Get a Quote Group (Full name) * Contact person at the company * Job Title * Telephone number * Id skype Email address * Company address Country Head office - None -AlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCabo VerdeCentral African RepublicChadComorosCongo THE DEMOCRATIC REPUBLIC OF THECongo, Republic of theCote d’IvoireDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauKenyaLesothoLiberiaLibyaMadagascarMaliMalawiMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSouth SudanSudanTanzaniaTogoTunisiaUgandaZambiaZimbabwePhilippinesIndiaPakistanBangladeshKazakhstanLebanonJordan Contract start date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Current group renewal date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072 Write a label for No of Employees - None -3-5050-100100-200200-300Large Group Number of dependent ? DO YOU NEED IN-PATIENT BENEFITS INCLUDING ASSISTANCE ? Yes No DO YOU NEED OUT-PATIENT BENEFITS ? Yes No DO YOU NEED A CO-INSURANCE ? Yes No DO YOU NEED MATERNITY CARE ? Yes No DO YOU NEED DENTAL & VISION CARE ? Yes No DO YOU NEED LIFE & PROTECTION INCOME INSURANCE ? Yes No HOW DID YOU HEAR ABOUT THINKINSURCARE? - None -Social MediaThink WebsiteGoogle Search EngineReferral / RecommandationOther / Autres REMARKS I agree and accept thinkinsurcare Privacy Policy statement and Terms and Conditions * Yes Read more about Thinking of moving insurer?
Get A Quote Get a Quote First Name * Last Name * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Nationality * - Select -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Email address * Phone * WhatsApp Country of Residence * - Select -AlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCabo VerdeCentral African RepublicChadComorosCongo THE DEMOCRATIC REPUBLIC OF THECongo, Republic of theCote d’IvoireDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauKenyaLesothoLiberiaLibyaMadagascarMaliMalawiMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSouth SudanSudanTanzaniaTogoTunisiaUgandaZambiaZimbabwePhilippinesIndiaPakistanBangladeshKazakhstanLebanonJordan Have you any Health insurance status Do you have any health related problems? Do you need In-patient benefits including assistance ? Do you need Out-patient benefits ? Do you need Maternity care ? Do you need Dental & Vision care ? Partner date of birth Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 No of Kids - None -12345 DOB Children 1 Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year200420052006200720082009201020112012201320142015201620172018201920202021202220232024 DOB Children 2 Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year200420052006200720082009201020112012201320142015201620172018201920202021202220232024 DOB Children 3 Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year200420052006200720082009201020112012201320142015201620172018201920202021202220232024 DOB Children 4 Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year200420052006200720082009201020112012201320142015201620172018201920202021202220232024 DOB Children 5 Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year200420052006200720082009201020112012201320142015201620172018201920202021202220232024 How did you hear about thinkinsurcare ? - None -Social MediaThink WebsiteGoogle Search EngineReferral / RecommandationOther / Autres Remarks I agree and accept thinkinsurcare Privacy Policy statement and Terms and Conditions * Yes Read more about Thinking of moving insurer?
Get a Quote Group (Full name) * Contact person at the company * Job Title * Telephone number * Id skype Email address * Company address Country Head office - None -AlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCabo VerdeCentral African RepublicChadComorosCongo THE DEMOCRATIC REPUBLIC OF THECongo, Republic of theCote d’IvoireDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauKenyaLesothoLiberiaLibyaMadagascarMaliMalawiMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSouth SudanSudanTanzaniaTogoTunisiaUgandaZambiaZimbabwePhilippinesIndiaPakistanBangladeshKazakhstanLebanonJordan Contract start date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Current group renewal date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072 Write a label for No of Employees - None -3-5050-100100-200200-300Large Group Number of dependent ? DO YOU NEED IN-PATIENT BENEFITS INCLUDING ASSISTANCE ? Yes No DO YOU NEED OUT-PATIENT BENEFITS ? Yes No DO YOU NEED A CO-INSURANCE ? Yes No DO YOU NEED MATERNITY CARE ? Yes No DO YOU NEED DENTAL & VISION CARE ? Yes No DO YOU NEED LIFE & PROTECTION INCOME INSURANCE ? Yes No HOW DID YOU HEAR ABOUT THINKINSURCARE? - None -Social MediaThink WebsiteGoogle Search EngineReferral / RecommandationOther / Autres REMARKS I agree and accept thinkinsurcare Privacy Policy statement and Terms and Conditions * Yes Read more about Thinking of moving insurer?
