Insurance policy for travel abroad 1. Trip information 2. Cost 3. Registration 4. Payment Insurance program Territorial limits SchengenThe insurance policy will cover every Shengen area nation (Austria, Bulgaria, Belgium, Croatia, the Czech Republic, Cyprus, Denmark, Estonia, Finland, France, Germany, Hungary, Iceland, Ireland, Italy, Liechtenstein, Latvia, Lithuania, Luxembourg, Malta, Norway, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland). In accordance with the Shengen visa requirements the insurance period for a single trip can be extended by 15 days free of coverage in prescribed circumstances. Choose country Choose country SchengenAndorra Insurance policies covering the Shengen area will include reference to the “Shengen area”. In accordance with the visa requirements, the insurance period can be automatically extended by 15 days. Currency EUR USD Period of insurance Single trip Annual Multi-trip (within one year)(up to 90 days in one year without limit on the number of days in each trip) Duration of a single trip cannot exceed 30 days. If your trip is longer you can buy a policy for multiple trips that covers 45, 60 or 90 days during the year. The period start date * Number of days during 365 days * - Select -15 days during 365 (for a leap year 366) days30 days during 365 (for a leap year 366) days45 days during 365 (for a leap year 366) days60 days during 365 (for a leap year 366) days90 days during 365 (for a leap year 366) days Trip start date * Trip end date * Activity Please note mountain skiing is covered by a separate insurance cover and will not be covered by selecting “Adventure travel”. Should your travel plans include mountain skiing, snowboarding, freestyle skiing or ski jumping please select the option “Mountain skiing” below. Mountain skiing Occupational health risk/hazards at work Sports competitions and training Sport I Sport II Sport III Sport IV Sport V Sport VI Tourists Number of Insured persons 123456789101112131415161718192021222324252627282930 Date of birth of the Insured 1 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 2 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 3 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 4 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 5 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 6 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 7 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 8 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 9 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 10 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 11 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 12 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 13 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 14 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 15 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 16 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 17 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 18 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 19 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 20 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 21 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 22 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 23 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 24 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 25 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 26 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 27 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 28 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 29 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943 Date of birth of the Insured 30 Day -Day12345678910111213141516171819202122232425262728293031 Month -MonthJanFebMarAprMayJunJulAugSepOctNovDec Year -Year202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943
