I/We, the undersigned, hereby decline travel insurance for the trip detailed above. I/We
acknowledge and understand the following:
1. Voluntary DecisionThis is my/our voluntary decision. I/We have been informed of the availability of travel insurance and have been provided with or offered the opportunity to review insurance options.
2. Financial Risk AcceptanceI/We accept full financial responsibility for all losses that may occur, including but not limited to: trip cancellation penalties, medical expenses abroad, emergency evacuation costs, baggage losses, and travel delays. I/We understand that these costs can be substantial.
3. Cancellation PenaltiesI/We understand that if I/we cancel my/our trip for any reason
— including illness, family emergency, or unforeseen circumstances — I/we will be
subject to the full cancellation penalties outlined in the Cancellation Policy I/we have received, and no refund may be available.
4. Medical CoverageI/We understand that my/our domestic health insurance (if
applicable) may provide limited or no coverage for medical treatment outside the United States. I/We accept responsibility for any medical costs incurred during international travel.
5. Emergency EvacuationI/We understand that emergency medical evacuation from a foreign country can cost tens of thousands of dollars and that I/we will be personally responsible for these costs without insurance coverage.
6. No Agent LiabilityI/We agree that [AGENT NAME / BUSINESS NAME] and
Cornerstone Collective shall have no liability for any financial losses, medical expenses, or other costs that could have been covered by travel insurance that I/we chose to decline.
7. Opportunity to ReconsiderI/We understand that I/we may reconsider and purchase travel insurance at any time prior to departure, though some benefits (such as pre-existing condition waivers and CFAR coverage) are only available within a limited window after initial deposit. Agent can assist with a quote at any time.