• 
  

• Travel Insurance Waiver Form

• 
  
• Booking Confirmation Number*
• Last Name, First Name
• Email
• Phone

  --
• Address

  Street Address 1

  Street Address 2

  City

  State/Province/Region

  Postal/Zip Code

  Country
• I have been advised of and offered Travel Insurance/Trip Protection options by my travel agent.*

  Yes No
• I choose to waive Travel Insurance for this trip.*

  Yes No
• Reason for Waiving Coverage* Select Already Have Coverage Cost of Use Do Not Want Ease of Use
• If already covered, please provider insurer, policy number, insurer phone and address.*
• List all travelers included under this booking confirmation.

  Name	Email	Phone

•