Holiday / Business
Travel Insurance

Please complete the form below and you will be sent a quote by post.

Your Detail's

Title

Forename(s)

Surname

Address

Area

Town

County

Post Code

Telephone

Mobile

Fax

Email

Type Of Cover

Personal Cover
(All policies)
Child Cover
(Annual Muti-Trip only)
Family Cover
(Single or Annual Multi-Trip)
Group Cover
(Single Trip only)
Winter Sports Cover
(Single or Annual Multi-Trip)
Business Equipment Cover
(Single or Annual Multi-Trip)
Business Trip Cover
(Annual Multi-Trip only, including Business Equipment Cover)

Territorial Limits

Area 1 - UK, Isle of Man, Channel Islands and Northern Island (Leisure cover only) Single Trip
Area 2 - Europe Single Trip
Area 2a - Europe Annual Multi-Trip
Area 3 - World-wide excluding USA, Canada & Caribbean Single Trip
Area 4 - World-wide including USA, Canada & Caribbean Single Trip
Area 4a - World-wide including USA, Canada & Caribbean Annual Multi-Trip

Additional Applicants

Name 1

Date of Birth

Name 2

Date of Birth

Name 3

Date of Birth

Name 4

Date of Birth

Name 5

Date of Birth

Name 6

Date of Birth

Definitions

CHILD - the special rate for each child applies only to children under 18 years of age accompanying any adult insured under the same policy. Infants under 2 years of age on the day of departure are insured free provided they are named on the Schedule. For Annual Insurance use the age at the start date of the policy.

COUPLE - two adults under 65, residing at the same address who are married or living together as married.

FAMILY - up to two adults, under 65 residing at the same address who are married or living together as married, with any number of children under 18 normally residing with them and travelling with them.

Cover Details

Travel Starting Date eg. dd/mm/yyyy
Period of travel      

Single Trip Number of Days

Annual Multi-Trip