Patriot Multi-TripSM Group
View Plan Details

Please complete the following form in order to begin your Patriot Multi-TripSM Group application.

If you would like to save your application and complete it at a later time, simply click on the "Save Application" button at the bottom of any page of the application after selecting a premium amount and before submitting your credit card information. If you have the authorization number and password from a previous application that was not completed, click here to continue with the previous application.

*Denotes a required field.

(Term Length is 12 months)
Age # of Primary Insureds # of Spouses # of Dependent Children

Multiple trips must be outside your Country of Residence.
Select U.S. if any of your destinations include the U.S.
--- Select a Country ---select
Optional File Upload

You have the option to upload a comma-separated value (CSV) file containing the group insureds. Select your file by clicking on the "Browse" button. Then, click on the "Upload" button.