Optimus

Please fill-in following form to get your Optimus 1 person quotation

Please read the following documentation before filling in the form below.Download brochureDownload brochure

Information about the subscriber (limited to 65 years old)

- Title Mr. Mrs. Miss.

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First name (required)

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Last name (required)

Your Email (required)

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Date of birth (required) limited to 65 YO
format yyyy-mm-dd

-Town of residence (required)

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Town ZIP Code :

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Country of residence (required) :

Nationality (required) :

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Telephone (required)


Select the insurance you want to subscribe

Geographical Zone
Zone A = Worldwide
Zone B = Worldwide excluding USA, Canada, Switzerland, Israel and Japan

In-patient plans
Choose level of coverage you need (more details in our brochure)

Out-patient plans
Choose level of coverage you need (more details in our brochure)

Dental plans
Choose level of coverage you need for dental care (more details in our brochure)

Optional Death benefit ( Leave blank if not interested)


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Please send me a free, no obligation, quotation based on the above :

« This quote is an indication only and is subject to a complete proposal form, medical questionnaire and acceptance by Insurers »