How to Apply for

a.gif (2332 bytes) tlas ravel Medical Series
Medical Insurance for US Citizens and Non-US Citizens Traveling
Outside of their Home Country. Renewable up to 36 months.

Click here for Instant Quotes & Online Application
If you reside in Florida or have a mailing address in Florida, please contact us at 877-211-3654 or Info@internationalriskmanagement.com before submit your application for Atlas Travel Series.

Click here for Brochure of ATLAS

Click here for Rates

OR

Just print and complete the following application.

APPLICATION--Atlas Travel Series

If you reside in Florida or have a mailing address in Florida, please contact us at 877-211-3654 or Info@internationalriskmanagement.com before submit your application for Atlas Travel Medical Insurance.

Before submitting an application for this plan, please read the Brochure carefully.

Please make sure your application is legible - print or type. Thank you.

Print all Names as you would like them to appear on your Identification Cards.
Please print clearly and provide complete information.

(Last)		(First)			(MI)
COMPLETE Mailing Address for all correspondence:
Telephone #:	E-mail Address*:		Fax #:
Requested Effective Date (mm/dd/yy):	Departure Date (from Home Country):			Date of Return to Home Country:
Countries to be visited:
Name of Beneficiary:		Relationship to Applicant:
(Note: You will be the Beneficiary for spouse and dependent children included on this Application.)

*REQUIRED FOR EXTENSION OF COVERAGE NOTIFICATION

OPTION(S) SELECTED: [_______] (Maximum of 2 options when there are multiple citizenships)

Names of All individuals to be covered. List applicable rates for the Option chosen:

Column M

Column R

Name (Last, Frist)

Birth Date (mm/dd/yy)

Citizenship

Passport Number

Monthly Rate

Daily Rate

1
2
3
4
5

A	Subtotals (add lines 1 through 5 above)	A
B	Trip Duration (# of Months and/or # of Days)	B
C	Multiply Line A by Line B	C
D	Enter Deductible Factor (from Deductible Factor Table)	D
E	Multiply Line C by Line D	E
F	Enter Factor for Hazardous Sports Rider, if Selected (1.20), otherwise Enter 1.0	F
G	Multiply Line E by Line F	G
H	Add Line G, Column M to Line G, Column R ( TOTAL Premium Due)	H
I	OPTIONAL Overnight Charge: Add $20.00 for US Delivery, $30.00 Non-US Delivery	I
J	Add Line H and Line I together ( TOTAL Amount Due)	J

Payment Mode: Check/Money Order Discover Card MasterCard VISA American Express	Credit Card #: Expiration Date (mm/yy):
Name as it appears on card:	COMPLETE Billing Address:
Daytime Phone #:	Signature:
PLEASE READ the following: Check or Money Orders should be made payable, in US dollars, to MultiNational Underwriters, Inc. If paying by credit card, I authorize MultiNational Underwriters, Inc. to debit my VISA, MasterCard or American Express account for the amount specified above. Coverage purchased by credit card is subject to validation and acceptance by the credit card company. Total payment for the initial term of coverage requested must be entirely paid in U.S. dollars at time of Application or prior to the Effective Date of Coverage.

PLEASE READ the following: I hereby apply for membership in the Atlas/International Citizen Group Insurance Trust, Hamilton , Bermuda and for the insurance provided to members by Lloyd’s. I understand that the insurance applied for is not a general health insurance policy, but is intended for use in the event of a sudden and unexpected event while traveling outside my Home Country. I understand this insurance contains a Pre-existing Condition exclusion, a Pre-notification Penalty and other restrictions and exclusions. I understand that if I am eligible for Extensions and Renewals of this insurance that they may only be transacted on line and will not be effective unless such transaction is made within the thirty (30) days immediately preceding my current coverage expiration date and confirmed in writing by MultiNational Underwriters, Inc. I understand that the information contained herein is a summary of the Master Policy and that I may obtain a complete copy of the Master Policy upon request to MultiNational Underwriters, Inc. I understand that Lloyd’s, as underwriter of the plan, is solely liable for the coverage and benefits provided under the insurance. I understand that Lloyd’s operates as an approved, non-admitted insurer in all states of the United States except Illinois and Kentucky where they are admitted. As such, claims under this insurance may not be made against any state guaranty fund. I understand and agree that the insurance agent/broker, if any, assisting with this Application is a representative of the Applicant. If signed by a representative of the Applicant, the undersigned warrants his/her capacity to so act. If signed as guardian or proxy of the Applicant, the undersigned warrants his/her capacity to so act. By acceptance of coverage and/or submission of any claim for benefits, the Applicant ratifies the authority of the signer to so act and bind the Applicant.
Signature of Applicant:	Date of Signature:
Signature of Spouse:	Date of Signature:

