Individual Health Insurance

Enter general information

Your travel destination is set to Qatar
Enter other details to avail the insurance coverage as you explore The State of Qatar.

"Please note that only credit cards are accepted for payment"

Email address Please enter correct email address Please enter main applicant’s email address

Please select main traveller's visa type Please select main traveller's visa type

Please enter main traveller's passport details

Passport number Please enter main applicant’s passport number Please enter valid passport number (should not include spaces or special characters)

Nationality Please select main applicant’s nationality

Are the travellers citizens/residents of State of Qatar or tourists/visitors?

Tourist/Visitor

Qatari Resident

Qatari Citizen

Please select main applicant’s type of residency

Insurance Plan Selection

Please select required Insurance Plan

Enter traveller information

Please enter main applicant’s personal information Insured name Please enter a name with minimum 3 characters (only alphabets allowed) Please enter main applicant’s full name Gender

Male

Female

Please select main applicant’s gender

Date of birth

Please select main applicant’s date of birth

Date of birth must be as in passport to reflect correctly to MOI

Occupation

Please enter main applicant’s contact information Mobile number Please enter a valid mobile number in the format 00(countrycode)(phonenumber) without any special characters or spaces. For example, a number in Qatar would be 00974XXXXXXXX Please enter main applicant’s mobile number

Main applicant’s details Country of residence Please select main applicant’s country of residence Passport expiry date

Please enter main applicant’s passport expiry date

The passport expiry date should be greater than travel start date

Source of fund Please select main applicant’s source of fund/wealth Source of fund (others) Please specify source of fund/wealth

Upload passport copy Please upload the main traveler passport copy before proceeding.

View your quotation

Your visitor insurance is taken for

visitor(s)

for an amount of

QAR

Policy period

Details of prime traveller

Name

Passport number

Email address

Phone number

I, the undersigned, hereby confirm that the information provided by me herein is accurate, correct and complete and that the documents I have submitted along with this application form are genuine. I understand that If the information and/or any of the documents I have provided is found to be false, fake, inaccurate or incomplete, AlKoot Insurance and Reinsurance may, at its sole discretion, cancel my application and if there is any amount of money to be refunded to me, any bank or other charges incurred in the refund will be deducted from that amount.

I undertake to inform AlKoot Insurance and Reinsurance immediately of any changes to the information or in the documents I have provided.

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