Who is Traveling? * First Name Last Name Date of Birth * Day-Month-Year MM DD YYYY Email * Phone * Country (###) ### #### Which Of Our Partners Are You Traveling With * Where do you need cover? * Worldwide Worldwide ex Canada & USA Australia New Zealand Option Europe What Country Do you Normally Live In? * Are You Already Traveling? * Please note if you are already travelling, you MUST select this option otherwise your Policy is not valid. No Yes, We can offer travel insurance for you if you've left home and already travelling but only on the strict understanding that nothing has already happened which has led to a claim or may lead to a potential claim. Choose Your Travel Start Date * MM DD YYYY Choose Your Travel End Date * MM DD YYYY Do You Require Coverage For Adventure Sport * Inc Rock-climbing, Mountaineering to 6,000M with (with ropes, picks or specialist climbing equipment) etc No Yes Do You Require Coverage For Snow Sports * Please select this option if you will be skiing or snowboarding on your trip. No Yes Thank you! Travel Insurance