FOR PRODUCER USE ONLY

Producer Number: 99256	Producer Name: JoAnne N. Green
Company Name: Sunburst Worldwide Insurance Services	Address: P.O. Box 1016
City: Clovis	State: CA	Postal Code: 93613
Country: USA	Telephone: 559-294-0316	Fax: 559-421-1956
E-mail: info@internationalriskmanagement.com	Signature:

All checks must be issued from a US bank.
Please make check payable to MultiNational Underwriters, Inc. (MNUI)
Mail the completed form, along with your payment, to:
Sunburst Worldwide Insurance Services
P.O. Box 1016, Clovis, CA 93613 USA
Fax: 559-421-1956
If paying by credit card, you may fax your application.
(Our fax machine is ready to receive applications 24/7.)

If you have any questions or concerns, please contact us today.
info@internationalriskmanagement.com
877-211-3654 or 559-294-0316

HERE'S THE FINE PRINT:
Availability, features, benefits and rates for all plans described on this site are subject to change without notice
at the discretion of the insurance carriers. This site is updated weekly, but we recommend contacting us
directly to be assured of getting the most up-to-date information available.

Copyright � 1999-2008 by Sunburst Worldwide Insurance Services. CA Insurance License #0B65721
Warning: All of the pages on this site are protected under U.S. and International copyright laws.
Reproduction by any means or for any purpose, except as specified on certain pages,
is not allowed without the express written permission of the copyright owner.

INTERNATIONAL SECURITY NEWS BRIEFS:
Please note that we at Sunburst International Risk Management provides the International Security News Briefs as a value-added service to our international clients and visitors of this website. Our International Security News Briefs are updated frequently, in order to provide you with current and reliable news and events as quickly as we can. We have no control over the content of external websites, and links to various external news sources may become inactive at any time. We suggest that you bookmark our website and return frequently to check the current global news posted on our website.

Europe - United Kingdom
Crime 'stable' but robbery rises July 19, 2007
Crime in England and Wales has remained stable during the past year, according to Home Office figures.

East Asia / Pacific - China
Fifth of China goods sub-standard July 4, 2007
Nearly a fifth of goods made and sold in China have been found to be sub-standard, Beijing has revealed. The worst problems were found in canned fruit, dried fish and fruit drinks, a food inspectors' report said.

Sub-Saharan Africa - Nigeria
Scots oil worker held in Nigeria April 1, 2007
A British oil worker is still missing after being kidnapped in Nigeria, the Foreign Office has said.

Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance

Middle East / N. Africa - Israel
Israeli union gripped by general strikes Mar. 21, /2007
Irael's main trade union has launched an open-ended general strike which threatens to bring transport and public services across the country to a halt.

Europe - Russia
55 Cities Could Face Spring Floods Mar. 15, /2007
More than 55 cities and towns across the country could be flooded this spring, according to a forecast released by the Emergency Situations Ministry.

Middle East / N. Africa - Algeria
Threat to Commercial Aircraft in Algeria Mar. 14, /2007
There is information that extremists may be planning to conduct an attack against a commercial aircraft carrying Western workers in Algeria. At this time, there is no additional information available as to the specific carrier or the timing of this attack.

Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance

East Asia / Pacific - Thailand
Army doubts Bangkok attacks likely Mar. 12, 2007
Council for National Security chairman Gen Sonthi Boonyaratkalin Sunday dismissed rumours that southern insurgents plan to launch disturbances in the Thai capital anytime from Tuesday through Thursday.

