INTERNATIONAL TRAVEL INSURANCE - SAGITARIES INSURANCE SERVICES

TRAVEL DETAILS

TRAVELLING AS

For Group

NO. OF MINOR(S) age 4 weeks to 17 years old

NO. OF ADULT(S) ages 18 to 80 years old

Notes
Minor(s) must be accompanied by at least 1 adult.Surcharges
For person aged between 60 and 65 years, subject to 50% premium surcharge
For person aged between 66 and 75 years, subject to 100% premium surcharge
For person aged between 76 and 80 years, subject to 150% premium surcharge

Type of Cover

TRAVEL TYPE*

Notes

Short trip plans can cover you for trips up to 180 days.

Annual cover for frequent travelers provides unlimited trips but not to exceed 180 consecutive days per trip

Travel date

DEPART FROM THE PHILIPPINES*

DEPART FROM THE PHILIPPINES

ARRIVE IN THE PHILIPPINES*

ARRIVE IN THE PHILIPPINES

Itinenary

Note: Please declare the country(ies) of your destination including stop-overs, lay-overs or connecting flights

COUNTRY

Personal Details

TITLE*

FIRST NAME*

MIDDLE NAME*

LAST NAME*

MOBILE NUMBER*

EMAIL*

PASSPORT NUMBER

IDENTIFICATION NUMBER

GENDER

DATE OF BIRTH(age eligibility: between 18-80 years old)

OCCUPATION

ADDRESS*

CITY*

PROVINCE*

COUNTRY

ZIP

Emergency Contact

NAME*

MOBILE NUMBER*

RELATIONSHIP WITH INSURED*

PERSONAL INFORMATION(ADULT)

FIRST NAME*

LAST NAME*

RELATIONSHIP*

PASSPORT NUMBER*

DATE OF BIRTH( age eligibility: between18-80 years old)

GENDER*

PERSONAL INFORMATION(CHILD)

FIRST NAME*

LAST NAME*

RELATIONSHIP*

PASSPORT NUMBER*

DATE OF BIRTHDAY(age eligibility: between 4weeks -17 years old)*

DATE OF BIRTHDAY(age eligibility: between 4weeks -17 years old)

GENDER*