Request a Quote

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Request a Quote

Please read through the information in the Personal Insurance section of the site and search FAQ's for additional detail. Then simply fill in one of the 2 forms below and we will return your quotation 24-48 hours later.

Please specify for which Insurance you would like a quote

Term life insurance
Serious Illness Protection
International Health Insurance

If you require a quote for Term Life Insurance or Serious Illness Protection, please answer the following questions and submit the form. Entries marked * are required fields


First Name, Family Name*
Date of Birth (dd/mm/yyyy)*
Sex
Occupation
Nationality*
Address 1
Address 2
City
Zip or Postal Code
Current Country of Residence*
Office Hours Phone*
Out of Office Hours Phone*
Fax
E-mail*
Which Insurance do you require?
For how long is cover required?
What amount of cover (How Much) do you require?	USD GBP EURO
Are you a smoker	Yes No
For Joint life applications please enter the full name and date of birth of spouse. Smoker y/n? If you would like a second quote for comparison please enter details of the revised amount and any changes to the term required.
Any additional information or special request


If you require a quote for International Health Insurance, please answer the following questions and submit the form. Entries marked * are required fields

First Name, Family Name*
Date of Birth (dd/mm/yyyy)*
Occupation
Nationality*
Address 1
Address 2
City
Zip or Postal Code
Current Country of Residence*
Office Hours Phone*
Out of Office Hours Phone*
Fax
E-mail*
Which Plan Level do you require? (click here to review plan details)
Preferred payment option
Geographic Coverage you require
Is cover for your family required? Please supply Full Name, Date of Birth and Nationality for spouse/partner and dependant children
Any additional information or special request

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