insurance.thaivisa.com

Quote Form

Quote Request

Name *

Address *


D.O.B *


Day *

Month *

Year *

Telephone No *

Email Address *

Confirm email *


---HEALTH INSURANCE---


Quote	Tick if quote required

Level of coverage	Basic Premium International

Present provider (if any)


Current policy expiration date


Day

Month

Year


---AUTOMOBILE INSURANCE---


Quote	Tick if quote required

Level of coverage	First class Second class Third class Third class with bt100,000 own veh cover

Make

Model

Engine size

Year

Body type		Sedan, pickup etc.

Number of doors

Colour

Value

Who is covered ?	Any driver Named driver(s)

Present provider (if any)


Current policy expiration date


Day

Month

Year


---MOTORCYCLE INSURANCE---


Quote	Tick if quote required

Level of coverage	First class Third class

Make

Model

Engine size

Year

Value

Present provider (if any)


Current policy expiration date


Day

Month

Year


---HOUSE INSURANCE---


Quote	Tick if quote required

Land area (Sqm)

House area (Sqm)

No of bedrooms

Roof Const.		Wood, tile etc.

Wall construction		Wood, brick etc.

Value - Bldg

Value - Fittings and Fixtures		kitchen, bathroom, fitted cupboards, air con etc

Value - Contents

Value - Personal

Present provider (if any)


Current policy expiration date


Day

Month

Year


---CONDO INSURANCE---


Quote	Tick if quote required

Condo Area (Sqm)

No of bedrooms

Value - Fixtures and Fittings

Value - Contents

Value - Personal

Present provider (if any)


Current policy expiration date


Day

Month

Year


---LIFE INSURANCE---


Quote	Tick if quote is required

Nationality

Level of Coverage

Present provider (if any)


Current policy expiration date


Day

Month

Year


---PERSONAL ACCIDENT INSURANCE--


Quote	Tick if quote required

Level of coverage	500,000 1,000,000 2,000,000

Present provider (if any)


Current policy expiration date


Day

Month

Year


---TRAVEL INSURANCE---


Quote	Tick if quote required

Level of coverage

Area visiting

Present provider (if any)


Current policy expiration date


Day

Month

Year


--OVERSEAS INSURANCE FOR THAIS--


Quote	Tick if quote required

Destination country

Number of days travel


--NOTEBOOK INSURANCE--


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Level of cover required	Option 1 - Bt25,000 Option 2 - Bt35,000 Option 3 - Bt50,000


--TRADE CREDIT INSURANCE--


Quote	Tick if quote required


Any Comments ?


Comments

Submit the form above online, or post or fax it to us: AA INSURANCE BROKERS CO., LTD. 565/62 Moo 10 (Next to Big C) South Pattaya Nongprue, Banglamung Chonburi 20150, Thailand Fax: 038 374 251 Int. Fax +66 38 374251 Skype: aainsure Click for printable version

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