Booking Form
Admin: Church Centre, Kingsgate Rd, Kilburn, London NW6 4PR
Correspondence: Suite 27 Joules Hse, Christchurch Ave. Kilburn London NW6 7QW.
Tel: (+44) 0208 451 0777 - Tel/Fax:(+44) 0208 451 6817
Website: h.sitravel.cwc.net - http://www.sallyintercon.co.uk
Email: Goa.Res@sallyintercon.co.uk
| Departure Date | Destination | No. of wks | Special Meal | Type of Room |
Tours |
Passenger Details
| Mr/Mrs/
Miss/Ms |
Initials | Surnames | Child Age under 12 | Special Requests | Nationality | Cost per person £ |
| - | - | - | - | - | - | £ |
| - | - | - | - | - | - | |
| - | - | - | - | - | - | |
| - | - | - | - | - | Total Cost | £ |
| - | - | - | - | - | Deposit | £ |
| - | - | - | - | - | Balance | £ |
I have read and understand and booking conditions and accept them on behalf of myself and every member of my party. Further, I authorise Sally Intercontinental Travel Ltd. to make the booking detailed above on my behalf and of my party.
DEPOSIT REMITTANCE ---£______ Payment ____________
Credit Card: VISA / ACCESS/ AMERICAN EXPRESS (Please Circle)
No.______________________________ Expiry Date:___________
Signed ___________________________ (Client) Date __________
Name: ___________________________
Address:_______________________________________________________________________________
Important Note: The person who signs this form must be aged 18 years or over. If they are not, the booking should not be acepted. If in doubt ask for proof of age.
next page: Package and Flight Insurance
Holiday and business travel insurance scheme. Please complete this form with your credit / visa card details:
Age limit 75 YEARS ONLY - COVER ONLY FOR U.K. RESIDENTS
IMPORTANT: FULL TERMS AND CONDITIONS WILL BE SENT TO YOU. Should for any reason you find they are insufficient for your needs please return the original certificate within 7 days of purchase, but in any event prior to travel in order to cancel the insurance and obtain a full refund. Cancellation of the insurance is subject to no claim having been made or pending. A specimen certificate is available if required. Insurers and their agents share information with each other to prevent fraudulent claims, and to assess whether to offer insurance, In dealing with your application, enquiries may be made of other insurers and their agents. In the event of a claim, the information you supply on the form and claim form, together with other information relating to the claim may be made available to other insurers and their agents.
Declaration: I hereby declare that to the best of my/our knowledge and belief there is no reason at the present time why the journey or holiday should be cancelled or curtailed or expense be incurred and that no person shall travel against the advice of a qualified medical practitioner, or for the purpose of obtaining medical treatment.
All material facts must be disclosed to the Underwriting Agents. Failure to do so may affect your rights under the insurance. A material fact is a fact likely to influence the Underwriting Agents in the acceptance or assessment of the insurance (for example, your own state of health or that of a close relative). If you are in any doubt as to whether a fact is "material" then for your own protection it should be disclosed to the Underwriting Agents by telephoning TPU HELPLINE on freephone 0800 281488, 9.00am- 5.30pm, Mondays to Saturday.
I understand that you may seek information from others to check the answers I have provided.
Please complete all sections
Period of Insurance for.............................. Days from:............. please state area:...........................
Name and address of first proposer age Name of any other age
Post code: _____________ Tel No. ______________
Visa Card number: _______________
premiums per person- EX U.K.
inclusive of insurance premium tax at the current rate.
Adults
| Period | Europe | world-wide |
|
up to 17 days |
£16.00 | £36.00 |
| 18-31 days | £18.00 | £40.00 |
| Each additional month
or part thereof (max of six months in all). |
£16.00 |
£34.00 |
| Children 2 & under 16 - half the above price | - | - |
under 2 - free of charge winter sports - double rates
Summary of covers
This insurance also incorporates a 24 hour medical emergency service and air ambulance cover
European area means (including Channel Island, and Republic of Ireland). Jordan, Madeira, Canary Islands and counteies bordering the Mediterrane sea.
Key:
AD=ADULT
CH=CHILD
AD/CH=INCLUDED IN ADULT COVER
A special Holiday Package Insurance Scheme through Cork Bays and Fisher, a division of Minet Limited a member of the Aon Worldwide Group which is underwritten by certain underwriters at Lloyds for any person travelling on any Holidays advertised on our Web site. The full terms, conditions and exclusions are incorporated in the Master Certificate which alone constitutes the contract of insurance between the Insured Person and the Insurers. In the event of a dispute regarding the terms and conditions of the Master Certifcate shall prevail. Shown below are brief details only. A more detailed summary will be sent to you with your confirmation of booking and of course you may inspect the Master certificate.
Valid only for persons usually domiciled in the European Union.
| The insured is free to choose the law applicable to this
Insurance Contract.Unless specifcally agreed to the contrary this Insurance
shall be subject
to English Law. If any persons to be insured have received in or out-patient in the last 12 months or are taking prescribed medication please refer to Cork Bays and Fisher (Tel: 0171-481-0707) for underwriters terms and conditions (Also please see warranty) PREMIUMS up to 60 days:Departures 1 Dec '97-30 Nov '98 49.(Premiums once paid cannot be refunded). Children under 16(on depar6ture date):50% of adult rate. Infants under 2 (on departure date):free inmsurance cover if accompanied by an insured adult.Hot air ballons double preimium. Premiums are inclusive of 17.5% Insurance Premium Tax and subject to change on any amendment to that tax or its rate. WARRANTY The Insured Person warrants that at the time of effecting this Insurance: A) No circumstances are known that are likely to lead to cancelation or curtailment of the Hoilday. (B) The Insured Person has disclosed all matreial facts concerening insurance of the Insurer. (C) No travel will be undertaken agaisnts medical practitioner's advice. (example:a known health condition of a close relative). EMERGENCY CLAIMS ASSISTANCE SERVICE A 24 hour emergency aid service operated by Medi-Call Limited is available. |
|
1. Personal Accident A) Death B) Loss of Limb(s) or Sight in one or both Permanent Total Disablement £15,000£15,000 2. Medical Expenses 3. Hospital Inconvenience Benefit (£10 per day) 4. Baggage and Personal Effects (Limits any one article, peror set £200) Cameras and Jewellery Limit £200 in all Includes Delayed Baggage (12 Hours)5. Money (Cash limit £150) 6. Personal Liability 7. Delay Departure Exceeding 12 hours (A)£25 after the first 12 hours delay £15 after each subsequent full 12 hours OR(B) Holiday Cost if holiday cancelled 8. Cancellation, loss of deposit. 9. Curtailment. 10. Missed Departure 11. Legal Expenses up to £1,000up to £50up to £250up to £2,000,000up to £100up to £5,000up to £5,000up to £5,000up to £200up to £25,000 EXCESSES: Sections 2, 4, 5, 7B, 8, 9, & 11-£50 each and every loss. (Delayed baggage- NIL,loss of deposit- £5) CLAIMS:Claim forms are only available from the addreee below: R. D.T. Adjusters Ltd. P.O.Box 2638, Chelmsford, Essex CMI 3AR. Tel: 01245 420125 |
£15,000
up to £1,000 up to £50 up to £250 up to £2,000,000 up to £100 ip to £5,000 up to £5,000 up to £5,000 up to £200 up to £25,000 |