Adapt

A representative will contact you back shortly by phone or by email with a quote and details of how to sign up online.

The application process will take less than ten minutes, and you will have a 30-day money-back guarantee from the date of application, if you decide this cover is not suitable for you (subject to no claims being filed).

Preferred Method of Sign Up:

First Name:

Last/surname:

Phone Number:

Home

Business

Country Code^* Telephone^*

(

)

Ext.

Email Address:

Re-type Email:

Country of Residence:

Country of Citizenship:

Year of Birth of each applicant:

How did you hear about us?

Name or code number of Your Representative (if any):

Message:

^* Required Fields

For the application, please prepare the following information:

	Name of your representative or code number (if any)
	Your full contact details (address/phone number/email)
	Dates of birth and passport numbers of all family members enrolling with you (a separate premium is required according to the Year of Birth of each family member)
	Contact details of an emergency contact person who can be contacted in the event of a medical emergency (close friend or family member recommended)
	Details of any existing medical conditions, and if any, the contact details of your doctor
	Credit card details (number, expiry date, and 3-digit security code from the back the card).

Please Note: We only accept Visa and MasterCard for installment payments. If you pay in full for one year, we can accept payment by bank transfer.

Applicants must be expatriates in order to be eligible to apply.

Persons living in the United States are not eligible to apply.