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Contact & Quote

Form

Last Name & First Name*
First Last
Email address*
Telephone number
Post code
How did you hear about our company?*
Subject
Would you like a quote?*
- Yes
- No
Your message / Comments
To be insured - Person 1
Date of birth*

DD
MM
YYYY
COVER REQUIRED*
- GOLD Health Insurance
- SILVER Health Insurance
- HOSPITALISATION Insurance
- TOP-UP Health Insurance
- BRONZE Temporary Health Insurance
Add a second person?*
- Yes
- No
Person 2
Date of birth*

DD
MM
YYYY
COVER REQUIRED*
- GOLD Health Insurance
- SILVER Health Insurance
- HOSPITALISATION Insurance
- TOP-UP Health Insurance
- BRONZE Temporary Health Insurance
Add a third person?*
- Yes
- No
Person 3
Date of birth*

DD
MM
YYYY
COVER REQUIRED*
- GOLD Health Insurance
- SILVER Health Insurance
- HOSPITALISATION Insurance
- TOP-UP Health Insurance
- BRONZE Temporary Health Insurance
Add a fourth person?*
- Yes
- No
Person 4
Date of birth*

DD
MM
YYYY
COVER REQUIRED*
- GOLD Health Insurance
- SILVER Health Insurance
- HOSPITALISATION Insurance
- TOP-UP Health Insurance
- BRONZE Temporary Health Insurance
Add a fifth person?*
- Yes
- No
Person 5
Date of birth*

DD
MM
YYYY
COVER REQUIRED*
- GOLD Health Insurance
- SILVER Health Insurance
- HOSPITALISATION Insurance
- TOP-UP Health Insurance
- BRONZE Temporary Health Insurance
Add a sixth person?*
- Yes
- No
Person 6
Date of birth*

DD
MM
YYYY
COVER REQUIRED*
- GOLD Health Insurance
- SILVER Health Insurance
- HOSPITALISATION Insurance
- TOP-UP Health Insurance
- BRONZE Temporary Health Insurance
From time to time we would like to contact you by email with details of the products and services we provide. Please confirm your consent below:*
- Yes
- No
We will not share your email address with any third parties and you can withdraw your consent at any time in accordance with our Privacy Notice.
GDPR*
- I authorize this website to store the information submitted via this form in order to answer me.

Information

Head office :

Imperial House
1 Harley Place. Bristol BS8 3JT
United Kingdom

Telephone :

00 44 (0) 117 974 57 70

Freephone from France : 0800 900 258

Email :

info@amariz.co.uk

claims@amariz.co.uk

Office hours :

08.30 – 16.30 (Monday to Friday)

Application form

0800 900 258 (free)

The AMARIZ SANTE policy is underwritten by the EUROPEAN INSURER ArgoGlobal SE - Malta

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