Insurance Quote Form

Travel Insurance Booking Form

Please submit this form with your details AFTER your flights are booked and your departure is confirmed. You can view the pricing below to check out the cost now before submitting this form. to receive a personalised quote from TWHC on Covermore policies. We will email you directly with the policy PDS and personalised quote. Please make sure you check your junk/spam folder and contact us at anytime if you have any questions 1300295579 or +6436676979 (NZ).
Australian Pricing:
Please Note that Covermore policies are only available for Australian or New Zealand residents and you must purchase this policy before departing Australia/NZ.
Are you an Australian/New Zealand citizen with a valid Australian/NZ Medicare card, or do you hold a visa allowing you to live, work or study in Australia/NZ?*

Yes
Full Name (As Shown on Passport)*

First NameLast Name
Date of Birth*

DayMonthYear
Email Address*
Mobile Number*

Area CodePhone Number
Residential Home Address: *

Street Address Line 1

Street Address Line 2

CityState (Aus Only)

Post Code
Policy Preference:*
Policy Length (Keep in mind if you travel with less then a 24 month policy you run the risk of being offer a shorter visa than cannot be extended) We recommend 24 months if you wish to be granted the full visa:*
Departure date: (This is the date your flights leaves Aus or NZ) Please make sure you have your flights booked before submitting this quote form*

DayMonthYear
Date
You have a duty to take reasonable care not to make a misrepresentation when entering into this contract of insurance. It's important you understand you've answered our questions for yourself and anyone else that you want to be covered by this insurance.You must take reasonable care to give a true and accurate account of matters. Your response should tell us everything that you know about the question. If you've made a misrepresentation to us, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your misrepresentation is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed. I'm an Authorised Representative of Cover-More and receive a commission for the sale of insurance. This is explained in the combined FSG and PDS. The PDS explains how Cover-More collects and uses personal information that you share about yourself or others. Cover-More's Privacy policy is available on its website. You have a 21 day cooling-off period, if you decide not to proceed with this insurance. The combined PDS and FSG also contains information about the insurer Zurich Australian Insurance Limited, Cover-More, and Cover-More's internal dispute resolution procedures. By entering this contract of insurance, please confirm you understand what we've advised you of, and confirm that the information you have provided in response to the questions asked, is true and accurate.*

YesNo
Pre Existing Medical Conditions - I am aware that these policies only cover the Pre Existing Medical conditions listed in the PDS as automatically covered. Covermore cannot offer any additional cover for anything not included.

Yes
Your quote and policy PDS will be emailed to you within 5 business days hours of submitting this form.
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Travel Insurance Booking Form

Your quote and policy PDS will be emailed to you within 5 business days hours of submitting this form.