Claim Information Request Form

Please remember to notify your tour operator / cruise line / travel agent of cancellation

Note: All required fields are marked as (*).
Travel Protection Plan Information
Name of Travel Plan Purchased *
Plan/Policy Number

Please refer to your description of coverage to locate plan details

Trip Specifics(Refer to travel documents or invoice)
Travel Dates: *
From: *

(example:MM/DD/YYYY)

To: *

(example:MM/DD/YYYY)

 
Date of Loss:

(example:MM/DD/YYYY)

Protection Plan Cost (Per Person)$
Booking Number or Passenger Identification Number
Total Trip Cost (Per Person)$
Destination and/or Ship Name
How many insured travelers incurred a loss for this claim? *