Name
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First Name
Last Name
Date of Birth
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Day
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Month
Year
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Gender
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Male
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Destination
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Aruba
Africa Eastern and Southern
Afghanistan
Africa Western and Central
Angola
Albania
Andorra
Arab World
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Argentina
Armenia
American Samoa
Antigua and Barbuda
Australia
Austria
Azerbaijan
Burundi
Belgium
Benin
Burkina Faso
Bangladesh
Bulgaria
Bahrain
Bahamas, The
Bosnia and Herzegovina
Belarus
Belize
Bermuda
Bolivia
Brazil
Barbados
Brunei Darussalam
Bhutan
Botswana
Central African Republic
Canada
Central Europe and the Baltics
Switzerland
Channel Islands
Chile
China
Cote d'Ivoire
Cameroon
Congo, Dem. Rep.
Congo, Rep.
Colombia
Comoros
Cabo Verde
Costa Rica
Caribbean small states
Cuba
Curacao
Cayman Islands
Cyprus
Czechia
Germany
Djibouti
Dominica
Denmark
Dominican Republic
Algeria
East Asia & Pacific (excluding high income)
Early-demographic dividend
East Asia & Pacific
Europe & Central Asia (excluding high income)
Europe & Central Asia
Ecuador
Egypt, Arab Rep.
Euro area
Eritrea
Spain
Estonia
Ethiopia
European Union
Fragile and conflict affected situations
Finland
Fiji
France
Faroe Islands
Micronesia, Fed. Sts.
Gabon
United Kingdom
Georgia
Ghana
Gibraltar
Guinea
Gambia, The
Guinea-Bissau
Equatorial Guinea
Greece
Grenada
Greenland
Guatemala
Guam
Guyana
High income
Hong Kong SAR, China
Honduras
Heavily indebted poor countries (HIPC)
Croatia
Haiti
Hungary
IBRD only
IDA & IBRD total
IDA total
IDA blend
Indonesia
IDA only
Isle of Man
India
Not classified
Ireland
Iran, Islamic Rep.
Iraq
Iceland
Israel
Italy
Jamaica
Jordan
Japan
Kazakhstan
Kenya
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Cambodia
Kiribati
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Korea, Rep.
Kuwait
Latin America & Caribbean (excluding high income)
Lao PDR
Lebanon
Liberia
Libya
St. Lucia
Latin America & Caribbean
Least developed countries: UN classification
Low income
Liechtenstein
Sri Lanka
Lower middle income
Low & middle income
Lesotho
Late-demographic dividend
Lithuania
Luxembourg
Latvia
Macao SAR, China
St. Martin (French part)
Morocco
Monaco
Moldova
Madagascar
Maldives
Middle East & North Africa
Mexico
Marshall Islands
Middle income
North Macedonia
Mali
Malta
Myanmar
Middle East & North Africa (excluding high income)
Montenegro
Mongolia
Northern Mariana Islands
Mozambique
Mauritania
Mauritius
Malawi
Malaysia
North America
Namibia
New Caledonia
Niger
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
New Zealand
OECD members
Oman
Other small states
Pakistan
Panama
Peru
Philippines
Palau
Papua New Guinea
Poland
Pre-demographic dividend
Puerto Rico
Korea, Dem. People's Rep.
Portugal
Paraguay
West Bank and Gaza
Pacific island small states
Post-demographic dividend
French Polynesia
Qatar
Romania
Russian Federation
Rwanda
South Asia
Saudi Arabia
Sudan
Senegal
Singapore
Solomon Islands
Sierra Leone
El Salvador
San Marino
Somalia
Serbia
Sub-Saharan Africa (excluding high income)
South Sudan
Sub-Saharan Africa
Small states
Sao Tome and Principe
Suriname
Slovak Republic
Slovenia
Sweden
Eswatini
Sint Maarten (Dutch part)
Seychelles
Syrian Arab Republic
Turks and Caicos Islands
Chad
East Asia & Pacific (IDA & IBRD countries)
Europe & Central Asia (IDA & IBRD countries)
Togo
Thailand
Tajikistan
Turkmenistan
Latin America & the Caribbean (IDA & IBRD countries)
Timor-Leste
Middle East & North Africa (IDA & IBRD countries)
Tonga
South Asia (IDA & IBRD)
Sub-Saharan Africa (IDA & IBRD countries)
Trinidad and Tobago
Tunisia
Turkiye
Tuvalu
Tanzania
Uganda
Ukraine
Upper middle income
Uruguay
United States
Uzbekistan
St. Vincent and the Grenadines
Venezuela, RB
British Virgin Islands
Virgin Islands (U.S.)
Vietnam
Vanuatu
World
Samoa
Kosovo
Yemen, Rep.
South Africa
Zambia
Zimbabwe
Departure Date
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Year
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Return Date
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Day
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Month
Year
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Travel Purpose
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Business
Pleasure
Medical
Other
Number of Travellers (Including yourself)
*
Please Select
1
2
3
4
5
Have you or any of your co-travelers ever suffered or are you/they suffering from any medical condition, disease, physical disorder or disability?
*
No
Yes
Insurance Cover
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Please Select
Plan A
Plan B
Plan C
Plan D
Schengen VISA Plan
Are you an existing client?
*
Νο
Yes - please give details (e.g. policy number, ID, account)
Phone Number
*
-
Area Code
Phone Number
Email:
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Address
Postal Code
District
Please Select
Nicosia
Limassol
Larnaca
Paphos
Famagusta
Important Notes:
1. Please note that this form is for quotation purposes only. If you wish to proceed with a contractual agreement you will be required to submit a proposal form. 2. Our quotation will be based on the information you have submitted, therefore, any alterations and/or misleading information, will cause a revision to the quotation accordingly. 3. We have collected only personal data you have voluntarily provided to us and which are processed solely for the purpose of risk assessment and preparation of this quotation.Where additional information is sought, you will be informed at the time of the data collection. If we do not conclude with a contract any personal data collected will be destroyed immediately. However, in case that you choose us for your policy, we are obliged by law to retain your personal data for a period of at least 13 (thirteen) years after termination.
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