HOLIDAY SERVICES Ltd
REF MS Proposal Form. Important - Please contact Mike on 01773 - 769406 ( 01773 - 747426 ) for details of Premiums and Current Information about this Scheme if you have not already done so.
Travel Master Scheme Only ( Single Trip )
HOLIDAY SERVICES - TRAVEL MASTER SCHEME. UK Residents Only, no one way trips.
This form is valid for applications up to 31/08/09 for trips completed by 31/08/10. Travelmaster Scheme Single Trip
Please complete this form completing all details as required. NB All ages are as on start date of your trip.
Mr/Mrs/Miss First Christian Name Surname Date of Birth Age on Ms/Title date of departure
........... ............................... .............................................. ................... ............
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My Trip Starts On .........................................
Date of Return Landing in UK ........................................
Number of days cover req. ( include date of return landing in UK ) ...............
Length of Holiday, please tick relevant box -
[ ] 1-5 days [ ] 6-10 days [ ] 11-17 days [ ] 18-24 days [ ] 25-31 days [ ]
Longer Periods, number of days req. including date of return landing in the UK -
.............. days
Area(s) you are covered for, please tick the relevant box(es) -
[ ] UK [ ] CI/IOM/Ireland [ ] Europe [ ] USA/Canada/Caribbean/Mexico
[ ] Rest of the World [ ] Aus/New Zealand * NB Stopover rules for Aus/NZ
Actual Destination(s) .......................................................................................................
Single Applicant Charge ( payable if only one person insuring ) ADD £2 to all premiums
YES [ ] No [ ]
Optional Extra Cover - Excess Waiver [ ] Winter Sports ( Double Premium ) [ ]
Premium Due £ ...................
Healthcheck Reference Number ( if applicable ) ....................................................
NB You will need to pay Healthcheck the extra amount to cover your medical condition(s) before completing
this form. Please enter the ref. number given to you by Healthcheck above ( this begins with MG etc )
All members of my party understand that they must read and be able to comply with the policy wording on receipt of the policy and have been advised to read the brochure/key facts as enclosed or on the website. There is a 14 day money back guarantee if this insurance does not fit your needs.
I enclose cheque payable to Holiday Services Ltd for £ .................... Print off this form and send to -
Holiday Services, 2 Kedleston Close, Huthwaite, Nottingham NG17 2SE
Name ..............................................................................
Address ............................................................................................................................................
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Post Code ............................. Tel ...........................................
Signature ( must be over 18 ) ................................................................
Date ...................................
Policies issued by Holiday Services Ltd who are authorised by the Financial Services Authority, Firm Ref. No. 309833. Your policy is issued subject to the full policy wording enclosed with your validation certificate. Please read this when you receive your policy documents from Holiday Services Ltd as you have a 14 day refund guarantee . The insurance is issued on the basis of the information supplied on the form and no responsibility can be accepted for information incorrectly supplied.