TRAVEL INSURANCE APPLICATION FORM

Endsleigh will share the personal details you provide with Zurich Insurance plc. To administer your policy Zurich will hold and use information about you supplied by you (and by medical providers). Zurich may send it in confidence for processing to other companies in the Zurich group (or companies acting on Zurich's instructions, including those located outside the European Economic Area.

It is Endsleigh's policy to take all necessary steps to ensure that your personal data held is processed fairly and lawfully in accordance with the Data Protection Act 1998 ("the Act"). We hold personal data relating to you in connection with insurance products and services you have asked us to provide. Except to the extent we are required or permitted by law, personal data provided to, or obtained by, us will be used for the purpose of providing you with the products and services you have requested. It may also be shared within other Endsleigh group companies, (full details of which are available on request), as well as carefully selected third parties. In the process of gathering your details we may collect sensitive information such as about your health or in relation to motoring offences. If you purchase products or services from us, you will have given us your consent to use this personal data as detailed in this Privacy Policy.

We may wish to contact you from time to time by telephone, e-mail or post about other products and services that may be of interest to you. If at any time you do not wish to receive this information then please write to Endsleigh's Group Data Protection Office at: Endsleigh Insurance Services Limited, Shurdington Road, Cheltenham, Glos GL51 4UE. Under the Act, as a data subject, you are granted certain rights. If you would like to know what information we hold about you. You can write to us as above. We may charge you a statutory administration fee to comply with your request. Should you have any other queries in connection with data protection then please contact Endsleigh's Group Data Protection Officer as above.

Complaints Procedure
We aim to provide a high level of service and pay claims fairly and promptly under the terms of your Travel Insurance Policy. If you are unhappy with any aspect of our service, please contact, in the first instance the person who originally dealt with your enquiry. Alternatively you can contact us by: Telephone: 0800 085 8698 Post: Customer Liaison Department, Endsleigh Insurance Services Limited, Shurdington Road, Cheltenham, Gloucestershire GL51 4UE

You may at any time contact the Head of Customer Care at Zurich Insurance plc. If you remain dissatisfied you have the right to ask the Financial Ombudsman to review your case. The Ombudsman can be contacted at the following address:-The Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR. Contacting the Ombudsman will not affect your right to take legal action against us.

You can cancel your policy at any time. We will refund your premium less a charge for the time you have been insured, provided you have not travelled or your policy has not been terminated following a claim, in which case no refund will be due. A £20 cancellation fee will be deducted from any refund due.

Travel Eligibility Statements
You and anyone named on the policy are:
Registered under the healthcare system in your home country
Travelling from and returning to your home country

Important conditions relating to health
It is essential that you read the important conditions relating to health as failure to comply with these conditions may jeopardise your claim or cover. You must comply with the following conditions to have the full protection of your policy. It is a condition of this policy that you will not be covered for any claims arising directly or indirectly from:

1. At the time of taking out this policy:
   1. Any medical condition you have or have had for which: a) symptoms or diagnosis has occurred within the last 12 months or b) There has been a change in treatment (including medication, dosage, surgery, tests, investigations or diet) in the last 12 months.
   2. Any medical condition where you, a close relative* or a close business associate**: -
      1. Are waiting for an operation, hospital consultation (other than for regular checkups), or other hospital treatment or investigation.
      2. Have within the last 6 months, been seen by a specialist (other than for regular checkups), had an operation or other hospital treatment or investigation.
      3. Have received a terminal prognosis.
   *The definition of a close relative is as follows:-mother, father, sister, brother, wife, husband, daughter, son, grandparent, grandchild, parent-in -law, son-in-law, daughter -in-law, sister-in-law, brother-in law, step parent, step child, step sister, step brother, foster child, legal guardian, partner or fiancé/fiancée.
   **The definition of a close Business Associate -Means any person whose absence from business for one or more complete days at the same time as your absence prevents the proper continuation of that business. Any circumstances you are aware of that could reasonably be expected to give rise to a claim on this policy.
2. At any time:
   1. Any medical condition you have in respect of which you are travelling against medical advice or for which you are travelling to obtain medical treatment abroad.
   2. Any medical condition for which you are not taking the recommended treatment or prescribed medication as directed by a medical practitioner.
   3. Your travel against any health requirements stipulated by the carrier, their handling agents or other public transport provider.

I have read and agreed to these important conditions relating to health *

I declare the answers given to questions asked in the application form are true and complete to the best of my knowledge and belief. I agree that the fees for the insurance will be added to the invoice for the trip.

I confirm that my travel details have been provided *