Travel Scheme Proposal Form
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1 In answering the following questions, should you need to expand on any answers please use the Notes section at the back. 1. Company Name Travel Scheme Proposal Form 2. Trading Name Contact Name 3. Brand(s) 4. Web address(es) 5. Number of insureds 6. Cancellation cover Minimum Maximum 7. Method of distribution Tick all those that apply and provide a percentage: Mail Order Web - Direct Web - Aggregator Other (please specify) 1
2 Please answer questions 8 to 14 as a percentage of your carryings: 8. Please tell us where your Consumers go 9. Please tell us the method of travel 10.Please identify the accommodation type 11. Please show your Consumer age profile Destination Europe North America Worldwide (ex N America) UK, Channel Islands, Eire Australia / New Zealand Method Flight Self Drive Coach Rail Cruise Accommodation Hotel Chalet/Villa Cruise Caravan/Tent Apartment Age Profile Under 18's & over 12.Please show the percentage of family bookings 13.Please show your Consumer travel pattern profile Days 14.Whilst on holiday do your Consumers do any of the following (whether offered by your company or not) Activities Winter Sports Water Sports - dinghy sailing, water skiing, canoeing, windsurfing Water Sports - scuba diving Other - please specify 2
3 15.Any changes to your distribution next year e.g. placing schemes on aggregator, direct marketing, affinities, etc. Yes [ ] No [ ] If "Yes" please give details: Continue on Notes page, if required. 16.We will make recommendations for improving your current travel insurance arrangement, if appropriate. However, are there any particular items of cover or service you would like us to consider particularly where you may have had cause for concern in the past. Cover Service 17.Important Dates Please show the date you would like to recieve our presentation/quote and other deadlines (not asap) Quote required by (please allow at least 4 weeks) Renewal date to (if applicable) Target date for launch 18.Current Broker/Provider and Insurer Please show the contact details for your current Broker/Provider: Company name Contact name How many years have you placed business with this Broker/Provider [ ] Please show the contact details for your current Insurer: Company name Contact name How many years have you placed business with this Insurer [ ] 3
4 19.Declaration I understand this is a request in the form of a proposal to provide us with a quotation for our Consumer travel insurance. I agree to provide any further information requested by P J Hayman & Company Ltd or their Underwriters. I accept that if an indication is supplied that this will be subject to further information or to Underwriters agreement, which is not binding until we recieve a quotation in writing. The information supplied in this proposal form is to the best of my knowledge true and accurate and I am aware it will be shown to Underwriters to form their judgement in settling the premium for our Consumers travel insurance and will be a binding part of our contract. I have not withheld any relevant information (details which may affect the Underwriters assessment of the risk and/or setting of rates - if you are in any doubt as to whether information is relevant or not it must be declared on this form). Signed Position Date 20.Additional Information Please also supply the following: 1) Current policy wording 2) Current rates and periods Note: in some circumstances we will ask you to provide historical claims and premium statistics. We recommend you use the words opposite. Dear (P J Hayman contact) We hereby authorise P J Hayman & Company Limited to investigate and report on our travel insurance and to provide alternative quotations. Yours faithfully, Have you completed the notes page (overleaf) for further explanations? Yes [ ] No [ ] 4
5 Please complete the notes section below, if further explanations are required for any of the previous questions. Question No. Notes 5 REF: PJH - Travel Scheme Proposal - Edition 2: Sep 2017
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