APPLICATION FOR TRAVEL INSURNANCE
"Fill in the form below duly completed and submit to Forte Insurance (Cambodia) Plc. via the website. Please type clearly in Capital letters"
STATEMENT PURSUANT TO ARTICLE 20 OF THE INSURANCE LAW OF THE KINGDOM OF CAMBODIA OR ANY SUBSEQUENT AMENDMENT THEREOF. YOU ARE TO DISCLOSE IN THIS PROPOSAL FORM, FULLY AND FAITHFULLY, ALL THE FACTS WHICH YOU KNOW OR OUGHT TO KNOW, OTHERWISE THE POLICY ISSUED HEREUNDER MAY BE VOID.
Terms and Conditions
Please confirm if you agree with our Terms and Conditions as below:
- You are a resident of the Kingdom of Cambodia;
- You do not purchase after your travel; y
- This purchase is non-refundable;
- (Only applicable when policyholder is under 16 years old) You are the parent or guardian of the applicant and give consent to the applicant entering into this insurance contract; and
- The information provided is true and complete. Otherwise, Forte Insurance has the right to either decline your claims or cancel the policy.
|Benefit and Limit Type||Super Plan (US $)||Standard Plan (US$)|
|1||Overseas medical and additional expenses||100,000||50,000|
|2||24-hour emergency medical assistance and services||Same benefits for each insured person; details as specified in the policy|
|3||Accidental death and permanent disablement||60,000||30,000|
|4||Baggage and personal effects||3,000||1,500|
|5||Loss of personal money||600||300|
|7||Loss of deposits and cancellation charges||6,000||3,000|