Benefits Per Person	Gold Plan
Section 1: Medical Protection Emergency Medical Expenses Repatriation of Mortal Remains In Hospital Cash Benefit, max 30 days Emergency Dental Cover Emergency Optical Cover Burial, Cremation, Return, Coffin Follow up Treatment in Your Country Hostage or Wrongful Detention Terrorism, Hijack Cover	Cover Limit USD 100,000 USD 5,000 USD 100 (10 per day) USD 350 USD 350 USD 30,000 USD 2,000 Included Included
Section 2: Personal Accident Accidental Death (Adult) Accidental Disablement (Adult) Accidental Death (Child) Accidental Disablement (Child) Exposure, Disappearance, Hijack or Wrongful Detention Terrorism and War Riots and Strikes	Cover Limit USD 25,000 USD 25,000 USD 7,500 USD 7,500 Included Included Included Included
Other Benefits Journey Cancellation Journey Curtailment Travel Delay Luggage Delay Personal Liability Legal Expenses Hijack, Hostage or Wrongful Detention Luggage (Single Item Limit 25%) Cash & Documents in Luggage	Cover Limit USD 1,000 USD 1,000 USD 100 USD 250 (50 per 12 hours) USD 150,000 USD 1,000 USD 500 (50 per day) USD 1,500 USD 150
Emergency Medical Assistance Cash Advances Consular Referral Accommodation Travel Arrangements Urgent Messages	Cover Limit Assistance Only Assistance Only Assistance Only Assistance Only Assistance Only
Premium Payment Modes	Order Processing
Pay "AAR Insurance Co. Ltd" via 1. Cheque Payment 2. Mpesa Paybill Number 333200 3. Bank Deposit, Order or Transfer > Barclays Bank, Barclays Plaza Bank Account No: 0775-0000-15 > Stanbic Bank, Chiromo Road Bank Account: 0100-0000-2305-6 > KCB Bank Kenya, Sarit Centre Bank Account No: 1106-6129-22 4. I and M Bank Premium Financing 5. NCBA Bank Premium Financing Ref: Name, ID, Passport or Policy N/b: Cash Payment is NOT Allowed	Complete Order Form Pay Insurer & Send Us Proof of Payment to: info@insurenow.co.ke, info@insurekenya.com, 0722111760, 0779211760, Contact page, or Chat box, or Call us for collection of > Bank Order Form > Bank Payment Slip > Cheque for collection > Mpesa Paybill Message > Premium Financing Forms Free Policy Doc Delivery: 1 Day
Declaration
1. I/we hereby declare that all persons named in this application form are in good health and will not travel unless they are in good health and fit to undertake the insured trip nor has anyone named in the application suffer been diagnosed with and does not suffer from any medical condition for which medical treatment may require. I am/We are aware that this is not a general health insurance policy and that pre-existing medical conditions are not covered. 2. I/We have been made aware of certain restrictions to do with the cover do apply as per the terms, conditions and exclusions which are fully described in the policy wording	3. I/We accept the levels of cover chosen and have read the cover involved as described in the summary of cover and the policy document. 4. I/We agree that the company shall have the right to access my/our medical records prior to the journey in order to proceed with the assessment of a claim and/or render medical assistance.
Emergency Contacts Worldwide 24 Hour Assistance: Specialty Assist Limited, Europoint 5 - 11 Lavington Street, London, UK operations@speciality-assist.com Tel: +44-20-7902-7400 Fax: +44-20-7928-4748 London Assistance SEI 0NZ Tel: +44-20-7902-7405 Fax: +44 20-7928-4748	USA Assistance: Tel: +1-215-489-3785 Fax: +1-215-489-8525 Africa Assistance: Tel: +27-10-209-8300, Fax: +27-10-209-8405 Asia Pacific Assistance: Tel: +662-645-3931 Fax: +662-645-3732

Thank you. 
Principal Officer 
Insurenow Insurance Agency
InsureNow.co.ke | Compare & Order
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Sum Insured USD 100,000, [Age 71 to 75 Yrs] AAR Travel Insurance, 11 - 15 Days Trip, Gold Worldwide Plan

Brand: AAR Insurance Company Ltd
Product Code: AAR Insurance
Reward Points: 142
Availability: In Stock

KSh 14,175.00

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Applicant Name

Applicant Gender

Applicant Date of Birth

Applicant Height (Ft & In)

Applicant Weight (Kgs)

Applicant ID Number

Applicant Passport Number

Applicant Tax PIN Number

Applicant Business / Employer

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Attach - Applicant National ID

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Attach - Applicant Tax PIN Certificate

Beneficiary Name

Beneficiary Gender

Beneficiary Date of Birth

Beneficiary Mobile Number

Beneficiary ID / Passport Number

Countries and Continent Visiting

Purpose of Travel

Cover Start Date

Cover End Date

Number of Travel or Journey Days

Has any persons to be insured suffered any accident previously? Yes/No. If Yes, please give details and extend of injuries

Does any of the persons to be insured suffer from any physical defect or infirmity? Yes/No. If Yes, please give details

Does any of the persons to be insured suffer from any chronic or recurring illness? Yes/No. If Yes, please give details

Is there any other medical condition that any of the insured person is suffering from? Yes/No. If Yes, please give details

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Select a Payment Mode to AAR Insurance Company Ltd

Cheque Payment

Mpesa Paybill Number 333200

Citi Bank, A/c 1-0338-8018, Upper Hill

KCB Bank, A/c 11-0661-2922, Sarit Centre

Absa Bank, A/c 07-7500-0015, Barclays Plaza

Stanbic Bank, A/c 0-1000-0002-3056, Chiromo

Insurance Premium Financing by Fincredit Services

Insurance Premium Financing by I and M Bank

Insurance Premium Financing by NCBA Bank

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