Insurance Declaration

Travel Insurance Customer Declaration Form
Hays Travel Limited is an Appointed Representative of Rush Insurance Services Limited, who are authorised and regulated by the Financial Conduct Authority for the sale of General Insurance. (Firm Reference Number 714385) Your insurance is underwritten by AWP P&C SA and administered in the UK by Allianz Global Assistance. Allianz Global Assistance is a trading name of AWP Assistance UK Ltd.
You can check the status of all the companies on the FCA website – https://register.fca.org.uk
Please read the following and sign at the bottom to confirm acceptance. It is your responsibility to provide complete and accurate information to insurers when you take out the insurance policy and to notify any changes in your health or medication between booking and travel.
1. I have been provided with a copy of the policy wording. I have read and understood the Conditions and General Exclusions stated within the policy wording, both on my own account and on behalf of the other insured persons on the policy.
2. I am aware that my insurance provides cover for before I travel and also covers risks from when I leave home. I accept that, if circumstances change, the insurer may change the terms of the travel policy covering the travel risks.
3. You will not be covered for any directly or indirectly related claims (see note at the end of this section) arising from the following if in the 12 months before taking out this insurance or booking your journey (whichever is later), you:
• have been prescribed medication;
• have received treatment or attended a medical practitioner for any medical condition;
• have attended a hospital or a clinic as an out-patient or in-patient;
• have been referred for tests, investigations, treatment, surgery or are awaiting results.
• have been diagnosed as having a terminal illness.
Unless you have declared any existing medical conditions to us and we have confirmed cover in writing.
• You will not be covered unless you are fit to travel and able to undertake your planned journey. • You will not be covered if you travel against the advice of a doctor or where you would have been advised not to travel if you had sought their advice before beginning your journey.
• You will not be covered if you know you will need medical treatment or consultation at any medical facility during your journey.
• You will not be covered if you had any undiagnosed symptoms for which you were awaiting investigations or consultations or the results of investigations and where the underlying cause had not been established. • You will not be covered if you are travelling specifically for the purpose of obtaining and / or receiving any elective surgery, procedure or hospital treatment.
• If we are unable to cover a medical condition, this will mean that any other person insured by us will not be able to make a claim arising from the medical condition(s). This may even apply if the person with the medical condition(s) purchases cover from another provider.
4. I am aware that, after buying my policy, I should notify the insurance company of any changes in my health or medication or that of anyone who is travelling with me as this may affect my continuing cover.
5. I understand and accept that there is no cover provided for cancellation or curtailment where the claim is caused by any pre-existing health condition of a close relative or close business associate who is not travelling.
6. I understand that, if I have purchased an annual multi-trip policy, I am not covered at all if the trip is more than 31 days in duration.