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Please use a separate line for each person

Family members must share the same family name and there must be at least one person over age 18 in the family

Figures are in Thai Baht

Typically annual policies allow unlimited number of trips but trips must not exceed a certain duration (60/90 days is typical)

Count day of departure and day of return plus all days in between

For motorcycles only 1st and 3rd Class cover is available

For cars use the "Red Book" value, for motorcycles please estimate market value in Thai Baht.

Day - Month - Year e.g. 26 March 1964 \Required for 1st Class Motorcycle cover only