1. If insurance is required for multiples or proportions of Annual Salary, please note Annual Salary is considered to be the total annual remuneration, excluding payments or overtime, commission or bonus.
State amounts to be insured under each heading
If insurance is required for fixed sum benefits
If flying is undertaken, state maximum total lump sum benefit for all persons flying together in any
If other flights are undertaken, state
Operative Time - tick as required
* If less than 5 persons are to be covered
Any Time' is the only option available.
** If this option is required, please complete the 'Business Travel Abroad' section also
N.B A minimum period of 7 days is applicable under the Illness Benefit Extension
If yes, state period required:
Give particulars below of all accidents (and illnesses if the Illness Benefit Extension is to be included(which have occurred during the last five years within the Operative Times ticked above
3. If the answer to question 2 is 'Yes' give details of persons to be insured and travel undertaken during last twelve months (including employees spouses and children)