Travel Insurance - Middlesea Insurance Malta

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	Note: The instant quote provides you a quotation for all three policies available:
	1. Budget Travel Insurance 2. Economy Travel Insurance 3. Club Travel Insurance
	Those travelling for a period exceeding 31 days, those from 71-79 years of age and those interested in making use of additional limits or applying for winter sports under the cover, please contact Middlesea Insurance on 2569 4244 or 2569 4457.

You have the right to cancel the travel policy you have purchased within 14 days of the date of issue or receipt of the terms and conditions, whichever is the later provided that you would not have lodged a claim under the policy and you have purchased cover for a period of travel of 30 or more consecutive days. We will refund you the policy premium you have paid but not the stamp duty and the policy fee.

Your Details (please insert the details of the first insured person travelling)

Title (Mr/Ms/Dr)
First Name		Last Name
I.D. Card number
Address		Telephone
Fax		Email address

Quote Details

1. How many persons are travelling? (Age 0-70)

2. What is their age?

Person 1 years old

3. Where are you travelling to?

Area 1: Europe (including Russia west of Ural Mountains), countries bordering the Mediterranean, the Azores, Canary Islands, Madeira and Iceland.	View countries in area 1

Area 2: Worldwide, excluding the USA and Canada This Area also includes Europe (including Russia west of Ural Mountains), countries bordering the Mediterranean, the Azores, Canary Islands, Madeira and Iceland.	View countries in area 2

Area 3: Worldwide, including USA and Canada. This Area also includes Europe (including Russia west of Ural Mountains), countries bordering the Mediterranean, the Azores, Canary Islands, Madeira and Iceland.	View countries in area 3

4. For how long are you travelling?

From - -
To - -

No of days:

5. Which cover do you want:

  Budget
  Economy
  Club

6. Do you have other current policies with Middlesea Insurance

Yes No

If Yes please specify

Please confirm that you and all others to be insured are full-time residents of Malta. This policy only covers people travelling from Malta and returning to Malta.

I / We do not have a pre-existing Medical Condition

Please read the following carefully.
- There is no cover for health conditions, which could reasonably be expected to give rise to a claim. This applies to you and any person upon whose health the journey may depend.
- There is no cover for any psychiatric or psychological conditions including depression or anxiety.
- There is also no cover if anyone is awaiting hospital investigation or treatment for any undiagnosed condition or set of symptoms.

Health Warranty
The admission of claims under this Travel Policy is subject to the express warranty that any Insured Person with whom the Insured has arranged to travel or stay was not to the best knowledge and belief of the Insured, physically or mentally disabled or receiving or awaiting medical or surgical treatment at the time of effecting the Insurance.

If you have pre-existing medical conditions please provide details here:

I have read and understood the Middlesea Policy Wording

These quotations are subject to Document Duty calculated at 10% to the next higher Lira subject to a minimum charge of € 11.65 (Lm5.00). In cases where the total premium is less than € 11.65 (Lm5.00), the document duty charge would be 50% of the premium quoted.

I/we acknowledge that Middlesea Insurance p.l.c. (MSI) may process the personal data that I/we provide in accordance with the Data Protection Act (Cap 440) and with the Data Protection Policy of the Company.

I/we acknowledge that I/we have a right to request to and rectification of such data as processed by MSI. Any such request must further be signed by myself as the applicant/joint assured/joint holder to whom the personal data relates.

We would like to keep you updated with our latest products & services. Your details will not be passed on to any third parties.

If you do not want to receive this information please tick this box

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	Middlesea Insurance p.l.c. Middle Sea House Floriana, FRN1442 Malta

	Tel: (+356) 21246262 Fax: (+356) 21248195

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Middlesea Insurance p.l.c. is a company authorised under the Insurance Business Act, 1998 to carry on both Long Term and General Business and is regulated by the Malta Financial Services Authority.Registration Number: C5553.

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