Insurance Questionnaire

Name

This field is for validation purposes and should be left unchanged.

Date of birth(Required)

Date of birth of additional person if applicable

Please indicate travel dates to be covered or if you prefer an annual multi trip policy.(Required)

Countries to be covered (this cannot be changed after policy has started)(Required)

Do any travellers have an Existing Medical Condition or Pregnancy? We call an Existing Medical Condition any disease, illness, medical condition, dental condition or physical defect that you have or have had – even if you're cured, or if it's under control or in remission. Some existing medical conditions are automatically included. For others, you need to complete an online medical assessment by telling us all your conditions. If your conditions are approved by us, you can then decide to buy the cover you need. An extra premium applies. That's why it's important you carefully answer these questions to understand if any traveller has an Existing Medical Condition that requires an online assessment.(Required)