High-end Healthcare Step 1

AEGIS High-end Healthcare Insurance

YOUR INFORMATION

* Indicates required field

The Policyholder (If a company will be policyholder please state name of company) *

Correspondence Address in Myanmar *

Gender *

Name *

First

Last

Date of Birth *

Phone Number *

Nationality *

Country of Residence *

Email *

Smoker/Non-smoker *

Pre-Existing Medical Conditions [if any] *

Weight/Height and/or Body Mass Index *

STEP 2 - Insurance coverage you would like to obtain *

ADDITIONAL COMMENTS

Special Needs & Requirements (If any) *

SUBMIT INQUIRY!

IMPORTANT NOTICE:

Please do note that No Coverage is provided by this sample of insurance Program. A detailed insurance summary with terms & conditions, premium will be provided upon receipt of your basic information. Insurance companies and underwriters, however, may reserve the right to tailor policies, guidelines, conditions on selected risk upon full declaration of underwriting information, completed proposal forms or questionnaires.

“Eligible Person” means

(a) a person who is not a Child; or
(b) a Child who has a parent who is or will become an Insured Person.

An Eligible Person will become an Insured Person when the Company accepts the Policyholder’s written request in accordance with its then current underwriting rules and receives the required additional premium.

To obtain quotation for family or group, please email us at enquiry@aegisrs.com for further advice and special group discount!

AEGIS High-end Healthcare Insurance​

YOUR INFORMATION

ADDITIONAL COMMENTS

​IMPORTANT NOTICE:

AEGIS High-end Healthcare Insurance

IMPORTANT NOTICE: