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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

Your name should read as stated in your passport
Your name should read as stated in your passport
Your name should read as stated in your passport
Your name should read as stated in your passport
Your name should read as stated in your passport
Your name should read as stated in your passport

Contact Information

You must decline travel insurance to submit this form.