Your Cover Details

Please confirm that you and any additional travellers:

-Are permanent UK residents

-Will depart from and return to the UK

-Are registered with a doctor in the UK

-Are not aware of any reason why a trip would be cancelled or cut short

-Are not travelling for the purposes of having medical treatment

-Have not started a trip

-Are not under investigation for any undiagnosed conditions/symptoms

-Do not have a terminal diagnosis

-You must be an existing member of an eligible membership scheme and remain a member for the duration of the policy.

I can confirm the above is correct

It’s important that you give us complete and accurate information. If you don’t this could affect whether we can offer cover and could result in a claim not being paid.

Select the membership scheme you are part of from the list:

Select your membership scheme

Please provide your membership, employee or pension number:

Policy Type:

Annual Multi-trip

Single Trip

Where are you travelling to?

Please select the region from the list

There is no cover to areas where the Foreign, Development & Commonwealth Office advised against all, or all but essential travel to your destination(s). For current information visit www.gov.uk/foreign-travel-advice.

When should the policy start?

*Start date:

Note - there is no cover in place until the policy starts

Travellers Details:

Single

Couple

Family

Lead Traveller

*Name:

Title

*Date of Birth:

*Mobile Number:

*Email Address:

*Postcode:

Promotional code:

We may from time to time contact you by email or other electronic means to provide you with information in relation to special offers, services and events which may be of interest to you.

Please select how you'd prefer to be contacted, or leave blank if you prefer NOT to receive such information.

Select all

phone

text

post

We need your consent to use the sensitive details about you in connection with your insurance, Where you have provided us details about other people, we and other insurance market participants also need their consent to use the sensitive details about them in connection with your insurance cover. We need you to make sure you have obtained their consent before you proceed.

Please tick to confirm you have read and understand the above statement and are happy to proceed on this basis.

For more information about our service to you and how we will use your information, please read our Terms of Business and our Privacy Policy.