ONLINE DECLARATION

Booking details

this is a required input
this is a required input
this is a required input
The address of the travel agent?

E-mail address and phone number of the travel agent or travel company?
this is a required input
this is a required input

Details of the insured person

this is a required input

this is a required input
this is a required input
this is a required input
this is a required input
this is a required input
this is a required input
this is a required input
this is a required input

Do you have other insurances that cover these costs such as a credit card or continuous cancellation insurance? this is a required input
this is a required input

Cancellation details

this is a required input
this is a required input
this is a required input
this is a required input
this is a required input
this is a required input

Reason for the cancellation


this is a required input
this is a required input
this is a required input
this is a required input

Person who caused the cancellation

The insured person
this is a required input
this is a required input
this is a required input
this is a required input

Was or is the person hospitalised? this is a required input

this is a required input
this is a required input
If cancelled due to a medical reason, the address of the patient during the recovery period if this is NOT the address of the insured person

Refund

To whom should the refund be made?

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Required documents

To settle a cancellation, we must receive the following documents:

  • Order form/Invoice
  • Cancellation invoice from the travel company mentioning the cancellation fees or any refund/credit notes from the airline for example
  • If cancelled due to a medical reason, the medical questionnaire completed by the doctor (link to the medical questionnaire)
  • For all other reasons, official documentary evidence

Closing statement

Would you like to explain the reason for the cancellation (nature of the illness, circumstances of the accident, reason for dismissal, etc.) at this time?

this is a required input


Overview

Please look over all the details one last time. After that you can print and send the declaration.

1. Booking details














2. Details of the insured person















3. Cancellation details












4. Reason for the cancellation





5. Person who caused the cancellation




From until




6. Refund






7. Required documents

To settle a cancellation, we must receive the following documents:
  • Order form/Invoice
  • Cancellation invoice from the travel company mentioning the cancellation fees or any refund/credit notes from the airline for example
  • If cancelled due to a medical reason, the medical questionnaire completed by the doctor (link to the medical questionnaire)
  • For all other reasons, official documentary evidence

8. Closing statement