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Travel Insurance Application Form - Wrightsure Services (Hampshire) Ltd

Please complete this form.

Lead Travellers Details

Cover & Premium Summary

Additional Travellers to be insured

Declaration

Health Conditions Exclusion


We shall not be liable for claims where at the time of taking out this policy:

  1. You are aware of any Medical Condition or set of circumstances that could reasonably be expected to give rise to a claim.
  2. You:
    1. Are receiving, or on a waiting list for, surgery, in-patient treatment or investigations in a hospital, clinic or nursing home.
    2. Are travelling against any health requirements stipulated by the carrier, their handling agents or other Public Transport Provider.
    3. Are travelling against the advice of a Healthcare Practitioner or for the purpose of obtaining medical treatment abroad.
    4. Have been given a terminal prognosis.

Please note: If You are on medication at the time of travel, Your medical condition(s) must be stable and well controlled.

Please tick box to confirm and then click SUBMIT FORM below

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