Request an insurance quote

A single form for both domestic and international applicants. A broker will review your request and issue the policy as applicable; they will contact you by email or through your profile.

Name *

Passport photo (policyholder) *

No image

Email *

Used for your Nexotick account and broker notifications.

Phone

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Nationality *

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Country of residence *

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This lets us know if your case is domestic or international; the process is the same and is handled by the broker.

Day-based coverage (how the broker uses it)

The insurance is quoted by coverage days on the calendar (consecutive days).
Flying: provide the outbound and return flight dates. The covered period is the days between both dates, both inclusive.
Not flying (for example only local or domestic activity without flights): specify the start date and how many days you need. The broker will issue the policy with that range.

I understand that coverage is measured in days and that I must choose below whether I use flights or local coverage without a plane.

Check the box in the previous panel to choose the coverage type and complete the rest of the form.

How do we define the days?

I'm flying (outbound and return)The flight dates mark the first and last day of coverage.No flights / local coverageSpecify the start and number of days (useful if you're local and not traveling).

Outbound flight date *

Return flight date *

Companions

Sports / activity

Equipment (optional)

The policyholder's passport photo is required.

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