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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.

Please note that we highly recommend travel insurance as protection.

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^*

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Contact Information

First Name^*

Last Name^*

E-mail^*

Address^*

City^*

Phone (night)

Phone (day)^*

Province/State^*

Postal Code^*

Departure Date^*

Signature Information

Signature^*

I decline to purchase any travel insurance plans that my travel agent has offered and explained to me. Date: Feb 12, 2026

You must decline travel insurance to submit this form.