Welcome! At Sunburst Worldwide Insurance Services, we are dedicated to providing you a trusted source for international travel, medical, life, and accident insurance with global emergency evacuation assistance 24/7/365 and war and terrorism related coverage for U.S. citizens traveling abroad, new immigrants, international employees, and non-US citizens worldwide. We are committed to providing quality global insurance protection and superior worldwide travel assistance to international travelers in over 100 countries. You can purchase high quality insurance coverage with ease and confidence from Sunburst Worldwide Insurance Services. We are knowledgeable about international insurance and responsive to your needs. You can easily get instant quotes and apply online for these global coverage from our secure system on our website. You also can find current and reliable International Travel News Briefs on our website. Wherever you are in the world, our worldwide assistance is by your side 24 hours a day, 7 days a week.

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APPLICATION FOR

tlas ravel Medical Series
Medical Insurance for Persons Traveling Outside of their Home Country
Renewable up to 36 months
Specially Designed for U.S. citizens traveling abroad and non-US citizens traveling outside of their home country.

SPECIAL NOTE:
Before submitting your application, please read Scheduled Benefits and Exclusions of your selected plan carefully.
When you click "Submit" button to send your application online for Atlas Travel Insurance, your application will go directly to the underwriting department of the insurance company. It will take only from 2 to 3 minutes for your payment to be approved. Then, you will receive Virtual ID Card(s) and Summary of Coverage immediately on your computer monitor. They are the official document. Please print them out for your records. You can use your Virtual ID Card to verify benefits and obtain assistance 24/7 while traveling.

Click here for Online Application
If you reside in Florida or have a mailing address in Florida, please contact us, 877-211-3654 or Info@worldwidemedicalplans.com before submit your application for Atlas Group Travel Insurance.

Click here for Atlas Benefits & Exclusions

Click here for Rates of Atlas Travel Series

OR

Just print and complete the following application.

APPLICATION for Atlas Travel Series
If you reside in Florida or have a mailing address in Florida, please contact us, 877-211-3654 or Info@worldwidemedicalplans.com before submit your application for Atlas Travel 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@worldwidemedicalplans.com Signature:

All checks must be issued from an 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 (available 24/7)
If paying by credit card, you may fax your application.

Bon Voyage!
Haben Sie eine sichere Reise! Abbia un viaggio sicuro!
�Tenga un viaje seguro! Ayez un voyage s�r! Have a safe trip!

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 companies. This site is updated frequently, but we recommend contacting Sunburst Worldwide Insurance Services 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.

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INTERNATIONAL TRAVEL NEWS BRIEFS:
Please note that we at Sunburst Worldwide Insurance Services provides the International Travel News Briefs as a value-added service to our international clients and visitors of this website. Our International Travel 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.

East Asia / Pacific - China June 30, 2007
Special police for Beijing games
The Chinese authorities say they have established a special military unit to provide security for the Beijing Olympics next year.

Sub-Saharan Africa - Kenya May 5, 2007
Kenya Airways plane crashed
A Kenya Airways plane that crashed in Cameroon on Saturday has been found submerged in a swamp and there is no chance of any survivors, officials say.

Europe - France
France opens fastest railway link Mar. 15, 2007
France's fastest rail link to date has been inaugurated with the service's first train travelling from Paris to the east on Thursday afternoon. Trains on the line are set to travel at 320km/h (200mph). The service will open to passengers on 10 June when they will be able to travel further east to other EU states.

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East Asia / Pacific - Japan
Ban on liquids expanded for all international flights Feb. 26, 2007
Tokyo, Japan: In a move aimed at further thwarting terrorist attacks, passengers on all international flights will be prohibited from bringing aboard liquids in containers larger than 100 milliliters starting Thursday

Europe - Russia
Explosion in Russian McDonald's Feb. 19, 2007
An explosion at a McDonald's restaurant in the Russian city of St Petersburg has slightly injured six people with concussion and cuts from flying glass.

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Americas - Mexico
'Safest city' now has drug war Feb. 16, 2007
Monterrey, Mexico:: An affluent city just two hours from Texas is the newest battleground in a war between drug cartels

Sub-Saharan Africa - Guinea
Guinea Airport Situation Feb. 14, 2007
This warden message is being issued to update American citizens regarding information on Air France flights out of Guinea. A flight left Guinea for Paris yesterday. We believe Air France will try to operate flights to Paris starting Thursday, February 15 to Sunday February 19, 2007.

East Asia / Pacific - Indonesia
Bird flu virus kills Indonesian Feb. 9, 2007
West Java, Indonesia A 20-year-old woman in Indonesia who tested positive for bird flu has died, becoming the country's 64th human victim, a health official said

Americas - Brazil
Brazil airport hub faces revamp after court battle Feb.9,2007
SAO PAULO, Brazil (Reuters) -- Slick runways at Brazil's busiest airport will undergo major overhauls this month after officials tried to ban wide-body jets because of fears they could skid off its short landing strips, the airport's authority said Thursday.

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East Asia / Pacific - Vietnam
Vietnam plans new railway link Feb. 6, 2007
Hanoi: The Vietnamese authorities have approved plans to build a $33bn (�15bn) rail link between the capital, Hanoi, to Ho Chi Minh City in the south.

New Thailand airport off to rough start Feb. 2, 2007
BANGKOK, Thailand - The taxiways are cracked, the terminal has leaks and some airlines even wonder whether it's safe to fly into Thailand's new international airport.

Australians warned about crime in Caribbean Feb. 2, 2007
SYDNEY, Australia: The foreign affairs department said in an official travel advisory that fans needed to be aware of safety issues at the World Cup, to be hosted by six Caribbean nations from March 10 until April 28. "In some parts of the Caribbean, violent crime, including armed robbery, kidnapping and murder is common," the advisory said.

Breaking News that International Travelers Need to Know!

Complimentary Safe Passages for Smart TravelersSM

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UK Updated Polonium-210 Information Jan. 31, 2007
Europe - United Kingdom: This information is meant primarily for Americans who were in Britain from November through December 2006. It is an update to the December 11, 2006 warden message concerning events in the UK involving the radioactive material Polonium-210, which have caused concerns for possible public health risks.

Islamabad Marriott Hotel Attack
Pakistan - It was reported that on January 26, 2007, at approximately 2:37 p.m. local time, a bomb exploded at the back area of the Marriott Hotel in Islamabad, Pakistan.

Kidnap group leader nabbed
East Asia / Pacific - Philippines LINGAYEN -- A leader of the Pepino kidnap-for-ransom group was arrested Wednesday in Bolinao, Pangasinan Wednesday, police officials said.

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for Global Travel Medical, Accident, Life Insurance, Emergency Medical &
Political Evacuation, & Trip Cancellation

If you have any questions, please contact our friendly specialists.
info@worldwidemedicalplans.com
877-211-3654 or 559-294-0316

Copyright � 1999-2007 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.

New Thailand airport off to rough start Feb. 2, 2007 BANGKOK, Thailand - The taxiways are cracked, the terminal has leaks and some airlines even wonder whether it's safe to fly into Thailand's new international airport.

New Thailand airport off to rough start Feb. 2, 2007
BANGKOK, Thailand - The taxiways are cracked, the terminal has leaks and some airlines even wonder whether it's safe to fly into Thailand's new international airport.