INSURANCE

Please complete one per person

Please complete Section 1. INSURANCE and submit when you have all the information needed to complete the form.

Section 1. INSURANCE

Expedition *

Select the expedition this information pertains to.

Full Name (as stated in passport) *

First / Middle / Last Name

INSURANCE

Travel Insurance Carrier *

Mandatory comprehensive travel insurance MUST include medical, medical evacuation and accident (incl. snorkelling and SCUBA diving for divers), Insurance cover for trip cancellation, interruption, luggage. and personal effects protection is highly recommended.

Policy Number *

Insurance Emergency Phone # *

(country code / area code / phone number)

DAN Policy Number *

We highly recommend you use DAN insurance for snorkelling and diving above and beyond your travel insurance. DAN specialises in emergency services in remote destinations and has proven to be the best help in hard times and a very affordable option that compliments your travel insurance. Please type "None" if you have chosen not to take out DAN insurance coverage.

Emergency Evacuation *

Does your DAN coverage include evacuation?

Yes

DAN International Emergency Phone # *

(country code / area code / phone number). Type "None" if this does not apply.