PER TRIP PLAN (Maximum period of travel is 90 Days)
Customer Name (As in passport)
 
Full Name :   *
 
Please select Area (All plan types are Schengen Visa application compliant)
 
   Area       :   
Worldwide excluding usual Country of Residence
 
Please select Plan (All plan types are Schengen Visa application compliant)

     Principal Sum Insured: $150,000
 
Plan       :   
Additional Coverage
 
Winter Sports : Not CoveredCovered
 
Travel Period
 
Departure Date : * Return Date : *
 
Traveller's Details (As in passport)
 

Name*

 

PP No

 

PP Expiry Date*

(DD/MM/YYYY)

DOB*

(DD/MM/YYYY)

Age

 

Relation*

 

Nationality*

 

Civil Id

 
  
Other Details
 
Benficiary Name :  
Address (in Kuwait) : * Telephone Number :
Mobile Number : * Email ID : *
 
 
Delivery Address (Delivery will be made by courier to the address mentioned below)
 
Contact Name : * Address 1   *
Address 2 : * Location : *
Contact Number : * Landmark :
 
 
             
* Fields are mandatory
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