Client Section - Client to complete

I understand that by not purchasing travel insurance as offered to me, I may be exposed to financial losses, including but not limited to:

• the cost of my trip if I must cancel,

• the unknown costs of trip interruption and travel delay,

• additional single supplement cost if I choose to still travel if my travelling companion cancels,

• out of province medical care expenses.

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I have declined travel insurance coverage for the following:

By entering my initials in this box and/or signing this document and entering the date, I will not hold my travel agent / travel consultant responsible for any expenses I incur as a result of my choice NOT TO purchase travel insurance.