,000 for Florida Residents
and $250,000 for California Residents).
Up to $15,000 per person of secondary coverage for Medical Expenses.
Up to a maximum of $300,000 combined medical and AD&D coverage per car
($500,000 for California Residents).
Up to $5,000 per person of secondary coverage for personal property,
maximum of $10,000 for all (Up to $15,000 per person, maximum of $25,000 for
Florida Residents).
This product does not include coverage for Liability, Uninsured or Underinsured
Motorist, or Disability.
Option 2
The $75,000 coverage level with a premium of $19.95 ($12.25 for Florida
Residents and $15.95 for California Residents) covers:
Up to $75,000 of primary damage and theft coverage for the rental car.
Up to $75,000 of Accidental Death and Dismemberment (AD&D) coverage
($150,000 for California Residents).
Up to $7,500 of AD&D coverage per passenger ($150,000 for California
Residents).
Up to $7,500 per person of secondary coverage for Medical Expenses.
Up to a maximum of $200,000 combined medical and AD&D coverage per car
($350,000 for California Residents).
Up to $2,500 per person of secondary coverage for personal property,
maximum of $5,000 for all.
This product does not include coverage for Liability, Uninsured or Underinsured
Motorist, or Disability.
Refunds:
If you cancel a refundable car rental reservation, the premium billed should
automatically be refunded to you. This credit will appear on the statement along
with the credited car rental reservation or on the following statement.
If premium charges are billed to your Enrolled Card in error, such as a cancelled
rental, no show, or other charges unrelated to the actual car rental (e.g. car
seats, GPS), please contact us for a refund by calling the number on the back of
your card or by filling out the refund form included with your billing statement.
Billing:

Premium will be automatically billed to your Enrolled Card Account(s) and

coverage activated each time you use the Card to pay for an eligible Rental Car
from an eligible Rental Company until your enrollment is terminated.
Cancellation:
You may request cancellation of your enrollment immediately or at any time
thereafter by means of written notice to American Express at American Express
Company, P.O. Box 981525, El Paso, TX 79998-1525 or verbal notice by calling
the number on the back of your Card.
Beneficiary:
You may name or change your beneficiary at any time. If you do not name a
beneficiary, benefits will be paid according to the terms of the Policy.
Exclusions:
Premium Car Rental Protection excludes certain vehicles, items, and actions
from coverage.
Excluded vehicles include: automobiles that have been customized or modified
from the manufacturer's factory specifications, except for driver's assistance
equipment for the physically challenged; any rented vehicle used for hire or
commercial purposes; antique cars (cars over 20 years old or cars that have not
been manufactured for over 10 years); limousines; off-road vehicles,
motorcycles, motorbikes, mopeds, recreational vehicles, golf or motorized carts,
campers, moving trucks or moving vans, and trailers. Insurance benefits will not
be available if the loss is partially or wholly attributed to pushing or towing
anything. Insurance benefits will also not be provided for damage to tires unless
other damage to the Rental Car occurred in the same Accident.
Coverage may be subject to exclusions and limitations including certain
exclusions related to pre-existing conditions. The exclusions and limitations may
reduce the levels of coverage available to you. Under Accidental Death &
Dismemberment coverage, depending on the severity, not all dismemberments
are eligible for payment.
Please refer to your Plan documents for a complete description of the coverage
exclusions.
Underwriter:
Premium Car Rental Protection is underwritten by AMEX Assurance Company,
Administrative Office, Phoenix, AZ. Coverage is determined by the definitions,
terms, conditions, and exclusions of Policy AX0610 or Policy PCRP-IND and is

subject to change with notice. Coverage is not available for ride-sharing

companies that allow individuals to rent out their personal vehicle. This document
does not supplement or replace the Policy.
This is a summary of Premium Car Rental Protection, an optional insurance
product offered through American Express Travel related Services Company Inc.
Please refer to your Plan documents for a complete description of the definitions,
terms, conditions, and exclusions.
Enrollment becomes effective when AMEX Assurance Company receives,
accepts, and validates Your Enrollment Request Form. This means your
enrollment is effective once you reach the confirmation page of this online
enrollment process. Approximately 7-10 days after your enrollment is processed,
you will receive your welcome kit as verification, which includes your Plan
documents. If you do not receive a welcome kit within 10 days, please call us as
this kit and the Plan Documents include the complete description of the
definitions, terms, conditions, and exclusions.
American Express Travel Related Services Company Inc., a licensed insurance
producer, will provide services to you as a representative of and on behalf of
AMEX Assurance Company and will receive compensation from AMEX
Assurance Company in connection with the placement of insurance. When
identifying insurance products that may be of interest to you, American Express
and its affiliates may also receive compensation or additional financial benefit
when AMEX Assurance Company or another American Express entity acts as
the insurer, reinsurer or intermediary for these products. The insurance producer
will not receive compensation based on the sale of insurance coverage from
AMEX Assurance Company or any third party.