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You have not been refused Travel Insurance by any other company nor are you insuring with the intention of receiving medical treatment or to claim for events which have already occurred.

You are not aware of any circumstances likely to lead to cancellation or curtailment of the trip. The underwriter is aware of all facts likely to affect the acceptance or conditions of this insurance. You will notify the underwriter of changes in circumstances or health occurring prior to your commencement date.

You confirm details have been correctly declared in this application form including the Medical Certificate incorporated in this document to be submitted for approval by the underwriter.

You agree, in the event of illness or injury giving rise to claims under the medical section of the policy, to be medically evacuated to Australia, New Zealand or your Country of Origin, as applicable, at the underwriters discretion.

You agree to a waiver of privacy in that you consent to any requested medical information being released by your doctor, specialist, or other health provider to the Underwriter or its agent and to the release of any further information necessary for the purposes of this insurance.

You authorise any claim to be paid to any named institution which has submitted claim details and requested payment to be made to them on your behalf.

You accept that failure to supply correct application and medical certificate details may affect the validity of the policy.

You have certain rights of access to and correction of this information.

You understand that this policy does not cover any event, which happens to you unless you, at the date of such event, are aged 65 years or under.

You understand and agree that the act of transmitting this application to Uni-Care, by activating the 'Submit Application' button on the web application form, will have the legal force of a signature.

You have read and understood and accepted the above statements and accept responsibility for all the information provided in this application.

Pre Existing Conditions

Our Privacy Statement

DECLARATION (Please read carefully)

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