costco.brokersure.com
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http://costco.brokersure.com/step1
Submission: On December 21 via manual from US — Scanned from GB
Submission: On December 21 via manual from US — Scanned from GB
Form analysis 1 forms found in the DOM
POST /step1
<form action="/step1" id="step1" method="post">
<h1>Important Information</h1>
<p><b>Important Information Coronavirus (COVID-19) Update:</b></p>
<p><b>We can confirm all of our policies now provide cover for Medical and other Expenses outside of the United Kingdom if you contract Coronavirus (COVID-19) whilst abroad.</b></p>
<p><b>Some of our policies now also offer other additional Coronavirus (COVID-19) benefits. The policies that offer the additional cover are clearly marked where we display our prices along with the full terms and conditions.</b></p>
<p><b>All our policies will only provide cover, if prior to your trip commencing, the Foreign, Commonwealth & Development Office (FCDO) has NOT advised against all (or all but essential) travel to your chosen destination.</b></p>
<p><b>If you are unsure about the cover available please call our friendly team on the number above for more information.</b></p>
<div id="divSchemeType" class="questionBox">
<p class="coverInfo">
<strong>Please select your type of cover</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">Single Trip</strong>Cover for a single trip starting in the UK and ending in the UK.</p>
<p><strong class="nH-Sub">Annual Multi Trip</strong>Annual cover for any number of trips starting and ending in the UK (limited to a maximum number of days for each trip unless a trip extension additional cover is purchased.)</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
</div>
<div data-toggle="buttons">
<div class="checkbox ">
<input class="" data-val="true" data-val-number="The field SchemeTypeSelected must be a number." data-val-range="Please select a travel type." data-val-range-max="999" data-val-range-min="1"
data-val-required="The SchemeTypeSelected field is required." id="st_1" name="SchemeTypeSelected" type="radio" value="1">
<label for="st_1">Single Trip</label>
</div>
<div class="checkbox ">
<input class="IsFixedDuration" id="st_2" name="SchemeTypeSelected" type="radio" value="2">
<label for="st_2">Annual Multi-Trip</label>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<!-- #region Destinations-->
<div id="divDestinations" class="questionBox" style="display:block;">
<p class="coverInfo">
<strong>Where are you going to?</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">UK</strong>United Kingdom - England, Scotland, Wales, Northern Ireland and the Isle of Man.</p>
<p><strong class="nH-Sub">Europe 1</strong> - Albania, Algeria, Armenia, Austria, Azerbaijan, Azores, Belarus, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark (including Faroe Islands), Estonia, Finland, France
(including Corsica), Georgia, Germany, Gibraltar, Greenland, Guernsey (including Alderney, Sark and Herm), Hungary, Iceland, Ireland, Italy (including Aeolian Islands, Sardinia, Sicily), Jersey, Kosovo, Lapland, Latvia, Liechtenstein,
Lithuania, Luxembourg, Macedonia, Madeira, Moldova, Monaco, Montenegro, Netherlands, Norway (including Jan Mayen, Svalbard Is), Poland, Portugal, Romania, Russia (west of Ural mountains), San Marino, Sardinia, Serbia, Slovakia, Slovenia,
Sweden, Ukraine and Vatican City.</p>
<p><strong class="nH-Sub">Europe 2</strong>- Those countries listed above and including: Andorra, Cyprus, Greece (including Greek Isles), Malta, Spain (including Balearic and Canary Islands), Switzerland and Turkey. </p>
<p><strong class="nH-Sub">Australia and New Zealand</strong> Australia and New Zealand</p>
<p><strong class="nH-Sub">Worldwide</strong>including Canada, Caribbean and the USA.</p>
<p><strong class="nH-Sub">Worldwide Exc</strong>excluding Canada, Caribbean and the USA.</p>
<p><strong class="nH-Sub">Please note:</strong> No cover is provided under this policy for any trip in, to, or through Afghanistan, Liberia or Sudan. No cover is provided for claims arising as a direct result of a situation highlighted by the
Foreign and Commonwealth Office where you have travelled to a specific country or to an area where, prior to your trip commencing, the Foreign and Commonwealth Office have advised against all (but essential) travel.</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
</div>
<div data-toggle="buttons">
<div class="checkbox ">
<input data-val="true" data-val-number="The field DetstinationIdSelected must be a number." data-val-range="Please select a destination." data-val-range-max="256" data-val-range-min="1"
data-val-required="The DetstinationIdSelected field is required." id="dt_6" name="DetstinationIdSelected" type="radio" value="6">
<label for="dt_6">Europe 1</label>
</div>
<div class="checkbox ">
<input id="dt_1" name="DetstinationIdSelected" type="radio" value="1">
<label for="dt_1">Europe 2</label>
</div>
<div class="checkbox ">
<input id="dt_5" name="DetstinationIdSelected" type="radio" value="5">
<label for="dt_5">Australia New Zealand</label>
