Skip to form
First Name
*
Name of frequent traveler (person to be insured)
Last Name
Email
*
Mobile phone number
Date of birth
Month
/
Day
/
Year
Preferred Annual Travel Insurance Plan
Please Select
Starr Annual TraveLead - Essential
Starr Annual TraveLead - Extra
Pioneer Safe Trip Annual [Plan 2]
Assist Card Multi-Trip 30 - AC 60
Assist Card Multi-Trip 30 - AC 250
Assist Card Multi-Trip 60 - AC 60
Assist Card Multi-Trip 60 - AC 250
Pacific Cross Annual Travel Safe - Worldwide Elite
Preferred effective date of the policy (optional)
This can be the departure date of your first trip
Month
/
Day
/
Year
Message (optional)
Submit