Information about insurance
Please enter the date in the format “dd/mm/yyyy” (dd = day, mm = month, yyyy = year - e.g. 25.07.2016) The insurance must be arranged for at least 1 month but no longer than for 36 months.
Date of birth of the insured
Start date
RadDatePicker
Open the calendar popup.
Duration of insurance Spin UpSpin Down (in months)

Insurance validity:
The insurance is purchased for a limited time period. The premium is a one-time payment. The insurance is established as of the date on which the insurance contract is signed. Provided that the premium has been paid, the insurance is effective from 00:00am on the date specified in the insurance contract as the insurance start date. The premium is considered paid as of the date on which the entire sum of the premium was credited to the insurer’s account.
How much will you pay?
Premium

Discount voucher
   
recalculate premium
   
Who will be insured?
First name
Last name
Birth date
Gender
Nationality
Street
Number
City
ZipCode
Country
E-mail
Phone number
   
back
   
 
   
payment
   
AXA ASSISTANCE CZ, s.r.o., Hvězdova 1689/2a, 140 62 Praha 4, Česká republika, IČO: 256 95 215.
(c) 2014 AXA ASSISTANCE