Order form - Asistur Insurance for Cuba

To book other Cuban Adventures services, along with travel insurance, please click here.

  • Please fill out the form below with your insurance requirements.
  • No payment is required at this stage. We will respond to you within 2 working days with confirmation of your requirements and instructions for payment.
  • We accept payment with Visa, Mastercard only.
  • Once we have received payment, we will put your insurance in place and then within 48 hours, send you a printable certificate for the insurance by email.


Date of Arrival to Cuba

We require a minimum of 3 days to process insurance orders. We cannot process your order if you are due to arrive to Cuba in less than 3 days time.

Date of Departure from Cuba

Personal Details: (click to open section for each traveler)


Traveler #1


Traveler #2


Traveler #3


Traveler #4


Traveler #5


Traveler #6


Payment

Payment is required only after the reservation office respond to your order form. You will receive an email confirming the amount payable, a payment reference number, and a link to a secure page to make the payment.

Preferred Currency for payment

We do not charge a fee for paying by credit card, however it is possible your own bank may charge you a fee if you pay in a currency different to that of your bank account.


Comments/Questions

Any other comments or questions:


Terms and Conditions

Asistur medical insurance is non-refundable.
Please select this box to agree with this condition of purchase and to confirm you accept the General Conditions of the policy.