</div>
<div class="checkbox ">
<input id="dt_4" name="DetstinationIdSelected" type="radio" value="4">
<label for="dt_4">Worldwide Exc USA/Canada/Caribbean/Mexico</label>
</div>
<div class="checkbox ">
<input id="dt_2" name="DetstinationIdSelected" type="radio" value="2">
<label for="dt_2">Worldwide</label>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<!-- #region Countries-->
<div id="divCountries" class="questionBox" style="display:none;">
<p class="coverInfo">
<strong>Where are you going to?</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">UK</strong>United Kingdom - England, Scotland, Wales, Northern Ireland and the Isle of Man.</p>
<p><strong class="nH-Sub">Europe 1</strong> - Albania, Algeria, Armenia, Austria, Azerbaijan, Azores, Belarus, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark (including Faroe Islands), Estonia, Finland, France
(including Corsica), Georgia, Germany, Gibraltar, Greenland, Guernsey (including Alderney, Sark and Herm), Hungary, Iceland, Ireland, Italy (including Aeolian Islands, Sardinia, Sicily), Jersey, Kosovo, Lapland, Latvia, Liechtenstein,
Lithuania, Luxembourg, Macedonia, Madeira, Moldova, Monaco, Montenegro, Netherlands, Norway (including Jan Mayen, Svalbard Is), Poland, Portugal, Romania, Russia (west of Ural mountains), San Marino, Sardinia, Serbia, Slovakia, Slovenia,
Sweden, Ukraine and Vatican City.</p>
<p><strong class="nH-Sub">Europe 2</strong>- Those countries listed above and including: Andorra, Cyprus, Greece (including Greek Isles), Malta, Spain (including Balearic and Canary Islands), Switzerland and Turkey. </p>
<p><strong class="nH-Sub">Australia and New Zealand</strong> Australia and New Zealand</p>
<p><strong class="nH-Sub">Worldwide</strong>including Canada, Caribbean and the USA.</p>
<p><strong class="nH-Sub">Worldwide Exc</strong>excluding Canada, Caribbean and the USA.</p>
<p><strong class="nH-Sub">Please note:</strong> No cover is provided under this policy for any trip in, to, or through Afghanistan, Liberia or Sudan. No cover is provided for claims arising as a direct result of a situation highlighted by the
Foreign and Commonwealth Office where you have travelled to a specific country or to an area where, prior to your trip commencing, the Foreign and Commonwealth Office have advised against all (but essential) travel.</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
</div>
<div data-toggle="buttons">
<div class="checkbox">
<input type="checkbox" class="checkboxCountry" name="CountriesSelected" value="82" id="ct_82">
<label for="ct_82">France</label>
</div>
<div class="checkbox">
<input type="checkbox" class="checkboxCountry" name="CountriesSelected" value="215" id="ct_215">
<label for="ct_215">Spain</label>
</div>
<div class="checkbox">
<input type="checkbox" class="checkboxCountry" name="CountriesSelected" value="242" id="ct_242">
<label for="ct_242">Usa</label>
</div>
<div class="checkbox">
<input type="checkbox" class="checkboxCountry" name="CountriesSelected" value="241" id="ct_241">
<label for="ct_241">United Kingdom</label>
</div>
<div class="checkbox">
<input type="checkbox" class="checkboxCountry" name="CountriesSelected" value="20" id="ct_20">
<label for="ct_20">Australia</label>
</div>
<div class="checkbox">
<label for="More" id="btnCountriesMore">More Countries</label>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<!-- #region AllCountries-->
<div id="divAllCountries" class="questionBox" style="display:none;">
<div class="twelve columns">
<p><strong>Please enter the country name or select from the list below:</strong></p>
<div class="twelve columns">
<div>
<input type="text" id="txtCountryName" class="BL-FullWidth">
<label id="btnCountriesAll">Clear/Show All</label>
<label id="btnHideCountries">Hide Countries</label>
</div>
</div>
</div>
<div data-toggle="buttons" class="questionBox">
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="7" id="ct_7">
<span class="ct_7"></span>
<label for="ct_7">Afghanistan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="317" id="ct_317">
<span class="ct_317"></span>
<label for="ct_317">Aland Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="9" id="ct_9">
<span class="ct_9"></span>
<label for="ct_9">Albania</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="10" id="ct_10">
<span class="ct_10"></span>
<label for="ct_10">Algeria</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="12" id="ct_12">
<span class="ct_12"></span>
<label for="ct_12">Andorra</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="13" id="ct_13">
<span class="ct_13"></span>
<label for="ct_13">Angola</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="114" id="ct_114">
<span class="ct_114"></span>
<label for="ct_114">Isle of Man</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="278" id="ct_278">
<span class="ct_278"></span>
<label for="ct_278">Greek Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="14" id="ct_14">
<span class="ct_14"></span>
<label for="ct_14">Anguilla</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="16" id="ct_16">
