Travel Insurance Enquiry Form *required *Forenames: *Your surname: *Address: *Postcode: *Tel no. *Email address: Single trip   Single trip? Yes No Area visited: UK       Europe     N America     Other If Other please specify       Start date:   Duration of trip:   Multi trip   Annual multi trip? Yes No Areas visited: UK      Europe      N America      Other If Other please specify       Start date:   Length of stay: 14 days 30 day 60 days 90 days     General Questions       Traveller’s age: No.     Under 3 16 - 59 60 - 64 65 - 69 70 - 79 80+ Do you require baggage cover? Yes No Limit £   Will you need winter sports cover? Yes No Are you undertaking any hazardous activities? Yes No If so list below:           NB: This quote form is for leisure trips only, if you need cover for business trips please refer to our web page headed business insurance, fill out the short form and email it to us and we will contact you to discuss suitable cover and terms.

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