Insurance Waiver

Your travel advisor is obligated to offer you travel insurance. If you choose to waive the travel insurance that they have offered you, please complete the following form.

All fields marked with asterisk* are mandatory

Trip Information
Add another Traveler

Your name should read as stated in your passport


Contact Information
Yes, I did receive a travel insurance quote from this agency.

I decline to purchase any travel insurance coverage for the following:
Trip cancellation, Trip interruption and Trip delay.
Emergency medical
Baggage loss, damage and delay, flight and travel accident and rental vehicle damage.