Travel Insurance Quotation Form

Please complete all the fields then press the submit button at the bottom of the page.

In providing our quotation we assume the following:-

• All persons are fit and well and there are no previous or existing medical conditions.
• No cover is required for hazardous activities.
• No previous travel claims.
• There is no reason why this trip may be cancelled.

In all other cases please ring 01624 626 370 for your personal quotation.
Title: (Mr/Mrs/Ms)
Full name:
Address:
Post code:
Telephone number:
E-mail:
Destination:
Period of travel:
Is annual cover required? yes no
If YES maximum peiod
any one trip:
NB - Discounts apply if luggage is deleted. (This often already covered under home contents)
  Insured persons   Age Luggage Winter Sports  
yes no yes no
yes no yes no
yes no yes no
yes no yes no
yes no yes no

yes no yes no