Travel quote form-M-



Welcome to Emsons Travel Quotation Form

Please note this form is for submitting details of your insurance risk to us. It does not in turn provide you with any automatic quotation or any cover. Any quotation that we subsequently offer on the basis of information that you have supplied will be confirmed to you by post or telephone. NO COVER will be in force unless we notify you. We may require additional information from you in order to prepare a quotation in which case you will be notified in writing, by email or post. Any quotation request you have submitted will be verified with you prior to any contract coming into force.
Please answer all questions. There is a submit button at the end of the form to mail it to us.
You will automatically be sent a copy of the form by e-mail, but if you wish to print it before sending, please press CTRL + P before submitting the form
Please complete the sections as directed
Wherever you see this means that there is further information to view from our technical archive.
Any quotation submitted to Emsons will be verified with the Client before any cover is granted or any liability to pay any premium is incurred. Any policy that this quotation form may apply to is written under UK Jurisdiction.

Section 1 - General Information

Name
Address

Telephone Number:
Full Names of Persons Travelling:

If under 18 or over 65, please state name and ages


Section 2 - Travel Information

Dates of Travel:
Location(s)

Are you travelling by motor car?	YesNo If yes, please provide registration number:
Do you require additional vehicle breakdown cover?	YesNo

Do you require the 'Winter Sports' extension?	YesNo

Does any person travelling have any prior medical conditions?	YesNo If yes, please indicate who and give details of condition:

Is any person who is travelling pregnant?	YesNo If yes, please advise who and when the baby is due to be born:

In the event of your travelling abroad more than 3 times a year, an annual policy may offer you an overall premium advantage
Would you like a quotation for annual travel insurance	YesNo


You will be forwarded a copy of this form by e-mail. Please enter your address below
E-mail address

IMPORTANT : You must have read and accepted the terms and conditions of the Declaration that accompanies this proposal - click here to view the terms - CLICK

Have you read and understood the terms of the Declaration?	Yes No

IMPORTANT : You must have read and accepted the terms and conditions of the Data Protection clause that accompanies this proposal - click here to view the terms - CLICK


Have you read and understood the terms of the Declaration?	Yes No

Upon receipt of your e-mail a response will be given within 1 working day at the most.