<span class="ct_16"></span>
<label for="ct_16">Antigua</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="17" id="ct_17">
<span class="ct_17"></span>
<label for="ct_17">Argentina</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="18" id="ct_18">
<span class="ct_18"></span>
<label for="ct_18">Armenia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="19" id="ct_19">
<span class="ct_19"></span>
<label for="ct_19">Aruba</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="261" id="ct_261">
<span class="ct_261"></span>
<label for="ct_261">Ascension Island</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="21" id="ct_21">
<span class="ct_21"></span>
<label for="ct_21">Austria</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="22" id="ct_22">
<span class="ct_22"></span>
<label for="ct_22">Azerbaijan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="262" id="ct_262">
<span class="ct_262"></span>
<label for="ct_262">Azores</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="23" id="ct_23">
<span class="ct_23"></span>
<label for="ct_23">Bahamas</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="24" id="ct_24">
<span class="ct_24"></span>
<label for="ct_24">Bahrain</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="263" id="ct_263">
<span class="ct_263"></span>
<label for="ct_263">Balearics</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="264" id="ct_264">
<span class="ct_264"></span>
<label for="ct_264">Bali</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="25" id="ct_25">
<span class="ct_25"></span>
<label for="ct_25">Bangladesh</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="26" id="ct_26">
<span class="ct_26"></span>
<label for="ct_26">Barbados</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="27" id="ct_27">
<span class="ct_27"></span>
<label for="ct_27">Belarus</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="28" id="ct_28">
<span class="ct_28"></span>
<label for="ct_28">Belgium</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="29" id="ct_29">
<span class="ct_29"></span>
<label for="ct_29">Belize</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="30" id="ct_30">
<span class="ct_30"></span>
<label for="ct_30">Benin</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="31" id="ct_31">
<span class="ct_31"></span>
<label for="ct_31">Bermuda</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="32" id="ct_32">
<span class="ct_32"></span>
<label for="ct_32">Bhutan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="33" id="ct_33">
<span class="ct_33"></span>
<label for="ct_33">Bolivia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="35" id="ct_35">
<span class="ct_35"></span>
<label for="ct_35">Bosnia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="36" id="ct_36">
<span class="ct_36"></span>
<label for="ct_36">Botswana</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="266" id="ct_266">
<span class="ct_266"></span>
<label for="ct_266">Bouvet Island</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="38" id="ct_38">
<span class="ct_38"></span>
<label for="ct_38">Brazil</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="40" id="ct_40">
<span class="ct_40"></span>
<label for="ct_40">Brunei</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="41" id="ct_41">
<span class="ct_41"></span>
<label for="ct_41">Bulgaria</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="42" id="ct_42">
<span class="ct_42"></span>
<label for="ct_42">Burkina Faso</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="268" id="ct_268">
<span class="ct_268"></span>
<label for="ct_268">Burma</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="43" id="ct_43">
<span class="ct_43"></span>
<label for="ct_43">Burundi</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="44" id="ct_44">
<span class="ct_44"></span>
<label for="ct_44">Cambodia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="45" id="ct_45">
<span class="ct_45"></span>
<label for="ct_45">Cameroon</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="46" id="ct_46">
<span class="ct_46"></span>
<label for="ct_46">Canada</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="269" id="ct_269">
<span class="ct_269"></span>
<label for="ct_269">Canary Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="47" id="ct_47">
<span class="ct_47"></span>
<label for="ct_47">Cape Verde</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="48" id="ct_48">
<span class="ct_48"></span>
<label for="ct_48">Cayman Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="49" id="ct_49">
<span class="ct_49"></span>
<label for="ct_49">Central African Republic</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="50" id="ct_50">
<span class="ct_50"></span>
<label for="ct_50">Chad</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="270" id="ct_270">
<span class="ct_270"></span>
<label for="ct_270">Channel Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="51" id="ct_51">
<span class="ct_51"></span>
<label for="ct_51">Chile</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="52" id="ct_52">
