Insurance Waiver

Your travel advisor is obligated to offer you travel insurance. If you choose to waive the travel insurance that they have offered you, please complete the following form.

All fields marked with asterisk* are mandatory

Trip Information

My Travel Advisor^*

Traveler Name^*

Your name should read as stated in your passport

Birthdate^*

Trip Name^* Contact Information

First Name^*

Last Name^*

Home Address^*

City^*

Region^*

Postal Code^*

Phone Day^*

Phone Night

Email^*

I decline to purchase any travel insurance plans that my travel agent has offered and explained to me. Date: Dec 24, 2024

You must decline travel insurance to submit this form.