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© Copyright Morgan Price 2005
Morgan Price International Healthcare Ltd
is authorised and regulated by the Financial Services Authority (FSA) under license
number 313738.

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We offer our own products for expatriate medical insurance, also known as international medical insurance.

These products are underwritten by Allianz Worldwide Care Ltd, part of the Allianz Group, who are registered in Ireland and regulated by the Irish Financial Services Regulatory Authority. Registered office, 20D Beckett Way, Park West Business Campus, Nangor Rd, Dublin 12, Ireland, Registered no. 310852

We will not provide you with advice or a recommendation. We will provide you with details of our products and you will need to make your own decision about whether to proceed. We recommend that you obtain the advice of an independent intermediary if you are looking for a range of alternative options.

At this stage, and in order to assess your requirements we will need to collect some basic information, detailed below, which we will not pass on to other companies. If you select a Morgan Price policy then we will need to pass information to our underwriters, their claims handlers and any assistance companies.

Your personal details - Main Applicant:

Title (Mr/Mrs/Miss/Ms/Other)
First Name
Surname
Date of Birth
Nationality on Passport {dual nationals please state both}

Your Spouse's personal details

First Name
Surname
Date of Birth
Nationality on Passport {dual nationals please state both}

Dependents' personal details

First Name
Surname
Date of Birth
Nationality on Passport {dual nationals please state both}
First Name
Surname
Date of Birth
Nationality on Passport {dual nationals please state both}
First Name
Surname
Date of Birth
Nationality on Passport {dual nationals please state both}
First Name
Surname
Date of Birth
Nationality on Passport {dual nationals please state both}

If you have more than 4 dependents, please specify in the comments box below.

Your contact details: Main Applicant {Where you are currently resident}

Address
City/Town
County/State/Province
Postcode/Zipcode
Country
Email
Phone
Fax

Additional Information

Country/countries of cover
Who is your current medical insurer?
Expiry Date of Current Insurance {{if any}}
(dd/mm/yy)
How long do you want cover for? {months}
(i) Do any of the above have pre-existing medical condition?
{If yes, please state below}
Pre-Existing Medical Condition(s){if any}
(ii) Are any of the above taking prescribed medication?
If yes, please state here


Additional questions, comments or suggestions, (include any other dependents and ongoing pre-existing conditions)
How did you find out about Morgan Price International Healthcare Ltd