TIS: Travel Insurance - On-line Application/Quotation Form

For people up to 79 years of age.

Full Name (1)
Date of Birth Date of Birth / DD / MM YYYY
Age
NIE /Passport Nº.
Tel./Mob. Number(s)
Email
Address
Post Code
Full Name (2)
Date of Birth Date of Birth / DD / MM YYYY
Age
Full Name (3)
Date of Birth Date of Birth / DD / MM YYYY
Age
Full Name (4)
Date of Birth Date of Birth / DD / MM YYYY
Age
Full Name (5)
Date of Birth Date of Birth / DD / MM YYYY
Age
Price required for...

Price required for... Single Trip Annual Multi-trip Both
Destination :

Destination : Europe Worldwide (ex USA/Canada) Worldwide
PLEASE STATE COUNTRIES TO BE VISITED
OPTIONAL COVERS - Select those to be included

OPTIONAL COVERS - Select those to be included COVID-19 Winter Sports Golf Sport/Cycle Equipment Weddings Business Extention Car Hire Excess Waiver Terrorism Disruption One Way Trip Gadgets
You can REDUCE the cost by REMOVING 2 of the following;-

You can REDUCE the cost by REMOVING 2 of the following;- Cancellation, Curtailment and related Benefits – Remove all cover under this section Medical, repatriation and related benefits – Remove all cover under this section Baggage and Personal Effects and related benefits – Remove all cover under this section
Departure Date Departure Date / DD / MM YYYY
Return Date Return Date / DD / MM YYYY
Credit Card Number
Expiry Date (MM/YY)
3 Digit Security Code
Any Comments, Questions or Suggestions :
Data Protection/Ley de Protección de Datos

Data Protection/Ley de Protección de Datos I agree to the sending and retention of this personal data in compliance with The Data Protection Act. / Estoy de acuerdo con el envío y la retención de estos datos personales de acuerdo con la Ley de Protección de Datos.
Type the letters you see in the image below.