Aussietravelcover
 
Aussietravelcover
 Please note all premium amounts are in Australian dollars.
 To effect this travel insurance policy you must read the:
   Combined Financial Services Guide, Product Disclosure Statement and Policy Wording
1. Traveller information
Surname * First Name * Title *  DOB
 Traveller 1  
 Traveller 2  N/A
* Mandatory Fields
  TRAVELLERS 71 YEARS AND OVER
Traveller 1 Traveller 2
 Approval No 81 Years and Over
 Departure Date  Return Date  
2. Agency your travel document(s) have been booked through.
If your travel agency is on the following list please select from the box provided, otherwise select the No option box.
Agent
NO
3. Personal details
Address * Suburb * State *
Postcode / Zip * Country *
Home Telephone No. * Work Telephone No. Fax
Mobile Email address (where your policy will be sent) *
* Mandatory Fields
4. Do you or your travelling companion require cover for a Pre-Existing Medical Condition?
  PRE-EXISTING MEDICAL CONDITIONS COVER
Pre-Existing Medical Condition View Pre-Existing Loadings
Traveller 1 YES NO Premium 1 Approval code for PE Conditions listed in Step 3
Traveller 2 YES NO Premium 2 Approval code for PE Conditions listed in Step 3
5. Do you require cover for additional luggage ? YES NO
6. Do you require Excess removal ? YES NO
Excess Options A NIL excess is automatically applicable to sections 2, 4, 5, 6, 7, 8, 12, 13 & 14. For all other sections, an excess of $100 applies to Plans A, B, D & E which can be removed by paying an additional premium of $25 per policy. A NIL excess applies to Plans C & F.
 
 
This insurance is managed by ETI Australia Pty Ltd. a company of the Mondial Assistance Group. ABN 52 097 227 177 (AFS Licence No. 245631)
and is issued and underwritten by Allianz Australia insurance Limited. ABN 15 000 122 850 (AFS Licence No. 234708).