Travel Insurance Disclaimer Form

Travel Insurance Disclaimer Form
Travel Insurance

Goldgell Getaways strives to create the perfect vacation for you & your family, however sometimes outside events happen that out of our control. Some suppliers can impose penalties even if travel is cancelled due to illness or emergency.

Trip Insurance is strongly recommended by Goldgell Getaways to protect you, our client, from certain situations that could cause your trip to be cancelled, interrupted, and/or delayed resulting from monies and time lost.

*Please note: The supplier will only allow travel insurance to be added to your vacation package BEFORE your final payment is made.
I, the client, understand the cancellation/amendment policies of the vendor/supplier's travel package I just purchased. I agree to pay all charges, fees, or penalties, and hereby hold Goldgell Getaways free of any claims made as a result of the changes/cancellation of this travel reservation due to waiving travel insurance offered to me.
Please Choose One

I would like to hear more about travel insurance.It is to my understanding that I have trip insurance already added to my reservation.I hereby waive trip insurance. I understand that Goldgell Getaways will be held free of any charges, fees or penalties made as part of this decision.
By typing and signing your name below, you are agreeing to the above terms, and your insurance selection.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail*
Your Agent's Name

First NameLast Name
Reservation Number
Trip Start Date:

MonthDayYear
Date
Trip End Date:

MonthDayYear
Date
Complete E-Signature
Today's date:*

MonthDayYear
We are partnered with Travelex, Allianz, and CHUBB Travel Insurance. So if you decide to add travel insurance AFTER your trip is paid in full, and more than 14 days prior to your travel dates, there is still an option to purchase an insurance package.
Please select one

AllianzChubbTravelexPlease choose for me
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