Insurance form

Please complete the form below as soon as possible after you have booked your trip.
You are advised to arrange travel insurance as soon as you book to cover you in case you have to cancel.

It is a condition of booking that you have adequate medical and travel insurance for your trip.
Your insurance must cover you for:
• the entire period of your travel away from home.
• the activities and the altitude involved in the trip.
• helicopter rescue and repatriation.
• You should also notify the insurance company of all pre-existing medical conditions.

Please note that many insurance companies do not cover these requirements. There are a few insurance companies that specialise in insurance policies suitable for trekking expeditions. If your current travel insurance company cannot provide you with a suitable policy, please contact us for further information.

We recommend that you also have insurance for cancellation and personal baggage

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To complete this form you will need:
• the dates of your trip
• the contact details of the person you would want us to contact in event of an emergency (typically your next of kin)
• the contact and policy details of your insurance company

If you prefer to submit this form by printing it off, scanning or photographing it and emailing it back to us, there is a printed version here.

Insurance and Emergency Contact Details Form

Name*
First Last
Your email address*
Trip Title*
Land-only trip start date*
DD slash MM slash YYYY
Land-only trip end date*
DD slash MM slash YYYY
Are there other people on the same booking with identical insurance and emergency contact information?*
- Yes
- No
Names of other people on the same booking with identical insurance and emergency contact details (click on + sign to add another name)
Contact details of the person you would like us to contact in an emergency
Their Name*
First Last
Their relationship to you*
Their email address*
Their telephone (mobile) - include country code*
Their telephone (daytime) - include country code*
Their telephone (evening) - include country code*
Insurance Information
Insurance company*
Insurance policy number*
Insurance company general telephone number - include country code*
Insurance company emergency international assistance telephone number - include country code*
I confirm that I have checked that this insurance covers me for*
- (1) the entire period of my travel away from home, (2) the activities and altitude involved in the trip and (3) for helicopter rescue and repatriation. (4) I have also notified my insurance company of all my pre-existing medical conditions
Form Submission Conditions*
- By submitting this form I am signing to say that I understand that responsibility for the payment of all bills incurred for rescue and repatriation, or for the alteration of an itinerary lies ultimately with myself, the client, in the event of the insurance company not paying for them. I am responsible for ensuring that these payments are made as outlined in the Booking Conditions.

email:	info@trekmountains.com
tel:	+44 (0) 7713 628763

Insurance and Emergency Contact Details Form

Contact details of the person you would like us to contact in an emergency

Insurance Information

Contact Details

Postal Address