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COMPLETE AN APPLICATION FORM ONLINE


Pressing the button below will enable you to complete an application form online and save it as a pdf file.

Before completing the form, please make sure you have the following information to hand:

  1. Your French Social Security number (Option 3 only)

  2. Your blood pressure

  3. Your medical history

  4. Your bank details if you wish to pay by direct debit

Once you have filled out the form, pressing the Save and Print button will create a pdf file, a copy of which will be sent to us automatically by email. If you have missed any compulsory sections, these will be highlighted in red and you can go back and complete them before pressing the Save and Print button again.

Please note that we will require the original signed document by post, along with all the relevant supporting documents.

Before sending us your completed application form, please ensure that you have read all the documents on the Documents to download page of our website, especially the Policy Summary, the General Conditions and the Initial Disclosure Document.





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   SPECIAL OFFER

YOUR FIRST MONTH'S
PREMIUM FREE
DURING 2012

   CONTACT US
Tel. 0800 900 258
(Freephone from France)
Email info@amariz.co.uk
Amariz Limited is registered and incorporated in England and Wales with Company Number 3711064
and is authorised and regulated by the Financial Services Authority.

We are members of the Financial Services Compensation Scheme and
the Financial Ombudsman Service.
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