B.A.G. Travel / InteleTravel - Travel Insurance Waiver

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Terms and Conditions*
I have been offered and advised of Travel Protection / Trip Insurance options and fees by my travel agent, Michael Henderson of B.A.G. Travel / InteleTravel.

I will also make my own provisions in the event of an emergency while I am traveling.
List price of insurance/Provider
*Example: IMG, Carnival Vacation Protection, Aliianz, AIG, etc
Do you have your own travel insurance?
If yes, list Travel Protection Provider and policy number below:
If No, please state your Reason for the Decline of Travel Protection:
Departure

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Return

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Booking/Confirmation#
Total Trip Cost
I decline the offer to purchase travel protection / trip insurance. I understand that I am solely responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own separate travel, medical and any other provisions in the event of an emergency while I am traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier or any travel-related operator default. This waiver confirms that I voluntarily decline travel insurance and travel protection insurance for the trip described above. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply, and I hereby release B.A.G Travel, and its host agency: InteleTravel, from any and all liability related to the trip described above.
List of Travelers that also decline Travel Protection
I have read this document. I understand this document and all consequences resulting from my decision to purchase or decline trip protection and trip insurance.
Date

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Date
Signature

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