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Refusal of Travel Insurance Declaration
Refusal of Travel Insurance Declaration
Please complete the Refusal of Travel Insurance Declaration Form. Contact us for more information.
Hastwell - Refusal of Travel Insurance Declaration
Fields marked with an asterisk (
*
) are required
NOTE: do not fill in this field. It is used to prevent automated unsolicited submission.
Consultant's Name:
*
Please select your consultant
Elizabeth Johns
Sarah Brown
Trinity Hastwell
Vanessa Pellaschiar
Meredith Symonds
Julie Green
Client Information
Full name as per passport:
*
Invoice number:
*
Date of departure:
*
Email address:
*
Please sign after carefully reading this declaration and considering its ramifications:
I have been offered a travel insurance policy by my agent, but have elected to:
*
I have been offered a travel insurance policy by my agent, but have elected to:
*
Purchased an alternative policy
Use my credit card policy (which I understand has limitations)
Depart without travel insurance at my own risk
Please read the following:
*
Please read the following:
*
I understand that travel insurance would protect me against incurred costs relating but not limited to: • The cost of overseas medical treatment, hospital and related expenses. • Cancellation imposed by transport and accommodation providers. • Loss, damage or theft of my luggage. On this basis, I waiver my right to pursue a claim on the agent’s negligence to offer me travel insurance.
I understand that Hastwell Travel & Cruise reserves the right to charge a service fee at their discretion (minimum $250) for the time providing claim lodgement support.
I acknowledge that this declaration is true and correct, and I make it with the full understanding that I cannot seek reimbursement for a travel emergency with my travel agent.
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