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William Russell - Elite Plan

William Russell, underwritten by the Hauteville Insurance Company, offers a range of international health insurance plans that give you access to first class medical care, wherever you are, without having to worry about the cost.

They have years of experience in the international health insurance industry - plus the financial security of their insurance partner, AGF, and the world-wide presence of their medical assistance partner - CEGA Air Ambulance - making Global Health the complete solution to your health insurance needs.

Award-winning international health insurance plans for expats, frequent travellers and international business people all over the world.

1 - About You

Title  * : Mr Mrs Ms Miss Master Other

First name  * :

Last name  * :

Date of birth DD/MM/YYYY  * :  /   /

Nationality, as on passport  * :

Country/countries where cover required  * :

Occupation  :

Do you wish to include spouse/dependant  * : Yes No

2 - Cover Required - Global Health Elite Plan

Level of Cover Global Health Elite Plan  * : Bronze Silver Gold Platinum

Start date required  * :  /   /

Currency required  * : Pounds Sterling US Dollars Euros

Premium frequency  * : Monthly Quartely Annually

3 - Medical History

If you have any pre-existing medical conditions or are currently receiving medical treatment, please provide details: If you don't have any pre-existing medical conditions or any medical treatment, please leave it blank.

4 - Your Contact Details

E-mail address  * :

Confirm email address  * :

Alternative E-Mail Address  :

Daytime Telephone Number  * :

Address 1  :

Address 2  :

Town/ City  :

State / Province / County  :

Post/ Zip code  :

Country  * :

5 - Additional Information & Submit

Please use this box to provide any further information or ask any questions that you may have for us: If you don't have any further information or question, please leave it blank.

We offer an APRIL Medibroker newsletter by E-mail. Would you like to subscribe?  * : Yes No

On an annual basis we carry out a customer satisfaction survey (carried out in confidence by a third party market research company employed by APRIL GROUP) in order to assess our service levels and standards. Would you like to participate ?  * : Yes No

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Use of your information will solely by used by APRIL Medibroker and any personal information will remain confidential within normal procedures in advising on and completing applications for private medical insurance and associated plans. Your information will not be disclosed to any third parties outside of APRIL GROUP or used for unsolicited marketing.