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IAG Core Partner / Assistance Partner Application Form
Thank you for your interest in becoming an IAG Core Partner or Assistance Partner. Please answer all questions on this form. If you need to you can save the form before it is completed just press submit at the end of the form (you would have to click next on all sections) and then go back to the link provided at the end to edit your responses. This method can also be used if more than one person is editing the form.

You are also invited to share any marketing documents such as a corporate brochure, website link and photographs of your facilit(ies) to support your application by email. For any questions please contact, David Cléro by email at application@netiag.com or by phone +33 1 55 30 09 10

All answers will be kept confidential and only shared within the IAG office personnel.

thank you

Ms Louise Heywood, General Manager.
Email address *
Name of Organisation
Your answer
Organisation address
Your answer
In which country are you applying for Partnership with the IAG?
Please note that most partnerships are offered for one country only
Your answer
Do you operate in other countries?
If yes please list them below
Your answer
Organisation/Company/Business Registration No
Your answer
VAT number (only for European companies)
Your answer
Your Full Name
Your answer
Your position/job title
Your answer
Your contact telephone number
Your answer
CEO / General Manager (First name, Surname)
Your answer
Website address
Your answer
Type of Organisation
Date of incorporation
MM
/
DD
/
YYYY
Parent Company, if applicable
Your answer
Annual Turnover (please specify currency)
If not in Euros please specify the currency. Please note you may be required to provide the most recent audited accounts to support your application at the next stage.
Your answer
Please list your top 3 clients by revenue
Your answer
Please list any clients lost in the past 2 years and the reasons for loss, or write none if not applicable
Your answer
Annual Gross Profit
Your answer
Number of employees (Full time equivalent)
Your answer
Do you have English speaking operational staff on a 24/7 basis?
Excluding English, what are the other languages available by your personnel on a 24/7 basis?
Are you able to provide an interpreter service if necessary?
Do you currently work with any other assistance companies?
If Yes, which assistance companies do you currently work with?
Your answer
Please tick to confirm you are able to supply the following documents to support your application:
If your application is approved you will be requested to supply copies of all of the documents ticked below.
What assistance services do you provide?
Do you offer security assistance services?
Medical Services
Yes
No
Provision of information on best suited hospitals, clinics, laboratories for specific medical conditions and treatments
Referral of doctors and specialist consultation in clinics
Provision of medical reports in English, reviewed by and signed by licensed/registered doctors 24/7
Arrangement of local hospital/clinic admission, all levels, including tertiary referral, ICU, psychiatric facilities
Arrangement of ground medical transportation
Arrangement of air medical transportation
Facilitation of medical clearance with airlines in region, including clearance of Oxygen (cylinders and/or O2 concentrators) and medical equipment
Provision of suitably qualified and registered escort medical doctors or nurses
Arrangement of meeting and medical transit services for medical team/medical doctors
Arrangement of repatriation of mortal remains
If you want to add comments regarding the question above (Medical Services):
Your answer
Non medical Services
Yes
No
Assistance to clients for replacement of lost documents
Assistance to clients for return to home for family events
Cash advance
Referrals to hotels, restaurants, entertainments
Referrals to legal consultants or lawyers
Referrals to bail bond providers
If you want to add comments regarding the question above (Non Medical Services):
Your answer
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