Assure-U Ltd - International Health Insurance

International Health Insurance

Policy Details

Are you an Individual or a Company?

IndividualCompany

Company Contact Details

Company Name

Group Secretary/Contact Person

Title

First name

Surname

Phone

Mobile

Fax

Individual

Title

First name

Surname

Occupation

Nationality

Phone

Mobile

Fax

Address Details

Postcode:

Existing Cover

Do you have existing health insurance?

YesNo

Current Provider

Current Scheme

Current Excess

Renewal Date

/ / (dd/Month/yyyy)

Last Year’s/Current Premium (if known)

Renewal Premium (if known)

Budget

Budget £:

Per Annum
Per Month

Policy Required

Please choose type of policy you required:

SingleCoupleFamilySingle Parent Family

Please select number of people to be included in the cover

Places you need cover for

Places you will be going to

Terms and conditions

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Terms of Business | Terms of Use | Initial Disclosure Document | Guide to buying Private Medical Insurance | Privacy Policy

Assure-U Ltd is Authorised and Regulated by the Financial Services Authority, Registered in England 5682094
Registered Office: Three Elms Office, Harts Lane, Ardleigh, Colchester,Essex, CO7 7QH | Tel: 0800 411 86 86 | Fax: 0870 974 90 70