Contact us at 301-696-0765 or info@asegurnet.com

Submit an Application

Please complete the Personal Accident Application and send it back to us to request coverage. We will contact you within 24 hours to approve it, provided that all required, key information has been provided to us.

Please note that coverage will not be effective until premium has been paid in full. We will send you an official payment and binding confirmation and, thereafter, transmit official documentation to you via our secure intranet ShareFile.