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10 minutes of your free time to get an insurance policy.

We cooperate with the well-known insurance companies. If you do not have a policy we will help you to get it in a few minutes. Just fill in this application form and give it it to a contact person or make an online application via our website www.mapcare24.com.

FEEL SAFE AND SOUND WITH MAP ASSISTANCE.

SAFE MEDICINE in the Kingdom of Cambodia since 2010. Cooperation with the best hospitals and clinics of the country.

with deductible - 64$ or without deductible - 81$ + optional

Street and no.

accident insurance, travel assistance, luggage and third party liability insurance - 24$ per month

C/o or room number

Start date of insurance Zip code End date of insurance City

Sex: female

All services are provided FREE of charge for owners of insurance policy.

Please enter your home address:

male

CiState (US only, e.g. CA)ty

Date of birth Country First name

+ Emergency medical care + House-call doctor visits + Consultations of medical specialists + Advice on insurance + Negotiations and proceedings with insurance companies

Phone Last name E-mail address Country of permanent residence

Date of departure from permanent residence

My insurance from another provider will run out, has expired a few days ago or does not cover my new destination. I need to get new travel insurance coverage.

braslavskaya mapassistance

I certify that all the information I have given is correct.

+855 977 355 911 +855 977 113 971 +7 925 581 39 11

viber

med@medcare24.com www.medcare24.com

I don't have any insurance coverage. Destination

h/p

date

signature

MAP Assistance is an independent medical organization. We work for the benefit of the high and safe health care in Cambodia. In case a negative precedent happens or inappropriate medical service has been provided to you in any Cambodian hospital/clinic, you can send us the relevant information to med@mapcare24.com or to our facebook page.


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