Global Underwriters: travel medical insurance, visitor insurance, war and terrorism coverage, and defense base act insurance.
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War & Terrorism Coverage from Global Underwriters

     As our country wages war, and terrorism remains a constant threat, more and more Americans are finding their jobs requiring them to travel to political hot spots in order to perform their duties.  Many of these professionals find it difficult to find adequate insurance coverage to take care of their families should an accident occur in one of these high-risk areas.  Global Underwriters specializes in securing top-notch insurance coverage for our clients and their employees in these high-risk situations.  Not only can we write Accidental Death & Dismemberment policies for up to $20 million, we can also use optional War & Terrorism coverage to make sure you’re covered for nearly any event that may occur overseas.

     If you are interested in more information on this coverage, along with a quote, you may fill out the form below.  Each case is individually underwritten specifically for you and your situation, so without complete and thorough information about your travel (duration, destination, purpose), we cannot provide you with a quote. Please be sure to fill out this form in its entirety.  Also, please note that the benefit amount cannot exceed ten times your annual income.  (Example: A client that earns $60,000 per year would be eligible for no more than $600,000 in AD&D coverage).


Proposed Insured:

First Name

Middle Name

Last Name
Residence Address:

Street and Number

Phone Number

City

State

Postal Code
Personal Information:

Date of Birth

Height

Weight

Email Address
Employer:

Name of Employer

Occupation

Annual Income
Business Address:

Street and Number

Phone Number

City

State

Postal Code
Purpose of Insurance:

Purpose of Insurance
Other Insurance:

Total Amount of Life Insurance in Force or Applied For
Air Travel:
Will all air travel be on regularly scheduled airlines? Yes No
Beneficiary:

Name

Relationship
Address:
Policy Owner:

Name

Relationship
Address:
Benefit Requested:
 (not to exceed 10 times annual income)
Principal Sum Benefit
Coverage Requested:
All-Risk, 24 Hour Common Carrier Air Travel Only
Optional Coverage:
War or Acts of War and Terrorism
Nuclear / Biological Weapon Coverage (excluded above)
Benefits Requested:
Accidental Death (AD)
Accidental Death & Dismemberment (AD&D)
AD&D + Accidental Permanent Total Disability
Period of Insurance:

Number of Weeks

Effective Date
Health Questions:
Yes No   Have you any physical defect or infirmity?
Yes No   Is your sight or hearing defective?
Yes No   Have you ever suffered from any nervous or mental condition, fainting episode, blackout, fit, or paralysis of any kind?
Yes No   Have you ever suffered from high blood pressure, a heat condition, rheumatic fever, or diabetes?
Yes No   Have you ever suffered from a "slipped disk" or other spinal disorder, a hernia, or any rheumatic or arthritic condition?
Yes No   Have you ever been declined or accepted on special terms for life, accident, or illness insurance?
Yes No   Do you intend to engage in hazardous sports or any other pastimes that expose you to extra personal injury?
Yes No   Have you ever been insured by this plan through Lloyd's of London?
   
Provide Details for Any "Yes" Answers Above
Destination #1:

Destination

Duration

Purpose & Activities
Destination #2:
(if applicable)

Destination

Duration

Purpose & Activities
Destination #3:
(if applicable)

Destination

Duration

Purpose & Activities
Additional Information:
(if applicable)

Provide Any Additional Travel or Activity Details Here