Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Date of birth
*
Country of Nationality
*
How long will your trip to Thailand be?
*
What kind of Visa will you travel with?
*
What are the insurance requirements according to your local Thai Embassy?
*
Coverage for COVID/100,000 USD
400,000 Baht Inpatient/40,000 Baht Outpatient
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