| Travel Insurance for Groups (and Individuals travelling to join a group) in UK, Europe or Worldwide other than the USA, Canada or the Caribbean |
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| If you are able to answer yes to the following 5 questions, you can obtain a quote and request cover on-line. All references to You or Your applies to You and any other person to be insured on this policy. Please click the links for more information. |
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| You are a UK resident |
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| Your travel is in more than 4 days time |
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| You have no Pre-Existing Medical Conditions for which you require cover |
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| You do not require cover for winter sports outside of the UK (ex CI) |
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| You are an organised group or an individual |
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| If you have answered No to any of the above questions, please click here to progress |
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| Please select the area to which you are travelling |
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| Are you participating in any hazardous activities |
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| Please click this link to select the level of activity undertaken. If your activity is not shown, please contact us on 0208 651 7420. |
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| How many adults aged between 18 and 69 are travelling? |
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| How many adults aged between 70 and 74 are travelling? |
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| How many adults aged between 75 and 110 are travelling? |
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| How many children aged 3 and under are travelling? |
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| How many children between 4 and 18 are travelling? |
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| What date do you start the travel? |
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dd/mm/yyyy |
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| What date do you return from your travel? |
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dd/mm/yyyy |
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| Premium including Insurance Premium Tax: |
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| Person(s) travelling: |
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| If you wish to proceed, please complete the rest of the information below and enter submit. If you wish to contact us at any time, please call us on 020 8651 7420. By completing the form you confirm that all the statements made on this form are correct and that you have read the Summary of Cover which notes the principal terms and significant exclusions of this policy. |
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| Name of Policyholder (title first name and last name): |
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| Please confirm your address for correspondence: |
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| Your Post Code: |
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| Your Telephone Number: |
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| Your E-mail address: |
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| Where will you be staying? |
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| Names and dates of birth of people travelling (separate with a comma): |
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| e.g. Sarah Smith 11/07/1970, Anthony Smith 14/12/1969, Joanne Smith 18/3/1993 |
| (or submit a list by e-mail to our underwriters - freetime@accessunderwriting.co.uk) |
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| Premium payment method: |
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| Name of Person completing this statement of fact: |
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| Position of Person completing this statement of fact: |
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| I have read the declaration and statements and notes below: |
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| Declaration |
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1. I declare the answers given to the questions asked are true and complete to the best of my knowledge and belief.
2. I understand that failure to do so could invalidate this insurance.
3. I agree that the details provided shall be the basis of the contract of insurance.
4. I also declare that I and all persons to be insured have read the Summary of Cover, Policy Wording, and about our insurance services document.
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| Statement of Demands and Needs |
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Freetime Travel Insurance is typically suitable for those who wish to insure themselves or groups when travelling for: cancellation charges, delayed departure, personal possessions, baggage delay, personal money & documents, emergency medical expenses, State hospital benefit, curtailment costs, personal liability, personal accident, organisers liability and legal expenses and activities and (optionally) hazardous pursuits.
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| Special Notes |
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Access Underwriting Ltd has not provided you with any recommendation or advice about whether this product fulfils your specific insurance requirements. You will need to make your own choice about how to proceed.
You may already possess alternative insurance(s) for some or all of the features and benefits provided by this product. It is your responsibility to investigate this.
We reserve the right to ask for special terms or decline this Statement of Fact. A copy of this Statement of Fact will be supplied by us when we issue the policy.
You should keep a record (including copies of letters) of all information supplied to us for the purposes of entering into a contract of insurance.
Any policy issued as a result of this Statement of Fact will be governed solely by the relevant laws relating to your postal address, provided that address is within England, Wales, Scotland, Northern Ireland, the Channel Islands or the Isle of Man. If there is any dispute as to which law applies, it shall be English Law.
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| Data Protection Act – Use of your information |
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For the purposes for the Data Protection Act 1998 the data controller in relation to the information you supply for this insurance is Travel Insurance Facilities Plc. As a data subject you have the right under the Act to ask your Data Controller for a copy of personal data you have supplied and ask for inaccurate data to be corrected. Information you supply is used for purposes of administration by the insurer and its agents, by re-insurers and your intermediary. It may also be made available to regulators and ombudsmen as necessary. In deciding whether to offer insurance, its terms or assessing claims made, insurers may undertake checks against publicly available information such as electoral roll, county court judgements, bankruptcy or repossessions. Information may also be shared with other insurers either directly or via those acting for the insurer such as loss adjusters or investigators.
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