Travel Insurance Quote Form

Policy Holder Details
Name and Surname*
Date of Birth*
Date Format: DD slash MM slash YYYY
ID Number*
Email*
Enter Email Confirm Email
Address*
Contact Number*
Business/Occupation
Travel Details
Commencement Date of Travel from Malta*
Date Format: MM slash DD slash YYYY
Return Date to Malta from Travel*
Date Format: MM slash DD slash YYYY
Destination*
Sports Activities*
Will you be engaging in any Sporting Activities? If Yes, give details
- Yes
- No
Sporting Activity Details

Additional Travellers

Name and Surname	ID Card	Date of Birth
			Edit Delete
There are no Travellers.

Maximum number of travellers reached.

Health Details
Give details of any Health issues that any of the Insured Persons listed has experience in the past 12 months (insurance cover may be restricted or even declines by insurers depending on the condition/s reported and declared by you)
Additional Details
Additional Comments
CAPTCHA
Terms Accept*
I have read and accept MIB's Client Terms of Business & Privacy Policy.*
I understand that by completing this form the data will be processed by MIB in line with GDPR and hereby consent that this data (including if needed sensitive data as defined in article 9 of GDPR) are used for the purposes of providing your insurance services.

I also understand that it is my responsibility to secure and hold the necessary consent from any employees, beneficiaries or other third parties direct or indirectly involved in the insurance proposal/arrangements and whose data will be processed by MIB and the providers of insurance and ancillary services.

Policy Holder Details