Complete the application form online and send it to us electronically or fill it in by hand and send it to us by fax or mail. If sent by fax or electronically, please send the original signed copy to us by mail.


  1. Your systolic and diastolic blood pressure (you can get this from a chemist or your doctor)
  2. Your medical history
  3. Your bank details if you wish to pay your premiums by direct debit and/or receive your reimbursements by bank transfer


If you tick ‘immediate’, your policy will take effect on the date we receive your application form. If you would like cover to start at a later, more convenient, date you can stipulate this.


If you had equivalent insurance which expired less than 3 months ago, put NO and attach evidence of this insurance to your application form in order to waive the waiting period. Otherwise, tick YES.


The Insurer accepts the following documents as evidence of previous equivalent cover:

GOLD & SILVER HEALTH INSURANCE: A copy of the ’attestation’ you received with your ‘Carte Vitale’ or a certificate of cancellation from a private insurer indicating the dates of cover and benefit levels

HOSPITALISATION INSURANCE: A certificate of cancellation from a private insurer indicating the dates of cover and benefit levels

COMFORT & LUXURY TOP-UP INSURANCE: A certificate of cancellation from your previous top-up insurer indicating the dates of cover and benefit levels.  There is no waiting period for Classic Top-Up cover.


Not necessarily. If you declare any pre-existing medical conditions, your completed medical questionnaire may be forwarded to the Insurer’s Consulting Doctor who will contact you for further information to enable the Insurer to decide whether a premium loading or an exclusion is appropriate.

For a person who is pregnant on joining: If you were previously insured during the three months preceding your date of inception, the standard costs of pregnancy (midwife, childbirth, lump sum of 275.00 EUR) will be excluded.  All other costs, for example complications, will be reimbursed provided that it is not a multiple birth and the mother has had no complications in a previous pregnancy.  If the mother cannot provide proof of previous insurance, the waiting period of 10 months for maternity will apply.


Premiums are payable in Euro by direct debit on a French bank account, or by cheque or bank transfer. You can choose to pay monthly, quarterly, six-monthly or annually (with a 5% discount).


Once you have filled out the form, a copy will be sent to us automatically by email. You will also receive a copy.  Please note that we will require the original signed document by post, along with all the relevant supporting documents.


All applications for membership should be sent to Amariz Limited in Bristol. Our address is on the last page of the application form.

We process the majority of new applications within 48 hours and you will receive an email confirming that we have received your proposal form.  If your application is accepted, we will send you your policy schedule as well as an ‘attestation’, a direct-settlement card and information on how to make a claim a few days later.