Travelteer – Travel Insurance Application
We have partnered with Banner Financial Services* to provide a travel insurance policy that covers participants for all authorised projects and activities undertaken with Travelteer in accordance with the terms and conditions of the policy.
Travel Insurance Application
I can confirm:
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Travel Dates
Dates of Travel
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Medical Declaration
Q1) Medical Declaration
Have you:
• Been diagnosed with a terminal condition?
• Had any cardiovascular problems, or any other heart condition, hypertension or any cerebrovascular problems that have occurred at any time before commencement of this trip?
• Any other medical condition that is ongoing or from which you have suffered symptoms that have required inpatient treatment (hospital admission)?
Have you:
• Been diagnosed with a terminal condition?
• Had any cardiovascular problems, or any other heart condition, hypertension or any cerebrovascular problems that have occurred at any time before commencement of this trip?
• Any other medical condition that is ongoing or from which you have suffered symptoms that have required inpatient treatment (hospital admission)?
Q2) Medical Declaration
Are you:
• Travelling against medical advice?
• Travelling with the purpose of seeking medical treatment?
Are you:
• Travelling against medical advice?
• Travelling with the purpose of seeking medical treatment?
Q3) Medical Declaration
During the 2 years prior to the commencement of cover under this policy have you:
• Been referred for any treatment surgery, investigations or follow-ups at any hospital, surgery?
• Required inpatient treatment (hospital admission) for any of the following conditions – Asthma, Bronchitis, any other lung or respiratory condition, cancer, any growth or form of malignancy, diabetes mellitus, epilepsy or fits, any kidney or bladder disorder, any mental or physiological condition?
During the 2 years prior to the commencement of cover under this policy have you:
• Been referred for any treatment surgery, investigations or follow-ups at any hospital, surgery?
• Required inpatient treatment (hospital admission) for any of the following conditions – Asthma, Bronchitis, any other lung or respiratory condition, cancer, any growth or form of malignancy, diabetes mellitus, epilepsy or fits, any kidney or bladder disorder, any mental or physiological condition?
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Your Details
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Your Premium
The total price is :
Declaration
I declare that the above answers to my knowledge and belief are true and complete in every respect and that no material fact has been suppressed or withheld. I understand that any change in information must be notified immediately and no cover exists until such change has been approved by the insurers.
Please note: Cover does not start until the application has been received and accepted by Banner Financial Services.
We will contact you by email to confirm we have received and accepted your application.
Confirmation
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Have a Question?
If you need help with your travel insurance quote then please call us on
between 8.30am and 5.30pm Mon – Fri
or email us using this contact form
*Banner Financial Services is a trading name of Harrison Beaumont Insurance Services Ltd who are authorised and regulated by the Financial Conduct Authority, registration number 303968. Registered address is Pond Hall, Pond Hall Road, Hadleigh, Suffolk, IP7 5PP. Registered in England and Wales, Registration number 4582221. Travelteer Limited is an Introducer Appointed Representative under Harrison Beaumont Insurance Services Limited.
