Insurance Acceptance / Waiver

Please complete and return the following insurance acceptance/waiver by fax, mail or email to Palace Travel.

Sample Insurance Considerations

Palace Travel, Inc. recommends that you purchase the following travel insurance. Indicate your acceptance of the purchase of each form of insurance by checking it. Palace Travel, Inc. cannot be responsible for cancellation, emergency evacuation, accidents abroad, illness, lost baggage, or flight mishaps, and thus strongly urges that you purchase available insurance coverage.

Acceptance is indicated by a check mark. If no check marks are indicated, it is considered rejected by client. ___ Trip cancellation/interruption Policy Name_____________________Number_____________________ ___ Trip cost default protection Policy Name_____________________Number_____________________ ___ Trip delay Policy Name_____________________Number_____________________ ___ Sickness and medical expense Policy Name_____________________Number_____________________ ___ Travel accident Policy Name_____________________Number_____________________ ___ Baggage and personal effects/Lost luggage Policy Name_____________________Number_____________________ ___ Emergency assistance Policy Name_____________________Number_____________________ ___ Flight insurance Policy Name_____________________Number_____________________ ___ All of the above

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