• Date of Birth*
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  • Departure Date*
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  • Return Date*
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  • Have you or any of your co-travelers ever suffered or are you/they suffering from any medical condition, disease, physical disorder or disability?*
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  • Important Notes:

    1. Please note that this form is for quotation purposes only. If you wish to proceed with a contractual agreement you will be required to submit a proposal form. 2. Our quotation will be based on the information you have submitted, therefore, any alterations and/or misleading information, will cause a revision to the quotation accordingly. 3. We have collected only personal data you have voluntarily provided to us and which are processed solely for the purpose of risk assessment and preparation of this quotation.Where additional information is sought, you will be informed at the time of the data collection. If we do not conclude with a contract any personal data collected will be destroyed immediately. However, in case that you choose us for your policy, we are obliged by law to retain your personal data for a period of at least 13 (thirteen) years after termination.
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