Cap Au Pair

1

Insurance
2

Subscriber
3

Insured
4

Summary
5

Payment
6

Finish

What is the departure date ? Indicate the date you want the cover to start.
What is the return date ? This is the last day of your cover (Maximum duration: 12 months)
What is your place of residence ? Indicate the place where you usually live.
What is your destination ? Indicate the country you are going to as an Au Pair.
I am a European Health Insurance Card holder
Only if you are a European resident, going to Europe.
What is your host family’s name ?
The insured acknowledges having received a copy of the Chartis Policy No 4.091.300 terms and conditions and accepts them  
I declare being on good health and knowing that any consequences of illnesses and accidents which occurred prior to the subscription will not be covered  
I certify I have not been hospitalised in the past six months and do not plan to undertake a treatment overseas  
If you have a discount code, enter it here




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