REI - Travel

Travel Quotation Request

Text in Red = Required Fields

Owner Details

First Name:
Surname:
Phone:		Email:

Risk Details

Address of Risk:
Suburb:
State:
Postcode:
What is your date of departure?	eg.(dd/mm/yyyy)
What is your return date?	eg.(dd/mm/yyyy)
Are you over 18 years of age?	Yes No
Are you an Australian Resident?	Yes No
Does your journey commence and end in Australia?	Yes No
Are all travellers under the age of 70 years?	Yes No
Do any of the travellers have what may be considered pre-existing medical conditions?	Yes No

Cover Required

Please select a cover type based on the number of Travellers		Singles � Includes you (one adult) and your dependant children under the age of 21 who are travelling with you
		Doubles � Includes any two adults (named on the Certificate of Insurance) and their dependant children under the age of 21 who are travelling with them
What is your farthest destination?
Select a plan type based on your farthest destination		International Super - Recommended for travel to USA, UK, Canada, Europe, Japan, South America, Russia, India, Middle East or Africa
		International Standard - The minimum cover recommended for travel to Asia
		International Economy - The minimum cover recommended for travel to New Zealand, Bali and the Pacific Islands
		Australia Plan - For Australian domestic travel only

Real Estate Agency Details

Name of Real Estate Agency that has referred you to Aon Personal Insurance
Situation Address of Real Estate Agency
Contact Name
Phone

Addtional Comments

General Comments (Incl. relevant information)