Request for a Quotation - Travel & Medical Assistance


By Submitting this form, I declare that I understand the Terms and Conditions of Agile Assistance Membership and understand that the Insurance Policy is issued and provided by a licensed Insurance Company of my place of residence/travel. I further understand that Agile Assistance will provide me with a printed Membership Card, if requested. I acknowledge that the Membership Guidelines, Insurance Policy Terms and Conditions that explains the use of the Membership Card and related plans of Travel Insurance will be provided by Agile Assistance and the respective Insurance Company issuing the Travel Insurance Policy.
I also understand that failure to comply with the Membership Guidelines of Agile Assistance and Insurance Policy Terms and Conditions may lead to cancellation of my Membership/Insurance Policy and filing a fraudulent case of misuse against me with the relevant authorities in the Country the Membership/Insurance Policy is issued.