Corporate Group Travel Insurance Declaration
Company Information
Company Name
Address
Contact Person
Email
Phone Number
Travel Details
Destination(s)
Purpose of Travel
Departure Date
Return Date
Total Number of Travelers
List of Insured Persons
Full Name
Gender
Date of Birth
Passport/ID Number
Designation
Declaration
I confirm that the information provided above is true and correct to the best of my knowledge.
I agree
Name of Authorized Signatory
Position/Title
Date
Signature