<span class="ct_52"></span>
<label for="ct_52">China</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="55" id="ct_55">
<span class="ct_55"></span>
<label for="ct_55">Colombia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="56" id="ct_56">
<span class="ct_56"></span>
<label for="ct_56">Comoros</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="57" id="ct_57">
<span class="ct_57"></span>
<label for="ct_57">Congo</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="60" id="ct_60">
<span class="ct_60"></span>
<label for="ct_60">Costa rica</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="61" id="ct_61">
<span class="ct_61"></span>
<label for="ct_61">Cote DIvoire</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="62" id="ct_62">
<span class="ct_62"></span>
<label for="ct_62">Croatia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="63" id="ct_63">
<span class="ct_63"></span>
<label for="ct_63">Cuba</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="64" id="ct_64">
<span class="ct_64"></span>
<label for="ct_64">Curacao</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="65" id="ct_65">
<span class="ct_65"></span>
<label for="ct_65">Cyprus</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="320" id="ct_320">
<span class="ct_320"></span>
<label for="ct_320">Cyprus - North</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="66" id="ct_66">
<span class="ct_66"></span>
<label for="ct_66">Czech Republic</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="58" id="ct_58">
<span class="ct_58"></span>
<label for="ct_58">Dem Rep Congo</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="67" id="ct_67">
<span class="ct_67"></span>
<label for="ct_67">Denmark</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="68" id="ct_68">
<span class="ct_68"></span>
<label for="ct_68">Djibouti</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="69" id="ct_69">
<span class="ct_69"></span>
<label for="ct_69">Dominica</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="70" id="ct_70">
<span class="ct_70"></span>
<label for="ct_70">Dominican Republic</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="71" id="ct_71">
<span class="ct_71"></span>
<label for="ct_71">Ecuador</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="72" id="ct_72">
<span class="ct_72"></span>
<label for="ct_72">Egypt</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="73" id="ct_73">
<span class="ct_73"></span>
<label for="ct_73">El Salvador</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="74" id="ct_74">
<span class="ct_74"></span>
<label for="ct_74">Equatorial Guinea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="75" id="ct_75">
<span class="ct_75"></span>
<label for="ct_75">Eritrea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="76" id="ct_76">
<span class="ct_76"></span>
<label for="ct_76">Estonia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="77" id="ct_77">
<span class="ct_77"></span>
<label for="ct_77">Ethiopia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="78" id="ct_78">
<span class="ct_78"></span>
<label for="ct_78">Falkland Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="79" id="ct_79">
<span class="ct_79"></span>
<label for="ct_79">Faroe Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="80" id="ct_80">
<span class="ct_80"></span>
<label for="ct_80">Fiji</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="81" id="ct_81">
<span class="ct_81"></span>
<label for="ct_81">Finland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="83" id="ct_83">
<span class="ct_83"></span>
<label for="ct_83">French Guiana</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="84" id="ct_84">
<span class="ct_84"></span>
<label for="ct_84">French Polynesia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="86" id="ct_86">
<span class="ct_86"></span>
<label for="ct_86">Gabon</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="87" id="ct_87">
<span class="ct_87"></span>
<label for="ct_87">Gambia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="88" id="ct_88">
<span class="ct_88"></span>
<label for="ct_88">Georgia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="89" id="ct_89">
<span class="ct_89"></span>
<label for="ct_89">Germany</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="90" id="ct_90">
<span class="ct_90"></span>
<label for="ct_90">Ghana</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="91" id="ct_91">
<span class="ct_91"></span>
<label for="ct_91">Gibraltar</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="92" id="ct_92">
<span class="ct_92"></span>
<label for="ct_92">Greece</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="93" id="ct_93">
<span class="ct_93"></span>
<label for="ct_93">Greenland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="94" id="ct_94">
<span class="ct_94"></span>
<label for="ct_94">Grenada</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="95" id="ct_95">
<span class="ct_95"></span>
<label for="ct_95">Guadeloupe</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="96" id="ct_96">
