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Please read through the following before completing our application form and complete in block capitals. All information supplied will be treated in strict confidence. All material facts relating to these questions must be disclosed. Failure to do so may invalidate the policy. A material fact is one which is likely to influence an Insurer in the assessment and acceptance of this application. If you are in any doubt as to whether a fact is material then it should be disclosed. As proposer you should answer all questions and sign the declaration on behalf of all persons to be insured. A copy of this application will be supplied to you by the Insurers on request within three months of completion. You should keep a record (including copies of all letters) of all information supplied to us for the purpose of entering into this contract. The 'proposer' is applying to be the policy holder and is responsible for paying the premium. Please download our application form, fill it in (you do not need to sign it yet) and send it to us via E-mail to insure@trafalgar-intl.com or via fax to (66) 0-2645-1180. We will then calculate the premium for your policy and send you the application form together with our quotation for signing. You return the signed application form to us together with your payment (checks accepted) and we welcome you as our customer ! Please return completed application form to:
Health and Hospitalisation Insurance
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