Request for an insurance certificate

In order to draw up your insurance certificate, we need the following information.

Please note that you will receive this certificate within 3 working days.

Title*

Passeport Number* First name (same as on ID)* Last name (same as on ID)* Country of living* Date of birth* Phone number* Email address* Travel start date* Travel end date* Country of destination* Policy number* Message field

* compulsory fields

The data collected allows Europ Assistance, responsible for processing, to process your request for information. If you do not fill in the compulsory fields (with an asterisk), we will not be able to process this request. In compliance with personal data protection legislation, you have the right of access, rectification, erasure and portability regarding your data. To find out more and to exercise your rights, you can read our Personal Data Protection Charter or the Personal Data section in the Terms and Conditions of the insurance policy.

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