<span class="ct_96"></span>
<label for="ct_96">Guam</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="97" id="ct_97">
<span class="ct_97"></span>
<label for="ct_97">Guatemala</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="98" id="ct_98">
<span class="ct_98"></span>
<label for="ct_98">Guernsey</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="99" id="ct_99">
<span class="ct_99"></span>
<label for="ct_99">Guinea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="100" id="ct_100">
<span class="ct_100"></span>
<label for="ct_100">Guinea-Bissau</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="101" id="ct_101">
<span class="ct_101"></span>
<label for="ct_101">Guyana</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="102" id="ct_102">
<span class="ct_102"></span>
<label for="ct_102">Haiti</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="163" id="ct_163">
<span class="ct_163"></span>
<label for="ct_163">Holland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="105" id="ct_105">
<span class="ct_105"></span>
<label for="ct_105">Honduras</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="106" id="ct_106">
<span class="ct_106"></span>
<label for="ct_106">Hong kong</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="107" id="ct_107">
<span class="ct_107"></span>
<label for="ct_107">Hungary</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="108" id="ct_108">
<span class="ct_108"></span>
<label for="ct_108">Iceland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="109" id="ct_109">
<span class="ct_109"></span>
<label for="ct_109">India</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="110" id="ct_110">
<span class="ct_110"></span>
<label for="ct_110">Indonesia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="111" id="ct_111">
<span class="ct_111"></span>
<label for="ct_111">Iran</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="112" id="ct_112">
<span class="ct_112"></span>
<label for="ct_112">Iraq</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="113" id="ct_113">
<span class="ct_113"></span>
<label for="ct_113">Ireland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="115" id="ct_115">
<span class="ct_115"></span>
<label for="ct_115">Israel</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="116" id="ct_116">
<span class="ct_116"></span>
<label for="ct_116">Italy</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="280" id="ct_280">
<span class="ct_280"></span>
<label for="ct_280">Ivory Coast</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="117" id="ct_117">
<span class="ct_117"></span>
<label for="ct_117">Jamaica</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="118" id="ct_118">
<span class="ct_118"></span>
<label for="ct_118">Japan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="119" id="ct_119">
<span class="ct_119"></span>
<label for="ct_119">Jersey</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="120" id="ct_120">
<span class="ct_120"></span>
<label for="ct_120">Jordan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="121" id="ct_121">
<span class="ct_121"></span>
<label for="ct_121">Kazakhstan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="122" id="ct_122">
<span class="ct_122"></span>
<label for="ct_122">Kenya</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="123" id="ct_123">
<span class="ct_123"></span>
<label for="ct_123">Kiribati</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="281" id="ct_281">
<span class="ct_281"></span>
<label for="ct_281">Korea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="126" id="ct_126">
<span class="ct_126"></span>
<label for="ct_126">Kuwait</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="127" id="ct_127">
<span class="ct_127"></span>
<label for="ct_127">Kyrgyzstan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="128" id="ct_128">
<span class="ct_128"></span>
<label for="ct_128">Laos</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="129" id="ct_129">
<span class="ct_129"></span>
<label for="ct_129">Latvia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="130" id="ct_130">
<span class="ct_130"></span>
<label for="ct_130">Lebanon</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="131" id="ct_131">
<span class="ct_131"></span>
<label for="ct_131">Lesotho</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="132" id="ct_132">
<span class="ct_132"></span>
<label for="ct_132">Liberia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="133" id="ct_133">
<span class="ct_133"></span>
<label for="ct_133">Libya</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="134" id="ct_134">
<span class="ct_134"></span>
<label for="ct_134">Liechtenstein</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="135" id="ct_135">
<span class="ct_135"></span>
<label for="ct_135">Lithuania</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="136" id="ct_136">
<span class="ct_136"></span>
<label for="ct_136">Luxembourg</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="137" id="ct_137">
