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Pre-contractual duty of disclosure

You must answer all questions contained in this application form honestly and with reasonable care. Failure to do so may result in your policy being cancelled or we may refuse to deal with any claims or reduce the amount of a claim payment, as detailed under the Impact of Misrepresentation section, which you should read carefully .
The answers you provide are the basis upon which an insurance cover quotation will be offered or refused.
Warning
If you are not in a position to answer all of the questions asked of you in this cover application process, honestly and with reasonable care, then you should not proceed with your insurance quotation request.
Completed Application Form
If you decide to purchase cover and once your contract of insurance has been concluded with Europe S.A. (AIG) , you will be provided with a copy of your completed insurance cover application form, either on paper or another durable medium.

Impact of Misrepresentation Section. Please read this section carefully.

The Impact of Misrepresentation by you, is as follows:

(a) Innocent Misrepresentation:
Where you have answered all questions in your application form honestly and with reasonable care but where you made an innocent misrepresentation (that is, one that is neither negligent nor fraudulent) we will pay any covered claim event subject to the terms and conditions of your policy.

(b) Negligent Misrepresentation: If you make a negligent misrepresentation or fail to take reasonable care in completing your application form your cover may not fully operate and in the event of a claim, we will exercise one of the following remedies:
- (a) If knowing the full details, we would not have entered into the insurance contract, we may avoid the contract, refuse all claims and return any premiums paid by you.
- (b) If we would have entered into the insurance contract, but on different terms (excluding terms relating to the premium), the contract may be treated as if it had been entered into on those terms.
- (c) If we would have entered into the insurance contract but have charged a higher premium, we may reduce proportionately the amount to be paid on your claim.
- (d) Where there is no outstanding claim under the insurance contract, we may either:
  (i) give notice to you that in the event of a claim we will exercise the remedies in paragraphs (a) to (c), or
  (ii) terminate the contract by giving reasonable notice to you.

(c) Fraudulent Misrepresentation: If you make a fraudulent misrepresentation or where any conduct by you involves fraud of any kind, we shall be entitled to avoid the contract of insurance and refuse any claims.

1. Your Details
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Title

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First Name

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Surname

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Email Address

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Contact Number

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2. Travel Details
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Type of insurance

* What type of Insurance would you like.

Where are you traveling to

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When should your cover start

* Cover start day required

* Cover start month required

* Cover start year required

What is your return date

* Cover end day required

* Cover end month required

* Cover end year required

Who is travelling

* Who is travelling

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