Europe Registration

- Country of departure*
- Departure Date*
  Date Format: DD slash MM slash YYYY
- Return Date*
  Date Format: DD slash MM slash YYYY
- Number of days
All of our plans offer full Schengen area coverage in partnership with AXA

Medical/Repatriation - Schengen Obligation

Trip Cancellation

Aggression - Theft Paper

Luggage - Precious Object

Attempt

Ski, Trek, Sport

Concierge
Please select your insurance plan - Gold or Platinium*
- PLATINIUM
  Full Coverage
  All your yearly trips
  10% Special Discount
  1 € per day
- GOLD
  Full Coverage
  Only for your trip
Your insurance plan is PLATINIUM - Please click on it below*
- PLATINIUM
Total Cost of your selected Insurance plan
0.00 €

Main Traveller Details
Gender*
- Male
- Female
First Name*
Last Name*
Address*
Street, Avenue... City Country
Nationality*
Passport number*
Date of birth*
Date Format: DD slash MM slash YYYY
Country of arrival*
Cell Phone*
E-mail*
email please confirm your email
Administrative Code
Additional Beneficiaries

First Name	Last Name	Date Of Birth	Passport Number	Nationality
					Edit Delete
There are no Additional Beneficiaries.

Maximum number of additional beneficiaries reached.

Beneficiary Subtotal
Cost: 0.00 €
Beneficiary Subtotal
Cost: 0.00 €
Number of Beneficiaries
Total Cost of your selected Insurance plan
0.00 €
Agreement*
- Yes I agree to the Terms and Conditions
Unique ID
Credit Card*

American Express
Discover
MasterCard
Visa
JCB
Maestro
Card Number Expiration Date Security Code Cardholder Name

First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY
Passport Number*
Nationality*
Main Traveler Passport Number
Main Traveler Numero Adhesion