<span class="ct_137"></span>
<label for="ct_137">Macao</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="138" id="ct_138">
<span class="ct_138"></span>
<label for="ct_138">Macedonia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="139" id="ct_139">
<span class="ct_139"></span>
<label for="ct_139">Madagascar</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="284" id="ct_284">
<span class="ct_284"></span>
<label for="ct_284">Madeira</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="140" id="ct_140">
<span class="ct_140"></span>
<label for="ct_140">Malawi</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="141" id="ct_141">
<span class="ct_141"></span>
<label for="ct_141">Malaysia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="142" id="ct_142">
<span class="ct_142"></span>
<label for="ct_142">Maldives</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="143" id="ct_143">
<span class="ct_143"></span>
<label for="ct_143">Mali</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="144" id="ct_144">
<span class="ct_144"></span>
<label for="ct_144">Malta</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="146" id="ct_146">
<span class="ct_146"></span>
<label for="ct_146">Martinique</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="147" id="ct_147">
<span class="ct_147"></span>
<label for="ct_147">Mauritania</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="148" id="ct_148">
<span class="ct_148"></span>
<label for="ct_148">Mauritius</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="149" id="ct_149">
<span class="ct_149"></span>
<label for="ct_149">Mayotte</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="150" id="ct_150">
<span class="ct_150"></span>
<label for="ct_150">Mexico</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="151" id="ct_151">
<span class="ct_151"></span>
<label for="ct_151">Micronesia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="152" id="ct_152">
<span class="ct_152"></span>
<label for="ct_152">Moldova</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="153" id="ct_153">
<span class="ct_153"></span>
<label for="ct_153">Monaco</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="154" id="ct_154">
<span class="ct_154"></span>
<label for="ct_154">Mongolia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="155" id="ct_155">
<span class="ct_155"></span>
<label for="ct_155">Montenegro</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="156" id="ct_156">
<span class="ct_156"></span>
<label for="ct_156">Montserrat</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="157" id="ct_157">
<span class="ct_157"></span>
<label for="ct_157">Morocco</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="158" id="ct_158">
<span class="ct_158"></span>
<label for="ct_158">Mozambique</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="159" id="ct_159">
<span class="ct_159"></span>
<label for="ct_159">Myanmar</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="160" id="ct_160">
<span class="ct_160"></span>
<label for="ct_160">Namibia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="161" id="ct_161">
<span class="ct_161"></span>
<label for="ct_161">Nauru</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="162" id="ct_162">
<span class="ct_162"></span>
<label for="ct_162">Nepal</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="287" id="ct_287">
<span class="ct_287"></span>
<label for="ct_287">Netherlands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="165" id="ct_165">
<span class="ct_165"></span>
<label for="ct_165">New Zealand</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="166" id="ct_166">
<span class="ct_166"></span>
<label for="ct_166">Nicaragua</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="167" id="ct_167">
<span class="ct_167"></span>
<label for="ct_167">Niger</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="168" id="ct_168">
<span class="ct_168"></span>
<label for="ct_168">Nigeria</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="124" id="ct_124">
<span class="ct_124"></span>
<label for="ct_124">North Korea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="172" id="ct_172">
<span class="ct_172"></span>
<label for="ct_172">Norway</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="173" id="ct_173">
<span class="ct_173"></span>
<label for="ct_173">Oman</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="174" id="ct_174">
<span class="ct_174"></span>
<label for="ct_174">Pakistan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="175" id="ct_175">
<span class="ct_175"></span>
<label for="ct_175">Palau</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="176" id="ct_176">
<span class="ct_176"></span>
<label for="ct_176">Palestinian Territory</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="177" id="ct_177">
<span class="ct_177"></span>
<label for="ct_177">Panama</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="178" id="ct_178">
<span class="ct_178"></span>
<label for="ct_178">Papua New Guinea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="179" id="ct_179">
