APolicyHolder


As the policyholder to the Plan, you are the legal representative towards Golden Care of all persons to insure included on this application form. The policyholder may choose not to be insured if cover is required for dependant(s) only.

Title*


Civil Status*

Gender*



Mobile phone*

BCoverage


EveriCover, with a deductible of CHF:
0 75 400 800 1500 4000 8000 15000
EveriCover Plus, with a deductible of CHF:
0 75 400 800 1500 4000 8000 15000
HospiCover, with a deductible of CHF:
0 75 400 800 1500
AcciCover
No deductible

C Persons to be insured


Fill out the section below, after reading the following specifications:

  • Area 1: Worldwide limited to 30 days per year in the United States and Canada
  • Area 2: Worldwide
  • If your child is between 21 and 24 years ol and full-time student, he/she benefits from the 0-20 years-old premium rate. Please attach proof of student status.
  • Any child up to 20 years old applying alone will be charged the 21 to 24-year-old rate. If several children apply together, the oldest will be charged the adult rate.

Policyholder: Do you wish to be insured?

If yes, select your area of coverage

Do you wish to insure another person?

DPremium


Please select the frequency of your premium: