| 1. FIRST APPLICANT’S DETAILS |
| 3. COVER DETAILS |
| Select type of cover |
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| Additional names to go on policy |
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| 4. OPTIONAL EXTRAS |
| Baggage & money cover? |
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| Winter sports cover? |
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| 5. UNDERWRITING QUESTIONS |
Are you aware of any reason why any holiday or
journey could be cancelled or abandoned? |
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Have you required consultation or treatment in the
last 12 months for any serious, chronic or recurring
medical condition? |
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Will you be booking a holiday or journey solely for the
purpose of taking part in any activity, or do you intend
taking part in an activity that involves an element of
risk e.g. safari, scuba diving or a team sport? |
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Have you made any travel claims in the last three
years (if yes please give details of loss date,
description and amount of loss)? |
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Has any insurer refused to give you travel insurance
in the last three years? |
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Have you ever been convicted, or charged (but not
yet tried), in respect of any criminal offence involving
dishonesty, fraud, violence, criminal damage, drugs
or arson; or been given a Police Caution in respect of
any of these offences? |
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Correspondence Address
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| 2. SELECT TRAVEL POLICY |
| Option 1 – Single Trip |
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| Which area are you travelling to? |
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Option 2 – Annual Multi-Trip
(Policy valid for 1 year from start date) |
| Which area are you travelling to? |
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Option 3 – Long Stay
(Policy valid for 1 year from start date) |
| Departure Date
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| Number of months abroad (select between
3 and 15 months)
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| Which area are you travelling to? |
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