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.

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
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