Travel Insurance Waiver

Primary Travelers Name *
Primary Travelers Name
Date of Departure
Date of Departure
The departure date for the trip for which you are declining coverage
PLEASE READ THIS INFORMATION CAREFULLY Without Travel Insurance you will not be protected for: Trip Cancellation or Interruption - to reimburse you for money lost if you must cancel or interrupt your trip due to sickness; Injury; death or for other non-medical reasons, such as: terrorist incidents, supplier bankruptcy or default (for those plans which include this coverage), cancellation of arrangements by your air carrier, etc. Travel Delay - to reimburse you for additional expenses associated with a travel delay. Accident & Sickness Medical Expenses - to cover emergency medical expenses incurred while on your trip. Emergency Medical Evacuation - to cover the cost of transport should you require emergency medical treatment when appropriate care is not available locally. Baggage & Baggage Delay - to reimburse you for your lost, damaged or delayed baggage. By purchasing a Travel Protection Plan, you will be protecting not only your well-being, but also your financial investment for your trip, along with receiving all the other coverages provided. Note: Certain benefits (such as the Waiver of Pre-Existing Conditions and Cancel For Any Reason Benefit, on plans including these benefits) are time sensitive and require that the plan is purchased within 14 days of your initial trip deposit.
At this time, I choose to decline the recommend Travel Protection Insurance
Today's Date
Today's Date