Travel Proposal Name (Mr/Mrs/Miss/Ms)(Of First Applicant) Surname: Email: Date of Birth: ID Card No. Cover: Budget Economy Club Address: NAME OF FIRST APPLICANTS Date of birth I.D. Card No Cover Additional Limit Lm Address of First Applicant NAME OF OTHER APPLICANTS Date of birth I.D. Card No Cover Additional Limit Lm Do any of the applicants to be insured suffer from any medical condition? (please refer to Health warranty) Destination Territorial Limits:*Area Duration of Holiday(maximum period of 90days) 1. for days from // // to // // 2. Premium LM Document Duty LM 3. Tick the box if Winter Sports cover is required Total LM Confirm you have read and agree to the data protection policy
Do any of the applicants to be insured suffer from any medical condition? (please refer to Health warranty)
