Travel Insurance Quote Request Form

Travel Insurance Quote Request Form
It is the policy of the Travel Curio to offer travel insurance. For this reason I require the completion of this form for a quote. Travel insurance must be selected before on or before the final payment is madee towards your trip. for It is important to note a Cancel for Any Reason plan (CFAR) are only available within 10 days of booking a trip.
Name

First NameLast Name
E-mail
example@example.com
Date of Birth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
State of Residence*
A client(s) state of residency is factored into insurance costs.
Additional Traveler
Name

First NameLast Name
Date

MonthDayYear
Date of Birth
Trip Details
Destination(s)*
Initial Deposit Date*

MonthDayYear
Date
Total Trip Cost*
If you have a land only package but would like to include airfare, include it here.
Trip Return Date*

MonthDayYear
Date
Trip Departure Date*

MonthDayYear
Date
Additional Comments
Feel free to include information such as if you're requesting coverage for airfare purchased outside of a land package.
The Benefits of Travel Protection Insurance
Emergencies can happen when you least expect it. I highly recommend that you protect your vacation with a travel insurance policy.  The cruise lines, airlines, hotels and tour operators all charge high penalties for cancellation, ranging from the full deposit to no refund at all. Another important fact to keep in mind is that that most health insurance policies will not cover you when you are out of the country. Your Travel Insurance will protect you in the following areas:

Trip Cancellation   Trip Delay   Trip Interruption   Missed Connection

Baggage LossTheft or Damage   Baggage Delay

Emergency Medical and Dental Expenses Emergency Medical Transportation

24/7 Hotline Assistance

Please also note that in order for you to benefit from pre-existing coverage your policy must be purchased before final payment. There is no added cost to the policy for pre-existing coverage.

It is also important to understand that you do NOT have coverage until you have an active policy. Pre-existing coverage will not apply to world events such as strikes, natural disasters, terrorism etc.

Please understand that I am not a registered insurance agent, and can not legally provide specific advice or information regarding insurance. For additional information, I will provide contact for the preferred provider, Allianz.

Your quote will be sent in a separate e-mail.
Should be Empty:

Travel Insurance Quote Request Form

Additional Traveler

Trip Details