travel medical insurance

Need travel Medical insurance for your visa application? You’re in the perfect spot! Simply complete the form below to submit your order. We typically process orders within 12-24 hours, even on weekends. For faster service, you can choose the urgent delivery option at the end of the form

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

When planning your travels, ensuring you have adequate medical insurance is essential. Travel medicals insurance provides crucial coverage for unexpected medical expenses, including accidents, illnesses, and emergency treatments, so you can explore with peace of mind. Designed specifically for international travelers, these policies help cover medical costs and even evacuation or repatriation if needed.

With our travel medical insurance, you can focus on your journey without the worry of unforeseen medical expenses. Whether you’re traveling for leisure or for a visa requirement, our policies are designed to keep you protected in unfamiliar territories. Get the assurance you need to make the most of every trip.

travel medical insurance