TravelCover Worldwide 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)*

8 10 15 22 31 45 62 92 122 152 180 213 244 274

C Persons to be insured

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

Area 1: Worldwide, excluding the United-States and Canada
Area 2: Worldwide, including the United-States and Canada

Policyholder: Do you wish to be insured?*

Yes No

If yes, select your area of coverage*

1 2

Do you wish to insure another person?

Yes No

Spouse Child Family member

Email address*

Spouse

Gender*

Area of
coverage*

TravelCover Worldwide quotation

APolicyHolder

Title*

Civil Status*

Gender*

Mobile phone*

BCoverage

C Persons to be insured

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

Spouse

Gender*

Area of coverage*

TravelCover Worldwide quotation

APolicyHolder

Title*

Civil Status*

Gender*

Mobile phone*

BCoverage

C Persons to be insured

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

Area of
coverage*