Frequent Flyer Travel Insurance Application
Full Name
Date of Birth
Passport Number
Nationality
Contact Address
Email
Phone Number
Frequent Flyer Program(s)
Frequent Flyer Number
Preferred Airline
Estimated Number of Trips per Year
Coverage Plan
Basic
Standard
Premium
Pre-existing Medical Conditions
Yes
No
If yes, please specify
Declaration & Consent
I confirm the above information is accurate and I consent to the processing of personal data for insurance purposes.