Get medical travel insurance

Need trusted medical travel insurance for your visa application or international trip? FRFV offers a quick and simple process for travelers who need reliable coverage support. Complete the form below with your details, and our team will process your request professionally.

Most orders are completed within 12 to 24 hours, including weekends. If you need urgent service, a faster delivery option is available at the end of the form. Get dependable travel medical insurance today with smooth support for travel planning and travel medical insurance for visa requirements.

Travel Medical Insurance Visa Application

"*" indicates required fields

Personal Details

Title*

First Name*

Last Name/Surname*

Contact Details

Email*

Phone Number*

Insurance Details

Traveling From*

Traveling to

Trip Start Date:*

Trip End Date:*

Please make sure your trip start and end date difference minimum should be 6

Travel Insurance Duration:

This field will automatically calculate the number of days based on your trip dates: (Trip Start Date – Trip End Date).

Ensure that your trip start and end dates are at least 6 days apart.

What is the intended use of this insurance?

For Visa Use Only: This insurance is specifically designed for submission with visa documents and should be presented at your interview or appointment.
Important: You may request adjustments to the insurance dates and location free of charge prior to the start date of the policy.

Number Of Travelers?

Traveler 1 Information

First Name*

Last Name

Are You A U.S. Citizen*

Select Traveler 1 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 2 Information

First Name*

Last Name

Are You A U.S. Citizen*

Select Traveler 2 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 3 Information

First Name*

Last Name

Are You A U.S. Citizen*

Select Traveler 3 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 4 Information

First Name*

Last Name

Are You A U.S. Citizen*

Select Traveler 4 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 5 Information

First Name*

Last Name

Last

Are You A U.S. Citizen?*

Select Traveler 5 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 6 Information

First Name*

Last Name

Are You A U.S. Citizen*

Select Traveler 6 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 7 Information

First Name*

Last Name

Last

Are You A U.S. Citizen?*

Select Traveler 7 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

Traveler 8 Information

First Name*

Last Name

Are You A U.S. Citizen*

Select Traveler 8 Age*

Date of Birth*

Gender*

Country Of Citizenship*

Passport # (Optional)

Home Country*

Home Country Address*

Home Country State*

Home Country City*

Home Country Postal Code*

Home Country Phone Number*

Beneficiary Name (Can not be itself)*

The term “Beneficiary” refers to the individual who will receive the benefits after you. This could be your father, spouse, or child.

Beneficiary Relationship*

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Delivery Option

Urgent Service

Order Summary

Travel Medical Insurance: (Useable While Journey)

Price: $0.00

URGENT Service

Price: $0.00

Total Amount:

Pay Your Bill

This field is hidden when viewing the form

How do you want to pay your bill?

We do accept almost all bank cards!

Credit/Debit Cards

We accept payments through following cards:

Credit Card

Get medical travel insurance

Travel Medical Insurance Visa Application

Personal Details

Contact Details

Insurance Details

Traveler 1 Information

Traveler 2 Information

Traveler 3 Information

Traveler 4 Information

Traveler 5 Information

Traveler 6 Information

Traveler 7 Information

Traveler 8 Information

Delivery Option

Delivery Option

Order Summary

Pay Your Bill

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