Travel Insurance Application

By submitting the information above, I/we hereby declare that the answers and declarations made, whether in my own hand or not, are true and that I/we warrant that no material fact has been withheld or misstated and agree that this application will form part of the policy and will form the basis of the contract with Underwriters. I/we understand that the Underwriters may declare any policy issued void in the event of any false statement, misrepresentation, omission or concealment whether made intentionally, innocently or accidentally.