We offer Travel Insurance to help you feel safe when you travel. Be prepared for your trip. Get a quote today.

Choose the one that applies to you:

Travelling from New Zealand on a holiday elsewhereVisiting New ZealandImmigrating - Anyone intending to immigrate to New Zealand who has a one-way ticket from South Africa

ImmigrationImmigrating to New Zealand from South Africa. We are not immigration advisers, thus the fact that you immigrate will remain private and have no bearing whatsoever on your immigration process. We solely provide medical travel insurance for immigrants.

Number of Adult Travellers?

Number of Children Travellers?Must be under 21 years of age

Departure Date: *

Email Address: *

Phone Number: *

Street Address

City

Country

Adult Traveler 1:Your submission of any personal information will only be used to create quotes. This information won't be used in any other manner unless the owner authorizes it.

Prefix

First Name *

Middle Name

Last Name *

Date of Birth *

Passport Number: *

Adult Traveler 2:

Prefix

First Name

Middle Name

Last Name

Date of Birth

Passport Number:

Adult Traveler 3:

Prefix

First Name

Middle Name

Last Name

Date of Birth

Passport Number:

Adult Traveler 4:

Prefix

First Name

Middle Name

Last Name

Date of Birth

Passport Number:

Child Traveler 1:

NameAs Shown in Passport

Date of Birth

Passport Number:

Child Traveler 2:

NameAs Shown in Passport

Date of Birth

Passport Number

Child Traveler 3:

Name

Date of Birth

Passport Number:

Child Traveler 4:

Name

Date of Birth

Passport Number:

Child Traveler 5:

Name

Date of Birth

Passport Number:

Child Traveler 6:

Name

Date of Birth

Passport Number:

Departing from New Zealand to another country:

Name

Email Address

Street Address

Apartment, suite, etc

City

ZIP / Postal Code

Country

Phone

Travel Start Date

Travel End Date

Travelling to:?Which country/countries are you travelling to? If more than one country, how many days will you spend in each country?

Number of Adults?

Number of dependent children?

Supply all travellers DATE OF BIRTH below

Visiting New Zealand:

Name

Email Address

Phone

Travel Start Date

Travel End Date

Journey ExtentionIs there a possibility that you would extend your stay in NZ?

Number of Adults?

Number of dependent children?

Enter all travelers DATE OF BIRTH

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Any Other Comments