AVI The Travel Insurance For GRAND TOURISM

SUBSCRIPTION FORM for tourism only.
For studies or work and travel please click here

	> Your address

Email

Mailing address of the documents

City

Zip code

Country

Phone

	> Your trip

Home country

French residents or French nationals, please click here.

Country from which you start your trip		Host country

This insurance is valid world-wide except in your home country.

Departure from your country

month day year

Departure date

month day year

week(s)

Return date

month day year

	> Yours options

Optional high risk activities (4 $ per week): No: Yes:

Please tick the corresponding box :
Flight ticket only Car rental Organized tour

Select the currency you wish to pay in: Euro: Dollars:

	> The Insured

For each person, please enter the following information and click on the button to add a person.
All the persons listed have to leave and return on the same day.

# Ms/Mrs/Mr Name First name Date of birth
Month Day Year

1.

2.

3.

4.

	> Ours conditions

The e-mail address as well as all datas you just gave to AVI Grand-Tourism are ONLY for AVI Grand-Tourism use. In NO CASE is that information meant for lease or sale to outside companies.

If you DO NOT WISH to receive our news letters, information about our products or special rates unclick here.

If I am not fully satisfied, I will immediately return the personal insurance card/s for refund. 
I hereby declare that I am in good health and clearly understand that all consequences from any illness or accident prior to my insurance coverage starting date as above mentioned are not covered, nor are any effects or consequences of the HIV virus or Hepatitis C transmission.
I also declare that I did not receive any medical treatment for the last 6 months and I do not plan to receive any medical care abroad.

Please, tick the box
I have read the general conditions and agree with them.

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