Trip Details
Trip Type
Short Trip       Annual Trip
Destination
SCHENGEN Countries:
Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Italy, Greece, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain and Sweden, Switzerland, Norway, Liechtenstein and Iceland.
Special ASEAN Plus:
Brunei, China, Hong Kong, Cambodia, Laos, Macao, Malaysia, Myanmar, Philippines, Singapore, Taiwan, Thailand, Vietnam, Timor Leste.
Type of Plan
Individual       Family
Number of People
Adults
Children
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Our Offer
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Platinum
Gold
Up to US $100,000 for Personal Accident & Medical Expenses.
Up to US $1,500 for loss or damage to baggage including items purchased during the trip.
Up to $300 for loss of travel documents and money due to robbery or theft.
Up to US $150,000 for Personal Liability to third parties for bodily injury or property damage.
Plus much more. (view details)
Getting price...[[data.premium.platinum | currency]] USD *
includes 20% discount
Up to US $35,000 for Personal Accident & Medical Expenses
Up to US $1,500 for loss or damage to baggage including items purchased during the trip.
Up to $300 for loss of travel documents and money due to robbery or theft.
Up to US $135,000 for Personal Liability to third parties for bodily injury or property damage.
Plus much more. (view details)
Getting price...[[data.premium.gold | currency]] USD *
includes 20% discount
Up to US $25,000 for Personal Accident & Medical Expenses
Up to US $1,500 for loss or damage to baggage including items purchased during the trip.
Up to $300 for loss of travel documents and money due to robbery or theft.
Up to US $125,000 for Personal Liability to third parties for bodily injury or property damage.
Plus much more. (view details)
Getting price...[[data.premium.asean | currency]] USD *
includes 20% discount
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Personal Information
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[[$select.selected.name]]
Beneficiary
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Disclaimer
I/We hereby acknowledge and agree that my personal data that I have provided in this application is used by PT. Mandiri AXA General Insurance for the purpose of making a travel insurance policy, providing services and developing related products, as well as administrative and legal purposes. For that I allow PT. Mandiri AXA General Insurance to store and use my personal data and send to the office of PT. Mandiri AXA General Insurance, authorized agents and third party business associates, government agencies, or service providers mentioned above.
I/We hereby declare and agree to give authority to the Company to act for and on behalf of and therefore represent the interests of the Insured in carrying out all actions deemed appropriate at the time I am/we are in the emergency situation, disability or death.
I/We agree to the requirement and regulations and provides authority to the PT. Mandiri AXA General Insurance to debit the credit card in accordance with the value of premiums listed above.
I/We agree that the credit card issuing bank may charge an additional fee for all transactions CROSS-BORDER defined as transactions carried the state bank cardholders different from the seller.
I/We agree that these additional costs are not imposed by PT. Mandiri AXA General Insurance and also we did not take advantage thereof. You are advised to seek further clarification from your credit card issuing bank if CROSS-BORDER fee will be charged for this transaction.
I/We agree and confirm that I/we will not travel to the destination of sanctioned countries which list issued by United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.
For Annual Trip, please note that the maximum period of trip is 60 days per trip.
I/We declare that all information provided by me in this application is true and I do not hide, any state or any write down all the facts. I/We have read and agree with the Policy Wording.
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Payment
[[_.find(meta.destinations, {id:data.destination}).name]]
[[data.premium[data.planGrade] | currency]] USD
CARDHOLDER DETAILS
[[$select.selected.name]]
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