Single Payment Policies...


Catering to the Consumer
Our company offers a virtually unlimited list of capabilities because of our vast corporate networking. Within our alliance are companies of all sizes. When it comes to our business, we offer our customers a powerful resource to reduce your Insurance costs



 
Your Country Of Residence (during the period of cover).*
 
Your Country of Nationality/Passport*
 
Date of Birth*
 
Your profession*
 
Have you ever been refused Health Insurance cover?*
 
Have you, your partner/spouse or any dependents had any disease, illness or injury for which you have received medication, advice or treatment (or symptoms you have experienced whether the condition has been diagnosed or not) during the three years prior to the effective date of this insurance?*
 
Please enter the on which you would like cover to commence*
 
Partner/Dependants Information (if applicable)
Would you like your Partner/Spouse to be covered under this policy?

 

 
Your Partners'/Spouses' Country Of Nationality/Passport
 
Your Partners'/Spouses' Date of Birth
 
Your Partners'/Spouses' Profession
 
Number of Children (age under 19)
 
If you have a discount code please enter it here.
Please enter your contact e-mail address:*
 
 

Your details
 
Title*
Gender*
First Name*
Last Name*
Address 1*
Address 2
Address 3
Town/City*
County/State
Country*
PostCode
Telephone No*