| |
|
|
 |
|
| |
 |
| Call one of our dedicated and friendly Staff between 8:00 a.m. - 4:15 p.m. |
| Port of Spain- 1-868-623-0576-9 |
| San Fernando- 1-868-652-5541 |
| Tobago 1-868-639-2986 |
| FAQ's on Travel Insurance |
|
|
| |
|
|
* Fields Mandatory. |
|
| |
|
|
Surname |
First Name |
Middle Initial |
|
| |
Proposed Insured * |
: |
|
|
| |
Date of Birth * |
: |
|
|
| |
National ID / Passport / Drivers Permit Number * |
: |
|
|
| |
Contact Number for the Proposed Insured * |
: |
|
|
| |
|
|
Street |
Town/City |
Country |
|
| |
Address of Proposed Insured * |
: |
|
|
| |
|
|
Surname |
First Name |
Middle Initial |
|
| |
Beneficiary * |
: |
|
|
| |
Relation to the Insured * |
: |
|
|
| |
|
|
Surname |
First Name |
Middle Initial |
|
| |
Proposed Spouse |
: |
|
|
| |
Date of Birth |
: |
|
|
| |
|
|
Surname |
First Name |
Middle Initial |
|
| |
Proposed Dependent |
: |
|
|
| |
Date of Birth |
: |
|
|
| |
Country Intented to Travel * |
: |
|
|
|
Package * |
: |
|
|
|
| |
| |
Bronze |
|
| | Accident & Sickness Medical Expense Reimbursement | $125,000 |
| |
Medical Evacuation |
$125,000 |
| |
Accidental Death & Dismemberment |
$125,000 |
| |
Repatriation of Remains |
$125,000 |
| |
Emergency Family Travel |
$18,750 |
| | TOTAL COVERAGE | $518,750 |
| |
Silver |
|
| | Accident & Sickness Medical Expense Reimbursement | $250,000 |
| |
Medical Evacuation |
$156,250 |
| |
Accidental Death & Dismemberment |
$156,250 |
| |
Repatriation of Remains |
$125,000 |
| |
Emergency Family Travel |
$18,750 |
| | TOTAL COVERAGE | $706,250 |
| |
Gold |
|
| | Accident & Sickness Medical Expense Reimbursement | $500,000 |
| |
Medical Evacuation |
$156,250 |
| |
Accidental Death & Dismemberment |
$156,250 |
| |
Repatriation of Remains |
$125,000 |
| |
Emergency Family Travel |
$18,750 |
| | TOTAL COVERAGE | $956,250 |
| |
Platinum |
|
| | Accident & Sickness Medical Expense Reimbursement | $625,000 |
| |
Medical Evacuation |
$156,250 |
| |
Accidental Death & Dismemberment |
$156,250 |
| |
Repatriation of Remains |
$125,000 |
| |
Emergency Family Travel |
$18,750 |
| | TOTAL COVERAGE | $1,081,250 |
| |
Bronze |
|
| | Accident & Sickness Medical Expense Reimbursement | $125,000 |
| |
Medical Evacuation |
$125,000 |
| |
Accidental Death & Dismemberment |
$125,000 |
| |
Repatriation of Remains |
$125,000 |
| |
Emergency Family Travel |
$18,750 |
| | TOTAL COVERAGE | $518,750 | |
|
| |
Number of days outside of Trinidad * |
: |
|
|
| |
Number of persons travelling * |
: |
|
|
| |
Kids under 15 years * |
: |
Yes
No |
|
| |
|
|
(Note: Once the Child or Children is 15 years and under , you are limited to Bronze package only) |
|
| |
Would you like to get Baggage Coverage * |
: |
Yes
No |
|
| |
Trip Duration ( Days ) |
: |
| |
|
|
|
|
|
|
|
|
|
|
| |
Worth of Baggage $ |
: |
|
|
|
| |
Occupation * |
: |
|
|
| |
Are you a professional Athlete? * |
: |
Yes
No |
|
| |
Effective Date of Cover * |
: |
|
|
|
| |
Disclaimer: |
|
| |
This policy will not cover any loss, injury, damage, or legal liability: |
|
| |
1. Arising directly or indirectly from travel in, to, through Afghanistan, Cuba, Democratic Republic of Congo, Iran, Iraq, Liberia, Sudan or Syria. |
|
| |
2. Sustained directly or indirectly, by any terrorist or member of a terrorist organization, narcotics trafficker, or purveyor of nuclear, chemical, or biological weapons. |
|
| |
Your privacy is important to us. Agostini Insurance Brokers Limited does not rent, sell, or share personal information about you with other people or non-affiliated companies. |
|
| |
All quotes from Agostini are valid for 30 days following the date of generation. |
|
| |
Agostini Insurance Brokers accepts no liability for quotations generated as QUOTATIONS ARE SUBJECT TO CHANGE. |
|
| |
For more information please contact, one of the friendly and courteous members, of our Personal Lines Department. |
|
|
|
| |
|
|
Accept
Decline |
|
|