Dvine Travels & Tour is proud to be a longstanding partner with AIICO. AIICO’s Travel & Health Insurance policy provides comprehensive coverage to outbound travellers including the following:
 
Reimbursement of Emergency Medical Expenses
  Evacuation
  Repatriation
  Emergency Assistance Services
  Return Assistance

                                                       Benefits Include:
 
Discounted Premiums
Download Travel Insurance Proposal Form
Click here to register as a Travel Agent

                                                        Customers Include:

  Clubs & Associations
  Family members
  Tourists
  Outbound Travellers
  Schools & Students
  Individuals
  Corporate Bodies

Fill the form below and we will contact you immediately to arrange your travel insurance.

Surname

Address:

E-Mail Address:

City:

State:

Postal Address/Zipcode:

Telephone/Mobile Number:

Fax Number:

Gender:

Single:

Female:

Relationship:

Destination:

First Name:

Travel Insurance Form

Marital Status:

Occupation:

Date of Birth:

Married:

Male:

Passport No:

Name of Next of Kin:

Address:

E-Mail Address:

Coverage Begins:

Coverage Ends:

Yes

No

Do you intend to stay in any one country for more than 90 days?

Do you have any Pre-existing Medical Condition(s)?

Yes

No

If yes, pleaseExplain in the box below

How did you hear about this Travel Insurance Policy:

Declaration:

a) I/We desire to effect an insurance in the terms of the usual policy of Health insurance and declare that the above statements and particulars are true. I/We further declare that this proposal shall be the basis of the Contract between me/us and the Company and that I/We will not expect any additional payment from the Company for claims exceeding the maximum amount of liability. b) I further declare that all Insured Person(s) are in good state of health and fit to travel.

Date:

Applicant Signature:

“PLEASE NOTE THAT PREMIUM PAID IS NOT REFUNDABLE”

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