TRAVEL INSURANCE WAIVER FORM

Traveller Information:

Name:(Required)

First Last

Date of Birth:

Address :

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:

Email:(Required)

Trip Information:

Destination:

Departure Date:

Return Date:

Travel Agency:

Travel Agent:

Waiver Acknowledgment:

I, the undersigned, acknowledge that I have been offered and have declined the option to purchase travel insurance for my upcoming trip. I understand that by waiving travel insurance, I am fully responsible for any financial losses or expenses that may arise as a result of unforeseen circumstances, including but not limited to:

1. Trip Cancellation or Interruption:

Due to personal or family emergencies, illness, or other unforeseen events.

2. Medical Expenses:

Costs incurred due to illness or injury while travelling.

3. Lost, Stolen, or Damaged Baggage and Personal Effects:

Expenses related to the loss, theft, or damage of personal belongings.

4. Travel Delays:

Additional costs incurred due to flight delays or cancellations.

5. Emergency Evacuation and Repatriation:

Costs associated with emergency medical evacuation and repatriation.

I understand that travel insurance provides valuable protection and that I am solely responsible for any and all expenses that may arise from my decision to decline coverage. I hereby release and hold harmless Kristy Sharpe — itravel, its agents, and employees from any liability related to my decision to waive travel insurance.

Signature:

Traveller Signature:

Date:

Witness (Travel Advisor)

Agent Name:

Agent Signature:

Date:

Important Notice:

It is highly recommended to carefully consider the risks associated with traveling without insurance. If you have any questions or concerns about travel insurance, please discuss them with your travel agent before signing this waiver form.

By signing this form, you confirm that you have read, understood, and agreed to the terms and conditions outlined above.

Waiver Received By:

Date Processed:

Booking Reference Number: