Contact Form
  • Buy online
  • Fee schedule
  • Coverage details
  • FAQ

Travel information

Home country *
Destination *


Billing address


Gender *Family Name *First name *date of birth *Email *Comments external ref.
Gender Family Name First name date of birth
Email Comments external ref.

I hereby declare that I am in good health and clearly understand that all consequences from any illness or accident prior to my insurance coverage starting date as above mentioned are not covered. I also declare that I did not receive any medical treatment for the last 6 months and I do not plan to receive any medical care abroad.