Find Certificate

APPLICATION FOR TRAVEL INSURNANCE

"Fill in the form below duly completed and submit to Forte Insurance (Cambodia) Plc. via the website. Please type clearly in Capital letters"

STATEMENT PURSUANT TO ARTICLE 20 OF THE INSURANCE LAW OF THE KINGDOM OF CAMBODIA OR ANY SUBSEQUENT AMENDMENT THEREOF. YOU ARE TO DISCLOSE IN THIS PROPOSAL FORM, FULLY AND FAITHFULLY, ALL THE FACTS WHICH YOU KNOW OR OUGHT TO KNOW, OTHERWISE THE POLICY ISSUED HEREUNDER MAY BE VOID.

TRIP DETAILS

Policy Duration (Number of Days)

Departure Date *
Return Date *
Your traveling period is
NOTE*: MUST DEPART FROM CAMBODIA AND RETURN BACK TO CAMBODIA

Itinerary (please select your destination):*

COVER PLAN AND PREMIUM

Cover Plan