War Cover Questionnaire

Please fill in the information below. Alternatively, if you would like to print off and post to us, please download the form here.

    Completed questionnaires are in consideration of the removal of the war exclusion to Sections A – Medical Emergency and Section C – Personal Accident only – No cover is provided under this insurance for any political evacuation.

    Dates of travel


    First Name


    Date of Birth

    Certificate Number