Allianz Waiver Form

Thank you for consulting with our agency for your travel needs. We value your business and appreciate the time you have spent with us to build your dream vacation. You will find a quote below that includes your trip cost, airfare, taxes/fees, and insurance.

Please enable JavaScript in your browser to complete this form.

Waiver of Travel Insurance Coverage

Please read this carefully!
You are a valued client and we want to do everything
possible to make your trip enjoyable and worry free.
Because the unforeseen and unexpected can occur -
before you leave or when you’re away from home - we
recommend the Allianz Plan, It offers excellent
benefits and combines insurance coverage with
Emergency Hotline Services. Please read the Allianz
brochure carefully for more information.

Amount at risk:

If you are forced to cancel or interrupt
your trip, you may forfeit up to:

Allianz Plan Cost:

You can protect your valuable travel
investment for only:

do not enroll me for the Allianz Protection Plan. I understand that I am responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own provisions in the event of an emergency while I am traveling.
Scroll to Top