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

Trip Name^*

Traveler 1 Name^*

Your name should read as stated in your passport

Birthdate^*

Traveler 2 Name^*

Your name should read as stated in your passport

Birthdate^*

Traveler 3 Name^*

Your name should read as stated in your passport

Birthdate^*

Traveler 4 Name^*

Your name should read as stated in your passport

Birthdate^*

Traveler 5 Name^*

Your name should read as stated in your passport

Birthdate^*

Traveler 2 Name^*

Your name should read as stated in your passport

Traveler 6 Name^*

+ Add Traveler - Remove Traveler

Contact Information

First Name^*

Last Name^*

E-mail^*

Address^*

City^*

Phone (night)

Phone (day)^*

Province/State^*

Postal Code^*

Signature Information

Signature^*

I decline to purchase any travel insurance plans that my travel agent has offered and explained to me. Date: Dec 24, 2024

You must decline travel insurance to submit this form.

Now working from my home office. Please contact me at 4126.499.9980 or doreen.rich@visiontravel.ca