Activity Application Name You should refer here only activities that are specifically excluded by the insurance. All other activities are covered as standard and do NOT need to be referred. Please confirm that the activity declared is excluded by the insurance Please confirm that the activity declared is excluded by the insurance. Employee number * Company * Contract Number if known Your Name * Your postcode * Your EMail address * Destination * Start date for your trip End date for your trip Activities you wish to undertake * Website with additional information Additional Information you wish to provide
