Barclay Carrigan Healthcare - ASSET PROTECTION WHEN YOU NEED IT MOST

Please complete the basic details below. Upon receiving your enquiry we will contact you to discuss your requirements in more detail.

Family Health Insurance and Personal Asset Protection

Company Name:

Contact Name:

Email Address:

Telephone Number:

Country:

Country of Cover (if different):

Number of Employees to be covered:

Number of dependents to be covered:

Do you presently operate a corporate scheme? Yes No

Renewal date of current scheme:

Please add any comments or questions that you feel

may be relevant to your quotation request.

Terms & Conditions | Privacy Statement© Barclay Carrigan International Healthcare Limited 2006
          C/O Anglo Assured Administration Ltd 4 Park Avenue, 58 Triq is-Sirk, Swieqi, SWQ 3217 Malta. Tel: +356 21 324 634 Fax: +356 21 311 043
This office is for administration purposes only and is not licensed to provide Investment 
Services under the Investment Services Act, 1999