Travel With Confidence

Answer a few simple questions and we'll prepare your Travel Insurance proposal for a Geminia advisor to quote — before you set off.

About you

Tell us about the traveller

This is Part 1 of the official Geminia Travel Insurance proposal form.

Title

Mr. Mrs. Miss

Full name *

Please enter your full name.

Mobile number *

Enter a valid Kenyan phone number.

Date of birth *

Please enter your date of birth.

Passport No *

Please enter your passport number.

Citizenship (optional)

Postal address (optional)

Postal code (optional)

Town (optional)

Country (optional)

Occupation *

Please enter your occupation.

Dependants

Any travelling dependants?

List up to 4 people travelling with you. If there are more, your advisor will collect the rest separately.

Are you travelling with any dependants? *

No, travelling alone Yes

Please let us know.

Your journey

Contact details & journey

Parts 2 & 3 of the form.

Permanent address (optional)

Telephone number (optional)

Destination — country of visit *

Please enter your destination.

Travel airline company (optional)

Purpose & dates

Why are you travelling, and when?

Part 4 & 5 of the form.

Purpose of journey (tick as appropriate)

Please select at least one purpose.

Others, please advise (optional)

Departure date *

Please enter a departure date.

Return date *

Please enter a return date.

Your plan

Choose your travel insurance plan

Based on what you've told us, here's an indicative premium from Geminia's current rate card. Your advisor confirms the final figure.

Type of cover (we've pre-selected one based on your answers — change it if it's wrong)

Travelling abroad — leisure, business, conference or training Studying abroad — student cover Pilgrimage Travelling within Kenya (100km+ from home) Visiting Kenya from abroad Staff / corporate travel policy

Please choose a type of cover.

Select a plan

Please choose a plan.

This is an indicative premium from Geminia's published rate card — not a binding quote. Ages 66+ and trips outside the listed bands need your advisor's confirmation.

In case of emergency

Emergency contacts

Part 6 of the form.

Local contact (Kenya)

Name *

Please enter a name.

Contact number *

Please enter a contact number.

Contact at country of visit (optional, if arranged)

Name

Contact number

Medical

Medical information

Part 7 of the form. Benefits may not be payable if material facts aren't fully disclosed — if in doubt, please disclose.

In the last two years, have you or any travelling dependant taken medication, had treatment, or sought medical advice for any condition? *

No Yes

Please let us know.

Regular doctor (or the last doctor you saw, if you don't have a regular one)

Name (optional)

Telephone number (optional)

Address (optional)

Quick check

Insurance history

Part 8 of the form.

Have you or any travelling dependant made a claim, been refused cover, or had an insurer decline or impose special conditions in respect of Life, Accident, Sickness, Hospital Expenses or Travel Insurance in the last 5 years? *

No Yes

Please let us know.

Almost done

Declaration

Part 10 of the form.

Name of intermediary, if any (optional)

Your signature *

Sign here

Draw with your mouse, or your finger on a touchscreen. This is embedded into your proposal PDF.

Please sign before submitting.

By signing and submitting, you declare that the above answers are true and complete and that you have withheld no information, and consent to Geminia contacting you about this proposal.

Review

Does everything look right?

Take a quick look before we prepare your quotation.

Thank You! 🎉

We've received your request. A Geminia Insurance advisor will prepare your quotation and contact you shortly.

If we need any additional information, we'll reach out to you.

Premiums can be paid via Geminia's M-Pesa Paybill 553201, using your name as the account number. Cover only begins once your proposal is accepted, premium received, and policy issued.

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Travel With Confidence

Tell us about the traveller

Any travelling dependants?

Contact details & journey

Why are you travelling, and when?

Choose your travel insurance plan

Emergency contacts

Medical information

Insurance history

Declaration

Does everything look right?

Thank You! 🎉

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