ICEA LION - Travel Insurance

FOR COVID-19 COVER PLEASE CONTACT 0719071115 OR 0719071999

ICEA LION TRAVEL INSURANCE -

TRAVEL DETAILS

Adults:

Children:

Reason for Travel :

Departure Date

Returning Date

Country Of Departure :

Country Of Travel :

CUSTOMER DETAILS

Nationality : *

Full Name : *

Email-Address : *

Mobile - Number : *

I'm not a Robot :

Quotation

Pricing :

Rate Plan :

Trip Time In days :

Period :

Age :

Years

Basic Premium :

USD

Levy Amount :

USD

Total Amount with levy :

USD

Total Amount payable :

USD

Surname : *

Other Names : *

Passport Number : *

ID Number :

PIN Number. :

Phone No. : *

Email Address : *

Postal Address :

Postal Code :

Physical Address :

Next of Kin Name : *

Next of Kin Phone No. : *

Relationship : *

Covid-19 Cover Declaration

COVID-19 STATUS 72 HOURS PRIOR: *

NEGATIVE

POSITIVE

DO YOU HAVE ANY PRE-EXISTING MEDICAL CONDITIONS? *

YES

IF YES, PLEASE PROVIDE MORE DETAILS:

MODE OF TRAVEL: IF AIR NAME OF CARRIER: *

DECLARATION OF HEALTH: *

I hereby declare that the information I have given in this declaration is, to the best of my knowledge, true and complete. I also hereby confirm that I have read, understood and agree to the Terms and Conditions relating to Covid-19 travel insurance coverage.

Confirm

Existing Customer
New Customer

Create Billing account

Enter your personal details below:

Full Name

Email Address

Password

Confirm Your Password

Enter your Username and Password below:

Enter your Email/Username and password.

Username/Email Address

Password

Forgot password

Client Information

Name:

Nationality:

Passport Number :

PIN Number:

ID Number:

Date Of Birth:

Country Of Travel:

Client Information

Departure Date/Valid date:

Returning Date/End valid date:

Phone No:

Email Address:

Postal Address:

Next of Kin Name:

Next of Kin Phone No:

Relationship:

Quotation

Trip Time In days:

Pricing:

Rate Plan:

Period:

Age:

Basic Premium:

Total Amount with levy:

Other Members

Total Amount Payable:

Back Continue

One: Fill in the fields with the requested details, and CONTINUE

Two: SELECT YOUR PREFERRED RATE PLAN, and CONTINUE

Three: Fill in the fields with the requested details, and CONTINUE

Four: Fill in the fields with the requested details, and CONTINUE

Five: Confirm the data and submit

Pricing :

Pricing :

TRAVEL DETAILS

CUSTOMER DETAILS

Quotation

Covid-19 Cover Declaration

Other Members

Create Billing account

Enter your personal details below:

Enter your Username and Password below:

Client Information

Client Information

Quotation