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Single Travel Insurance Quote Request

Title	Mr Mrs Ms Miss
First Name
Surname
House Number or Name
Postcode
Contact Email
Contact Phone Number
Best Time to call back	Morning Noon Afternoon Saturday morning Any office hours
Cover/Renewal Date
Length of Cover not exceeding	5 10 17 23 31 days
Area of Cover Required	UK EU XU WW  * See note 1
Names and Ages of Travellers requiring cover (maximum age limit of 79 applies)	Age:   Age:   Age:   Age:
Winter Sports Cover	Yes No Require further details
Would you like to exclude Baggage Cover	Yes No Require further details
Would you like to exclude Cancellation Cover?	Yes No Require further details
Is Golf Cover required?	Yes No Require further details
Is Wedding Cover required?	Yes No Require further details
Is Business Equipment Cover required?	Yes No Require further details

Notes

1. Area Code

• UK = England, Scotland, Wales and Northern Ireland including Isle of Man
• EU = Europe, Channel Islands, Republic of Ireland, Madeira, Canary Islands, Syria, Tunisia, Turkey, Egypt, Israel and Countries bordering the Mediterranean Sea
• XU = Worldwide excluding the United States, Canada and the Caribbean
• WW = Worldwide

© Giles Insurance 2005 Authorised and regulated by the Financial Services Authority Number 125098