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Travel Insurance Decline Form; Acceptance of Loss & Risk from Cancellation.

WAIVER OF TRAVEL INSURANCE COVERAGE

Without Travel Insurance you will not be protected for:

• Trip Cancellation or Interruption - to reimburse you for money lost

if you must cancel or interrupt your trip due to sickness; Injury; death or

for other non-medical reasons, such as: terrorist incidents, supplier

bankruptcy or default (for those plans which include this coverage),

cancellation of arrangements by your air carrier, etc.

• Travel Delay - to reimburse you for additional expenses associated

with a travel delay.

• Accident & Sickness Medical Expenses - to cover emergency

medical suspenses incurred while on your trip.

• Emergency Medical Evacuation - to cover the cost of transport

should you require emergency medical treatment when appropriate

care is not available locally.

• Baggage & Baggage Delay - to reimburse you for your lost,

damaged or delayed baggage.

By purchasing a Travel Protection Plan, you will be protecting

not only your well-being, but also your financial investment for your trip,

along with receiving all the other coverages provided. See the Description

of Coverage for details of coverages, benet limits, denitions, claim

procedures and premiums at either Travel Safe or InsureMyTrip.com.


Note: Certain benets (such as the Waiver of Pre-Existing Conditions and

Cancel For Any Reason Benet, on plans including these benets) are time

sensitive and require that the plan is purchased within 21 days of your

initial trip deposit.


No, I am not purchasing a Travel Insurance Plan


I Agree


Name & Date

April 28, 2024


Purchasing the Right Amount of Insurance

Are you using Frequent Flyer points for your tickets? You cannot

insure the value of the tickets because they were earned with points

instead of dollars; however, if you prepay any fees to use the points those

fees are insurable, but you can insure for the cost of a one-way ticket

home, in the event of an interruption. To calculate this, determine the

approximate cost of airfare from the furthest point of your trip to return

home, and add that cost to your prepaid land or cruise fees. This is the

total cost to be insured.

How do I determine how much to insure? You should insure 100% of

the cost of all travel arrangements (include the cost of your airline tickets

if not totally refundable) that are subject to cancellation penalties or

restrictions.


Important - To be eligible for the Cancel For Any Reason Benefit (for

plans including this coverage), you must: 1) pay your premium within 21

days of the date of the initial deposit/payment for your trip; and 2) insure

100% of the cost of all Travel Arrangements that are subject to

cancellation penalties or restrictions.


Do I have to insure the entire cost of my trip? If you insure less than

the total cost of your travel arrangements that are subject to cancellation

penalties or restrictions, the maximum benefit payable will be limited to

the amount of insurance you purchase and you will not be eligible for the

Cancel For Any Reason Benet, if applicable. For example if your trip cost

is $2,085 and you only purchase coverage for $1,500, the maximum

benet payable if you cancel your trip is $1,500.


Important Tip - Travel arrangements which are fully refundable up to

the time of departure do not have to be insured.

Can I insure a voucher or certicate I received for future travel? 

No, vouchers or certicates may not be insured as they have no cash value.


First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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