Online Application Forms

You can purchase one of our plans by credit card (Visa or MasterCard) by simply completing the relevant Online Application Form below. Please note that this will take approximately 10-15 minutes. Alternatively, if you wish to pay by bank transfer, you can download the relevant Application Form, complete your details and send to Allianz Worldwide Care for processing. You will need the following items to complete your application online.

  • Policyholder details
  • Details of persons to be covered
  • Policy start date
  • Plan and area of cover you have chosen
  • Credit card details (Visa or Mastercard)
  • Medical history for yourself and any dependants to be covered

 
   

International Healthcare plan

If you want to apply for one of our International Healthcare plans and wish to make payment via Visa or MasterCard please complete the following form. We will respond to your application within 2 working days. You will then have 30 days to change your mind.
>Apply Online

 
   

International Healthcare plan for Asia

If you want to apply for one of our International Healthcare plans for Asia and wish to make payment via Visa or MasterCard please complete the following form. We will respond to your application within 2 working days. You will then have 30 days to change your mind.
>Apply Online

             
Online Services