Group Travel Insurance Application

Please complete this form to obtain a quote for Go Insurance Group Travel Insurance.

Contact Name*
First Last
Contact Email*
Destination*
Tell us where your group is heading to and what activities will be undertaken. ie School travelling to Japan and will be skiing and sightseeing.
Start Date*
What day should the policy commence?
End Date*
When does the group arrive home?
Number of travellers under 18 years?*
Number of travellers aged 18 - 60 years?*
Number of travellers aged over 61 years?*
Does any member of your group suffer a pre-existing medical condition/s which is/are not automatically covered under the Group policy?*
- Yes
- No
- Don't Know
If yes, we may require further information before providing a quote.