Outreach

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Outreach Sign Up (v15) - 01 October 2024

Insured's Details

First Name (Must match passport name):

Last Name (Must match passport name):

Known As:

Date of Birth:

Main Insured Sex:

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

Spouse's First Name (Must match passport name):

Spouse's Last Name (Must match passport name):

Spouse's Date of Birth:

Spouse's Sex:

1st Child's First Name (Must match passport name):

1st Child's Last Name (Must match passport name):

1st Child's Date of Birth:

1st Child's Sex:

2nd Child's First Name (Must match passport name):

2nd Child's Last Name (Must match passport name):

2nd Child's Date of Birth:

2nd Child's Sex:

3rd Child's First Name (Must match passport name):

3rd Child's Last Name (Must match passport name):

3rd Child's Date of Birth:

3rd Child's Sex:

4th Child's First Name (Must match passport name):

4th Child's Last Name (Must match passport name):

4th Child's Date of Birth:

4th Child's Sex:

5th Child's First Name (Must match passport name):

5th Child's Last Name (Must match passport name):

5th Child's Date of Birth:

5th Child's Sex:

Email Address (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:

Mobile Phone Number (Please provide the best mobile phone number to reach you)

Primary Mobile Number:

Alternative Phone Number:

Country of Nationality

Home Address Line 1:

Home Address Line 2:

Home Address Line 3:

Home State if American:

Home Post Code:

Home Country:

Country of Destination

Overseas Address Line 1:

Overseas Address Line 2:

Overseas Address Line 3:

Overseas State/Province:

Overseas Post Code:

Overseas Country:

Communication Preferences *

If you are in a country where language relating to Christianity or missions could compromise your ministry, we are able to modify our communication methods and language to remove all references to anything that may be sensitive. Note: Sensitive communications will also remove references to Talent Trust, and may mean that you will not receive all of our communications.

Communication Preferences

I would like standard communications

I would like you to modify how you communicate with me

Church or Mission

Mission's Name:

Mission's Email Address:

Mission's City/ Country:

Purpose of Trip

Purpose of Trip:

Program Start

Start Date:

End Date:

Plan Required:

Additional Options Note: The option, if purchased, must be applied to all dependants on the policy

All prices are quoted in US$.

Follow Me Home for Plan 1, US$35/person

Follow Me Home for Plan 1, US$35/person

This option is for members serving near their home country. It extends the medical benefit to cover up to US$50,000 or thirty (30) days (whichever comes first) should a member be evacuated to his/her home country (being the nearest country with appropriate medical facilities to the place of incident) during a medical emergency.

Note: Without this option, should a Plan 1 member be evacuated to his/her country of domicile or country of residence, all medical treatment costs incurred would become the member's own responsibility.

US Transit for Plan 1, US$15/person

US Transit for Plan 1, US$15/person

Normally Outreach Plan 1 will not cover expenses that arise within the United States. This option will cover accident and emergency treatment in the USA for members travelling in transit through an airport in the USA to a destination outside of the USA up to US$50,000 or thirty (30) days, whichever comes first.

Zero Excess. For all plans, pricing sent with quote

Zero Excess. For all plans, pricing sent with quote

To waive the excess of US$50 for each claim outside the USA and US$100 for each claim inside the USA.

Payment Details

How would you like to pay?

Credit Card

Pay By Organization

Credit Card Details

When your policy is set up, we will email you the credit card payment link.

Organization Details

Name of the organization

Contact Person

Organization Email

How did you hear about us?

By clicking the 'Submit' button below, you are declaring that you have read, understood, and agree to the following 5 points:

I declare that I have read, understood, and agree to the terms of my choosen plan:
Outreach Plan 1 Table of Benefits and Benefits Guide.
or
Outreach Plan 2 Table of Benefits and Benefits Guide.
I declare that all the information supplied for all persons on this enrollment form is accurate and complete.
I understand that no cover is provided for professional sporting activities.
I understand that I may not complete this enrollment until all material facts* connected with this enrollment have been declared in full, without misstatement or misrepresentation, and have been accepted by us in writing. I understand that failure to do so will result in cover being void from inception.
I understand that pre-existing conditions are not covered. (A pre-existing condition is any disease, illness or injury, secondary or associated complaint for which you have sought or received advice, treatment, therapy, or been submitted to a special diet - whether or not the condition has been diagnosed).

* A material fact is any information that may affect our assessment or acceptance of your enrollment for insurance. If you are unsure as to whether any piece of information is a material fact, it should be declared.

I understand that if I have Covid19 symptoms immediately prior to this policy start date, or am receiving on-going treatment for Covid19 at time of this policy start date, or have had in-patient treatment for COVID19, this insurance will not cover COVID19 nor complications from it. *

To continue, please click here so we can send your policy and other relevant info like discounts and benefits. Your info is never shared outside Talent Trust, and you can opt out at any time. *

I/We agree that Third Parties can share all relevant claims information with my personal information with Talent Trust for the purposes of tracking and processing my claims. *

NEED ASSISTANCE?

If you require assistance,
please email our support team at:

Email: info@talent-trust.com
Skype: ttc.insurance
Phone, WhatsApp: +60 (11) 1051 2677
Working hours:
Monday to Friday 10am – 6pm, GMT +8

Enter you Email/WhatsApp and we'll get back to you:

Request for Assistance filling in a Quote or Signup

Text Input

Phone/Mobile

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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