Hastwell Travel & Cruise
Refusal of Travel Insurance Declaration

Refusal of Travel Insurance Declaration

Please complete the Refusal of Travel Insurance Declaration Form. Contact us for more information.

Hastwell - Refusal of Travel Insurance Declaration

Fields marked with an asterisk (*) are required

NOTE: do not fill in this field. It is used to prevent automated unsolicited submission.

Consultant's Name: *

Client Information

Full name as per passport: *

Invoice number: *

Date of departure: *

Email address: *

Please sign after carefully reading this declaration and considering its ramifications:

I have been offered a travel insurance policy by my agent, but have elected to: *

Purchased an alternative policy

Use my credit card policy (which I understand has limitations)

Depart without travel insurance at my own risk

Please read the following: *

I understand that travel insurance would protect me against incurred costs relating but not limited to: • The cost of overseas medical treatment, hospital and related expenses. • Cancellation imposed by transport and accommodation providers. • Loss, damage or theft of my luggage. On this basis, I waiver my right to pursue a claim on the agent’s negligence to offer me travel insurance.

I understand that Hastwell Travel & Cruise reserves the right to charge a service fee at their discretion (minimum $250) for the time providing claim lodgement support.

I acknowledge that this declaration is true and correct, and I make it with the full understanding that I cannot seek reimbursement for a travel emergency with my travel agent.

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Refusal of Travel Insurance Declaration

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