Insurance declaration

Please complete this form in full, giving the details of only one person per form.

Insurance details

Full Name (required)

Your Email (required)

Insurance Company

Emergency Contact Number

Insurance Company Email

Assistance Company Name

Assistance Company Contact Number

Assistance Company Contact Email

Duration of cover in days

Insured from

Insured to

Insurance Policy Number

 

Please leave this field empty.

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Unique Trails will use the information you have provided here for the purpose of providing you with adventure travel services. Unique Trails will not disclose this information to any other person or organisation except in connection with the above purpose, Unique Trails products and services. If you do not want us to contact you about these products and services, or if you have any queries about how we make use of your data, please do not hesitate to Contact Us.