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Personal Information
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Travel information
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Purchase

Who is the insurance for

For me

For someone else

For me and for someone else

I read it and i agree Insurance terms In addition, I authorize JSC "Insurance Company Alfa" (204568896) to process the personal data of me and my insured person (s) (including special category data) for the provision of insurance services and other insurance services (ies) for which the insured ( S) I have obtained consent (s) of an identical nature from him.

Personal Information

First name in English

Last name in English

ID number

Passport number

Citizenship of the traveler

Gender

Date of birth (MM/DD/YYYY)

Phone number

Choose a country

Where are you departing from?

To which country are you travelling?

Policy type

Single

Multiple

Beginning of the journey (MM/DD/YYYY)

End of journey (MM/DD/YYYY)

Policy limit

30 000 €

50 000 €

60 000 €

50 000 $

50 000 € – with COVID coverage

Geotour-USD

Geotour-EUR

Geotour-USD with COVID coverage

Geotour-EUR-with COVID coverage

Luggage delay warning

Luggage loss warning

Flight delay warning

Legal service, Translation service, Personal property insurance warning

Legal service, Translation service, Third-party reponsibility insurance warning

Trip cancellation, Early cessation of travelling warning

Refusal to enter a country warning

Questionnaire for Foreign Natural Persons

In the process of prevention of illicit income legalization, in accordance with law of Georgia, Insurance Company is obliged to apply respective procedure based on which it is determined whether the customer and his beneficiary is a Politically Exposed Person

Politically Exposed Person (PEP) - Person, who has been entrusted with prominent state (public) functions in a respective country or / and carries out significant public and political activities. The PEPs are as follows: the head of the state, the head of the government and members of the government, their deputies, senior official of government institution, a member of the parliament, a member of the supreme court, a member of the constitutional court, a senior military official, a member of the central (national) bank’s council, an ambassador, a senior executive of state owned corporation, important political party (union) official and member of executive body of the political party (union), other prominent politician, his / her family members as well as persons having close business relations with him / her; a person shall be considered as a politically exposed during a year following his / her resignation from the foregoing positions;

Family member – a spouse of a politically exposed person (PEP), his / her parents, siblings, children (including step – children) and their spouses;

Person having close business relationship with the politically exposed person (PEP) – a natural person who owns or / and controls a share or voting stock of that legal entity, in which a share or voting stock is owned or / and controlled by the Politically Exposed Person (PEP); also, a person having other type of close business relationship with the Politically Exposed Person (PEP).

According to the above mentioned information, please answer the following questions:

Are you, or are you affiliated with, a Politically Exposed Person?

yes no

1) Are you holding a senior public position (e.g. state president, prime minister, minister, deputy minister, senior official of government institution) in your domicile?

yes no

2) Are you a member of parliament?

yes no

3) Are you a member of the Supreme Court or Constitutional Court?

yes no

4) Are you a Head of the Military Forces?

yes no

5) Are you a member of the central (national) bank’s council?

yes no

6) Are you an Ambassador?

yes no

7) Are you a head of the managing or supervisory board of (majority) state-owned legal entities?

yes no

If yes, please specify the name of legal entity union and position:

8) Are you a senior executive of political party (union), member of executive body of the political party (union), other prominent politician?

yes no

If yes, please specify The name of the political party (union) and position:

9) Are you an immediate family member of the person stated under 1-8 questions:

yes no

If yes, please specify information about Politically Exposed Person:

spouse Parent Siblings Child (Including step-child) or his/her spouse

10) Are you a professional associate with Politically Exposed Person:

yes no

Have or control a share or voting stock of legal entity?
Have a close business contact with the upper stated person(s)?

please specify information about Politically Exposed Person:

11) Has a time period of at least 1 year expired since the termination of any of the upper mentioned senior public position?

yes no

12) Are you the ultimate owner/Beneficial owner of the issued policy, you have taken from the JSC “Insurance Company Alpha”?

yes no

13) If you are a Politically Exposed Person (the person stated under 1-8 questions) please state :

a) The source of your funds and property b) Total estimated annual income in GEL:

<30,000 GEL 30,000 GEL - 100,000 GEL 100,000 GEL - 500,000 GEL >500,000 GEL

c) Total estimated net worth in GEL (assets, investments):

Please, review information

Insurer

First name

Last name

Gender

Citizenship

Personal number

Passport number

Birth date

Insured

Travel

Start date

End date

Days of travel

Country of departure

Country of arrival

Selected insurance products

Main product

Additional coverage

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Who is the insurance for

Personal Information

Choose a country

Policy type

Policy limit

Questionnaire for Foreign Natural Persons

Please, review information

Insurer

Insured

Travel

Selected insurance products

Additional coverage