Cancellation and Amendment Fees

Overseas Medical, Emergency Dental, Hospital and/or Other Expenses relating to a medical incident and/or Expenses incurred due to Cutting Your Trip Short

Loss, theft or damage to your Luggage (including Delayed Luggage), Valuables, Cash, Credit Cards and/or Documents

Travel Delay Expenses

Rental Vehicle Insurance Excess

Personal Liability

Costs incurred due to Catastrophe

Additional Expenses incurred or any other incident not outlined above

Description

I/We have completed the Claim form and declare it to be true and accurate and am enclosing the documents as requested to support this claim. I subrogate to my Insurer all rights of recovery/salvage against any person or organization and will do whatever else is necessary to secure such rights. With regards to any MEDICAL, CURTAILMENT & EMERGENCY CLAIMS I give authority to Insurers or their representatives to contact my Doctor if need be, for any additional medical information required in connection with this claim. I authorise any hospital, physician or other person who attended me, to give my travel insurance company or its representative, any, or all information, with respect to any sickness or injury, medical history, consultation, prescription, or treatment, and copies of all hospital or medical records.

I/We have the consent of each person who is insured on this Policy and making a claim in relation to this event (if they have been included in this claim form) for settlement monies to be transferred into the above account.

I/We acknowledge that payment of any unpaid accounts will be issued to the provider.

I/We understand that an excess/excesses may apply to my claim as stated in my PDS.

* Please consult your PDS for the privacy statement of your insurer.