Travel Insurance Your journey starts here "*" indicates required fields Departure Date* MM slash DD slash YYYY Return Date* MM slash DD slash YYYY Name of Policy Holder*Email* Where a copy of policy certificate will be sent to.Date of Birth* MM slash DD slash YYYY Passport Number*Client AgeAddress*Cover* Medical Only A-C Full Package A-I Plan*Choose PlanPlan A (World Wide Excluding USA & Canada)Plan B (World Wide Including USA & Canada)This field is hidden when viewing the formTravel Period (days)Covid19 Extension Cover* Yes No This will attract extra charge of 20% of the total premium.Country of Origin*Destination Country*Premium Price: PaymentNet Premium (before tax)This field is hidden when viewing the formTaxTotal Premium (after tax)Covid19 Extension Fee (50%)Covid19 Extension Fee (35%)Covid19 Extension Fee (20%)This field is hidden when viewing the formStamp DutyTotal Premium PayableIncluding MK5,000.00 Stamp DutyPremium Payable Price: $0.00 Total This field is hidden when viewing the formDatePolicy NumberTerms of Service*By ticking the below box, you agree to our Terms and Conditions. You can also, check our Privacy Policy to see how we handle your personal data. I agree to the Terms of Service {all_fields:exclude[195,40,49,207,217,218], nopricingfields} FacebookThis field is for validation purposes and should be left unchanged.
