Hi Europa form

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Your insurance needs

Destination country

Select the country for which you are looking for an insurance solution from the list below *

Your contact details

To enable the insurer to contact you, please enter your contact details below

Mr. Mrs.

Last Name *

This field is mandatory

This field can only contain letters

First Name *

This field is mandatory

This field can only contain letters

Email *

This field is mandatory

There is an issue in your email

International calling code *

This field is mandatory

Phone number *

This field is mandatory

This field can only contain numbers

Your situation

Select your country of origin *

What is your current situation? *

Student / Trainee
Expatriate employee
Retired
Other

This field is mandatory

This field must contain at least 3 characters

Your insurance needs

Agreement *

By clicking on "Send my request", I agree that the information collected via this form will be sent by Euresa to the Euresa member insurance company(ies) operating in the country in which I am looking for an insurance solution and that this data is used to contact me.

This field is mandatory

I have read Euresa's privacy policy

This field is mandatory

Your personal data collected via this form will be processed by Euresa for the sole purpose of managing your request. The data collected will be automatically sent to the Euresa member(s) operating in the country in which you are looking for an insurance solution. We do not sell or transfer it to other third parties, nor do we use it for advertising or commercial purposes.

Fields marked with an asterisk are mandatory. Otherwise, we will not be able to process your request. Once your request has been processed, this data will be anonymised and kept by Euresa for statistical purposes only.

To find out more about the processing of your data and your rights, please consult our privacy policy.

Destination country

Your contact details

Your situation

Your insurance needs

Agreement *

The Euresa association

GDPR

Members

Insurance abroad

Head office - Euresa Association