Apply For Your Global Health Insurance Card Here

1 GHIC Info
2 Contact Details
3 Payment
4 Confirmation

Main Applicant Details

Title:*

Forename(s):*

Surname:*

NI No.:*

Date of Birth:*

EHIC PIN Number:

Spouse / Partner Details

Are you also applying for your spouse or partner?* Yes No

Title:*

Forename(s):*

Surname:*

NI No.:*

Date of Birth:*

EHIC PIN Number:

Dependent Child Details

Are you also applying for your children?* Yes No

Number of Children:*

Child no.: #{{$index+1}}

Title:*

Forename(s):*

Surname:*

NI No.:*

Date of Birth:*

EHIC PIN Number:

NEXT STEP

Address Line 1:*

Address Line 2:

Town or City:*

County:

Country:*

UK Postcode:*

Phone Number:*

Email:*

Acknowledgement

Please confirm your nationality*
UK citizen
A national of the EU, Switzerland, Norway, Iceland, or Liechtenstein
A dual national, which includes nationality of a country in the EU, Switzerland, Norway, Iceland, or Liechtenstein

I confirm that I live in the UK.

I confirm that I do not have healthcare cover from another country besides the UK (such as having an S1, E121, E106, or E109).

I confirm that I am not studying or do not intend to study in the EU, Switzerland, Norway, Iceland or Liechtenstein.

I acknowledge that I will lose the right to cancel the order within the statutory period of 14 working days as we will commence the delivery of an order immediately and before this statutory period ends. Therefore the services will have deemed to have been provided and you will lose the right to cancel your order. I acknowledge that I have British, EU, EEA or Swiss nationality and that all persons to be specified in this application are UK residents. I understand that should any person on this application decide to remain abroad to live or work, then the relevant authorities must be informed and the GHIC returned. The information that I give on this form is correct and complete to the best of my knowledge and I have read and accept the terms of the privacy policy.

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Main Applicant Details

Title: {{formData.ma_title}}

Forename(s): {{formData.ma_forename}}

Surname:{{formData.ma_surname}}

Date of Birth: {{formData.ma_dob}}

NI No.: {{formData.ma_nhs_or_ni_no}}

EHIC PIN Number: {{formData.ma_ehic_pin_number}}

Spouse / Partner Details

Title: {{formData.pa_title}}

Forename(s): {{formData.pa_forename}}

Surname:{{formData.pa_surname}}

Date of Birth: {{formData.pa_dob}}

NI No.: {{formData.pa_nhs_or_ni_no}}

EHIC PIN Number: {{formData.pa_ehic_pin_number}}

Dependent Child Details

Number of Children: {{formData.ca_number}}

Children No.#: {{$index+1}}

Title: {{formData.ca_title[$index+1]}}

Forename(s): {{formData.ca_forename[$index+1]}}

Surname:{{formData.ca_surname[$index+1]}}

Date of Birth: {{formData.ca_dob_d[$index+1]}}-{{formData.ca_dob_m[$index+1]}}-{{formData.ca_dob_y[$index+1]}}

NI No.: {{formData.ca_nhs_or_ni_no[$index+1]}}

EHIC PIN Number: {{formData.ca_ehic_pin_number[$index+1]}}

Contact information

Address Line 1: {{formData.addressline1}}

Address Line 2: {{formData.addressline2}}

Town or City: {{formData.city}}

County: {{formData.county}}

Country: {{formData.country}}

UK Postcode: {{formData.postcode}}

Phone Number: {{formData.phone}}

Email: {{formData.email}}

Registration fee: £35.00

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Thank you for your order. We are now processing your order.
Please check your email for your confirmation.

Apply For Your Global Health Insurance Card Here

Main Applicant Details

Spouse / Partner Details

Dependent Child Details

Child no.: #{{$index+1}}

Acknowledgement

Main Applicant Details

Spouse / Partner Details

Dependent Child Details

Children No.#: {{$index+1}}

Contact information

Thank you for your order. We are now processing your order. Please check your email for your confirmation.

Thank you for your order. We are now processing your order.
Please check your email for your confirmation.