Business Travel Insurance Plan

Enquiry Form

Name of Proposer

Telehone Number

Fax Number

Occupation

Type/s of Work Undertaken by traveller

Please State Details of Any Manual Work Effected

Business Travel Pattern

Europe
Number of Trips Average Duration

USA/Canada
Number of Trips Average Duration

Elsewhere
Number of Trips Average Duration

Do you wish cover to be extended to include Business trips within the United Kingdom where Air travel or an overnight stay away from home is involved? If so please state.

Number of Trips Average Duration

Do you wish cover to be extended to include Holiday Travel? If so please provide separate Travel Pattern

Number of Trips Average Duration

Do you wish cover to be extended to include Holiday Travel? If so please confirm number of specified employees requiring cover:

Do you wish cover to be extended to include Holiday Trips by Employee Spouse/Partner and Children? If so please state number of persons requiring this extension:

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