Travel Insurance

Insurance Quote Form

Destination

Departure Date*

Return Date to New Zealand (International Travel) or Hometown (Domestic Travel)*

Leisure Travel Single Trip
Leisure Travel Multi trip
Business Travel Single Trip
Business Travel Multi trip

Number of travellers*

Traveller 1

Name as shown on passport*

First Name Middle Name Last Name

Date of Birth*

Pre-Existing Conditions*

Yes
No

Traveller 2

Name as shown on passport*

First Name Middle Name Last Name

Date of Birth*

Pre-Existing Conditions*

Yes
No

Traveller 3

Name as shown on passport*

First Name Middle Name Last Name

Date of Birth*

Pre-Existing Conditions*

Yes
No

Traveller 4

Name as shown on passport*

First Name Middle Name Last Name

Date of Birth*

Pre-Existing Conditions*

Yes
No

DESTINATION DETAILS

Number of Destinations

For overseas travel list the countries you will visit and the number of days in each country

Destination 1

Number of Days

Destination 2

Number of Days

Destination 3

Number of Days

Destination 4

Number of Days

Personal Details

Name*

First Last

Phone*

Email Address*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Kiwi Travel Club Insurance

Insurance Quote Form

Traveller 1

Traveller 2

Traveller 3

Traveller 4

DESTINATION DETAILS

Personal Details

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CONTACT KIWI TRAVEL CLUB

New Zealand 0800 895 194

International +64 4 934 6721

info@ktctours.com

Kiwi Travel Club (KTC)

Tours & Packages