Sub-Saharan Africa - Kenya
Mombasa Athletic Event Threats Mar. 6, 2007
Recent information emanating from alleged extremist elements suggests the World Cross-Country Championship may be the target of an unspecified terrorist attack. The embassy is also aware of public statements by leaders of Kenya�s Coastal Muslim community threatening to disrupt the Championship if the Government of Kenya does not satisfy various demands

Sub-Saharan Africa - Ethiopia
Tourists 'kidnapped' in Ethiopia Mar. 2, 2007
Addis Ababa, Ethiopia: A group of 15 foreign tourists has been kidnapped in north-east Ethiopia. They include 11 French nationals, at least one Briton and an Italian.

Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance

East Asia / Pacific - Thailand
Muslim insurgency stokes fear in southern Thailand Feb. 26, 2007
PATTANI, Thailand: Some are already calling it war, a brutal Muslim separatist insurgency in southern Thailand that has taken as many as 2,000 lives in three years, with almost- daily bombings, drive-by shootings, arson and beheadings.

American Tourist kills mugger with bare hands Feb. 24, 2007
SAN JOSE, Costa Rica - An American tourist who watched as a U.S. military veteran in his 70s used his bare hands to kill an armed assailant in Costa Rica said she thought the attempted robbery was a joke � until the masked attacker held a gun to her head.

Sub-Saharan Africa - Nigeria
Three Croatians kidnapped in Nigeria Feb. 19, 2007
Port Harcourt, Nigeria: Gunmen kidnapped three Croatian oil workers from a bar in Nigeria's oil city of Port Harcourt.

Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance

East Asia / Pacific - China
Buddhist beheaded in Thai south Feb. 9, 2007
A 72-year-old Buddhist rice miller was beheaded in Thailand's rebellious Muslim south on Thursday in an apparent retaliation for a bomb attack on a village tea shop owned by Muslims, police said.

Europe - Russia Feb. 5, 2007
Registration Rules Stir Up Confusion
Moscow, Russia: According to a new law that came into effect Jan. 15, foreigners are now required to hand over their registration papers to migration officials -- via their employer or other sponsor -- every time they leave the country and re-register upon subsequent entry into the country.

Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance

Sub-Saharan Africa - Nigeria
Captors release nine Chinese oil workers in Nigeria Feb. 5, 2007
Nigeria, Lagos: Hostage takers in Nigeria released nine Chinese oil-worker captives, officials said on Sunday, amid rising violence in Africa's biggest petroleum producer.

Sub-Saharan Africa - Nigeria
Force no solution for Nigeria's oil delta Feb. 2, 2007
The Nigerian government faces a new challenge from spiralling crime in the oil-producing Niger Delta, but wants to avoid turning Africa's oil heartland into a battleground, Energy Minister Edmund Daukorua said.

Sub-Saharan Africa - Nigeria
Demands made for release of hostages 2/1/07
Manila - Nigerian kidnappers holding 24 Filipinos hostage have made "political demands" that have hampered negotiations to free them, the Philippine foreign department said Thursday.

East Asia / Pacific - Thailand 1/30/07
Two explosions in northern Bangkok
Bangkok - Two explosions occurred early on Tuesday morning along the main road in northern Bangkok. There were no casualties reported in the blasts near the Daily News newspaper and Rama Gardens Hotel Bangkok.

More Global Safety
& Security
News Briefs

For Information on How to Protect Yourself, Your Family, Your Employees, and Your Trips Abroad,
Contact our experienced Risk Managers today.
info@internationalriskmanagement.com
877-211-3654 or 559-294-0316

Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance

Copyright (c) 2002-2007 by Sunburst International Risk Management.
Warning: All of the pages on this site are protected under U.S. and International copyright laws.
Reproduction by any means or for any purpose, except as specified on certain pages,
is not allowed without the express written permission of the copyright owner.

Sub-Saharan Africa - Nigeria Three Croatians kidnapped in Nigeria Feb. 19, 2007 Port Harcourt, Nigeria: Gunmen kidnapped three Croatian oil workers from a bar in Nigeria's oil city of Port Harcourt.

Sub-Saharan Africa - Nigeria
Three Croatians kidnapped in Nigeria Feb. 19, 2007
Port Harcourt, Nigeria: Gunmen kidnapped three Croatian oil workers from a bar in Nigeria's oil city of Port Harcourt.