Free Personal Quotation

Your personal details

Name
Email
Telephone
Date of Birth
Nationality
Country
Length of time you require cover for ?

0-3 months   3-6 months   6-9 months
9-12 months   12+ months

What is your approximate budget per person?

Up to $1,000   $1,001-$1,500   $1500+

Start Date
Occupation
Who pays for your insurance ?

You    Your Company

Your Spouse's personal details

First Name
Surname
Nationality on Passport
{dual nationals please state both}

Date of birth {dd/mm/yy}
Occupation

Dependents' personal details

First Name
Surname
Nationality on Passport
{dual nationals please
state both}

Date of birth {dd/mm/yy}

First Name
Surname
Nationality on Passport
{dual nationals please
state both}

Date of birth {dd/mm/yy}

If you have more than 4 dependents, please specify in the comments box below.

Your contact details:
Main Applicant -Where you are currently resident

Address
City/Town
County/State/Province
Postcode/Zipcode
Country

Additional Information
Main country where
you require cover

Other countries where
you may require cover

Who is your current
medical insurer?

Expiry date of current insurance {if any}

Do any of the above have pre-existing medical condition?

Pre-Existing Medical Condition(s) {if any}

Are any of the above taking prescribed medication?

If yes, please state here
Additional questions, comments or suggestions

How did you find out about Expatriate Insurance?

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What our customers say

"My new job provides insurance when I travel overseas. I won't be renewing my Expat plan when it expires in August. Thank you for the FANTASTIC service. I will continue to recommend you highly. If I should need insurance again, you will be the first place I'll turn to."

R. Barr (Israel)

See more customer feedback

Contact Us

UK: 01379 643098
International: +44 (0) 1379 643098
USA & Canada: (Toll Free) 1 800 341 8150
Fax : + 44 (0) 1379 643087

Email: info@expatriate-insurance.com