TravelCover Schengen quotation

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.

BCoverage

Choose your deductible plan (in CHF)

100

Length of the contract (number of days)*

3 8 10 15 22 31 45 62 92

C Persons to be insured

Policyholder: Do you wish to be insured?*

Yes No

Do you wish to insure another person?

Yes No

Spouse Child Family member

Email address*

Spouse

Gender*

TravelCover Schengen quotation

APolicyHolder

Title*

Civil Status*

Gender*

Mobile phone*

BCoverage

C Persons to be insured