High Risk Quote Name and Location of Your Organization (*) Contact Person (*) Email (*) Phone or Skype Age(s) Nationality(s) What type of insurance are you looking for? Kidnap and RansomHigh Risk Medical or Travel InsuranceHigh Risk Life and/or AD&D InsuranceEvacuation Services and/or Onsite ClinicOther What is the nature of the work to be performed? Do you have a Defense Base Act or other International Workers Compensation insurance?YesNo Which country(s) will your employees be working in? How long will your employees need coverage? 1 month – 6 months6 months – 12 months12 months or longer How many employees will need insurance? Is there any additional information you can provide which might be helpful?