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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

     

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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.