World Explorer Hotspot General Quote Request (MB)
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First Name
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Last Name
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Primary Email
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Primary Phone
Company Name
Are you representing a Company? Complete this field with your Company Name. Or, if you are doing business as an Individual, then leave this field blank.
Company Website
Company address
Are you looking for an annual policy
Yes
No
How many people would you like to be insured under the policy
Please enter the earliest start date of your traveler(s).
How many trips for countries in Group A
Average duration per trip
How many trips for countries in Group B
Average duration per trip
How many trips for countries in Group C
Average duration per trip
Have you had any claims over 1,000 in the last 3 years?
Yes
No
Which benefits would you like included:
Personal Accident: Accidental death & PTD & Dismemberment
Personal accident: Temporary Total Disability from accident
Emergency Medical Expenses (with covid) and evacuation
Crisis, Political and Natural catastrophe Evacuation and Kidnap & Ransom
Do you have any specific coverage limits for any benefits?
Do you have any specific coverage requirements?
Do you have a risk management process in place?
Yes
No
If Yes, provide details.
If travelling to Group A countries, will you have full time security in country of destination?
Yes
No
If travelling to Group A countries, will you be travelling more than 2 hours per day?
Yes
No
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