Can
you agree with the medical declaration found Here ?
I have read and can comply with the declaration
I have read but cannot comply with the
declaration - I have not contacted medical screening
I have read but cannot comply with the
declaration. I have contacted and accepted medical
screenings results
I have not read the declaration, but
have made a full disclosre of ALL medical conditions
below
The policy to which the declaration applies is
not suitable for me
Your name
E-mail address
Address line 1
Address line 2
City
State/County
Country
Post code
Age
Telephone No.
Policy Type
Please Select
Standard Holiday Insurance
Winter Sports Holiday Insurance
Annual travel insurance policy
Long Stay Travel Insurance Policy
Quality Insurance Policy - single trip
Quality Insurance - annual trip
Travel Details - single Departure Date :
No
On Piste Only
Off Piste
Other - details needed
Travel Details - annual Max days / trip
No
On Piste Only
Off Piste
Other - details needed
You Age
Partner Age
Child Age
Child Age
Child Age
Child Age
Countries Visiting
Excess What is the preferred policy
excess?
Select
£100
£75.00
£65.00
£50.00
£40.00
£35.00
£30.00
NIL
Cancellation cover What cancellation cover do
you need?
Select
£1000
£1500
£2000
£2500
£3000
£4000
£5000
NIL
(per person)
Medical expenses What medical expenses cover
is needed?
Select
£1,000,000
£2,000,000
£3,000,000
£4,000,000
£5,000,000
£10,000,000
NIL
We offer a fair market analysis
and will provide you with a quote matching your selected
options if possible or explain why we cannot do so.
Even
if you have read and accepted the declaration, you must
still provide us with full details of medical conditions
and names/ dosages of all medicines taken and other
treatment undertaken.
Details of all material facts
about your holiday including info on medical conditions,
hazardous activities, whether any work involved and if so
what type. Also medical conditions of close relatives.
Any other demands and needs?
