Good Neighbor Insurance

Alpha Quote

GNI Alpha Quote (v12) - 29 October 2024

Insured's Details

First Name:

Last Name:

Known As:

Country of Nationality:

Country of Destination:

Date of Birth

Sex:

Family Members (ONLY family members that will be on this policy)

Spouse's Date of Birth:

Spouse's Sex:

1st Child's Date of Birth:

1st Child's Sex:

2nd Child's Date of Birth:

2nd Child's Sex:

3rd Child's Date of Birth:

3rd Child's Sex:

4th Child's Date of Birth:

4th Child's Sex:

5th Child's Date of Birth:

5th Child's Sex:

Contact Information (In order to ensure your email is reachable, kindly check that you receive a notification email shortly after submission of this form)

Email Address:

Please Repeat:

Skype:

Church or Mission

Mission's Name:

Program Start

Start Date:

Additional Options (Some options have a waiting period. Please refer to the Options Page for details)

All prices are quoted in US$ per year.

Vision Care:

$78/person

Dental:

$367/person

Travel Cover:

$30/person

Pregnancy Cover:

$4,000 benefit, $696 / $10,000 benefit, $957 / $25,000 benefit, $957 (10% co-insurance applies)

Travel costs of insured members to be with a close relative who is at peril of death or who has died:

$384 per policy

Personal Accident:

$212 per adult

Restricted Territories Cover:

This option reduces your Alpha premium by 25%
Please read this clarification if you are considering this option

Non-Emergency Travel:

4% of total policy premium

Crisis Assistance Program (CAP):

$90/year per adult, $75/year for each dependent child

Additional Chronic Conditions Cover:

$1,136 per adult and $385 per child

Other Notes

Any comments or notes you would like to add:

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If you have questions, please email us, and we will get back to you as soon as we can.

info@talent-trust.com

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