Multi Trip Travel Insurance

 Travel Insurance

Multi Trip Travel Insurance application - step 1 of 3
Your details (UK Residents Only):
applicant name *
age *
  18 - 70   71 to 76
date of birth *
occupation *
  number of adults  
  1   2
name of spouse  
is your spouse or partner over 70?  
  Yes   No
spouses date of birth   in the format DD/MM/YY
number of dependant children  
  None   1-3   4 5+ Please contact us on 0871 726 1245 for a quotation
 
Your contact details:
address

please include your postcode		 *
email Address *
daytime phone number *
mobile number
do you live in the isle of man?
  Yes   No
 
Your cover details:
date cover to commence *
do you require any extra days winter sports cover?
(14 days are provided as standard) 		 
   
Pre-Existing Medical Conditions For Travel Within U.S.A., Canada or Caribbean
 
Please note that there is no cover under this insurance if at the time of effecting this insurance or booking Your Trip You, Your travelling companions or anyone upon whom Your travel plans may depend:
  1. are expected to give birth within fourteen weeks of the return date of Your Trip
  2. are on a waiting list for in-patient treatment in a hospital or awaiting results of tests  and/or medical investigations
  3. are travelling against the advice of a medical practitioner or for the purpose of obtaining treatment abroad
  4. have received a terminal prognosis
  5. have received medical consultation and/or hospital treatment in the last 12 months for:
    1. a heart or circulatory related condition
    2. a lung or breathing related condition (excluding well controlled asthma)
    3. hypertension (high blood pressure)
    4. any form of cancer
    5. a stroke

Pre-Existing Medical Conditions For Travel OutsideU.S.A., Canada or Caribbean

Please note that there is no cover under this insurance if at the time of effecting this insurance or booking Your Trip You, Your travelling companions or anyone upon whom Your travel plans may depend:

  1. are expected to give birth within fourteen weeks of the return date of Your Trip
  2. are on a waiting list for in-patient treatment in a hospital or awaiting results of tests  and/or medical investigations
  3. are travelling against the advice of a medical practitioner or for the purpose of obtaining treatment abroad
  4. have received a terminal prognosis
  5. have received hospital treatment in the last 12 months for: 
    a) a heart or circulatory related condition
    b) a lung or breathing related condition (excluding well controlled asthma)
    c) any form of cancer
    d) a stroke
please confirm that you have read and understood the pre-existing medical conditons.
*

I confirm that I have read and understood the above pre-existing medical conditions.
   

 

PLEASE NOTE: All insurance policies advertised on this website are applicable only to residents of the United Kingdom.
 Family Travel Insurance Senior Travel Insurance
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