Group Travel Insurance Application

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

Group Name*
(School)
Contact Name*
First Last
Contact Email*
Phone Number*
Nature of Trip*
Tell us the reason for the trip.
Departure Date*
Return Date*
Destination(s)*
What activities will be undertaken on the trip?*
Do you have an itinerary?
If Yes, please upload.
Number of travellers under 18 years?*
Number of travellers aged 18 - 60 years?*
Number of travellers aged over 61 - 65 years?*
Does any member of your group suffer a pre-existing medical condition(s)?*
- Yes
- No
- Don't Know
If yes, we may require further information before providing a quote.
If you have answered Yes to a member suffering pre-existing medical conditions please advise the age of the traveller and their condition.
Alternatively you may wish to upload information in relation to your member's pre-existing medical condition.