Страхование туриста на Кипре. Шаг третий

Step 3: Confirm your order

Please verify that the following information is correct and proceed to the bottom of the page to place order. Thank you.

First Name: test
Middle Name: t
Last Name: test
Date of Birth: 01/01/1974
Passport #: 123
Send Certificate to: test
Address Ln 1: test
City: test
State:
Country: Afghanistan
Zipcode: 123
Telephone: 123
E-Mail: 123@123.net
Citizenship: Afghanistan
Home Country: Afghanistan
Requested Effective Date: 01/01/2009
Amount of Coverage: $1,000,000.00
Date of Departure: 01/01/2009
Date of Return: 01/04/2009
Number of Months, Days: 0 months 5 days
Are you coming to Florida to work? No
Destinations: Algeria
Name of Beneficiary: test
Policy Selected: International
Quoted Cost: $10.00
Deductible: $250.00
Credit Card Type: Visa
Card Number: xxxxxxxxxxxxx7564
Expiration Date: 01/10
Name on Card: test
Billing Address Ln 1: test
Billing City: test
Billing State:
Billing Country: Afghanistan
Billing Zipcode: 123
Daytime Phone: 123
Agent Information: WT



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