<span class="ct_179"></span>
<label for="ct_179">Paraguay</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="180" id="ct_180">
<span class="ct_180"></span>
<label for="ct_180">Peru</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="181" id="ct_181">
<span class="ct_181"></span>
<label for="ct_181">Philippines</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="183" id="ct_183">
<span class="ct_183"></span>
<label for="ct_183">Poland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="184" id="ct_184">
<span class="ct_184"></span>
<label for="ct_184">Portugal</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="185" id="ct_185">
<span class="ct_185"></span>
<label for="ct_185">Puerto Rico</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="186" id="ct_186">
<span class="ct_186"></span>
<label for="ct_186">Qatar</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="187" id="ct_187">
<span class="ct_187"></span>
<label for="ct_187">Reunion</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="188" id="ct_188">
<span class="ct_188"></span>
<label for="ct_188">Romania</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="189" id="ct_189">
<span class="ct_189"></span>
<label for="ct_189">Russia (east of urals)</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="296" id="ct_296">
<span class="ct_296"></span>
<label for="ct_296">Russia (west of urals)</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="190" id="ct_190">
<span class="ct_190"></span>
<label for="ct_190">Rwanda</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="297" id="ct_297">
<span class="ct_297"></span>
<label for="ct_297">Saint Barthelemy</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="193" id="ct_193">
<span class="ct_193"></span>
<label for="ct_193">Saint Kitts</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="194" id="ct_194">
<span class="ct_194"></span>
<label for="ct_194">Saint Lucia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="197" id="ct_197">
<span class="ct_197"></span>
<label for="ct_197">Saint Vincent</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="198" id="ct_198">
<span class="ct_198"></span>
<label for="ct_198">Samoa</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="199" id="ct_199">
<span class="ct_199"></span>
<label for="ct_199">San Marino</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="200" id="ct_200">
<span class="ct_200"></span>
<label for="ct_200">Sao Tome</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="300" id="ct_300">
<span class="ct_300"></span>
<label for="ct_300">Sardinia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="201" id="ct_201">
<span class="ct_201"></span>
<label for="ct_201">Saudi Arabia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="202" id="ct_202">
<span class="ct_202"></span>
<label for="ct_202">Senegal</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="203" id="ct_203">
<span class="ct_203"></span>
<label for="ct_203">Serbia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="204" id="ct_204">
<span class="ct_204"></span>
<label for="ct_204">Seychelles</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="205" id="ct_205">
<span class="ct_205"></span>
<label for="ct_205">Sierra Leone</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="206" id="ct_206">
<span class="ct_206"></span>
<label for="ct_206">Singapore</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="208" id="ct_208">
<span class="ct_208"></span>
<label for="ct_208">Slovakia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="209" id="ct_209">
<span class="ct_209"></span>
<label for="ct_209">Slovenia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="301" id="ct_301">
<span class="ct_301"></span>
<label for="ct_301">Solomon Islands</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="211" id="ct_211">
<span class="ct_211"></span>
<label for="ct_211">Somalia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="212" id="ct_212">
<span class="ct_212"></span>
<label for="ct_212">South Africa</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="125" id="ct_125">
<span class="ct_125"></span>
<label for="ct_125">South Korea</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="214" id="ct_214">
<span class="ct_214"></span>
<label for="ct_214">South Sudan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="216" id="ct_216">
<span class="ct_216"></span>
<label for="ct_216">Sri Lanka</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="303" id="ct_303">
<span class="ct_303"></span>
<label for="ct_303">St Helena</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="304" id="ct_304">
<span class="ct_304"></span>
<label for="ct_304">St Martin</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="217" id="ct_217">
<span class="ct_217"></span>
<label for="ct_217">Sudan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="218" id="ct_218">
<span class="ct_218"></span>
<label for="ct_218">Suriname</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="220" id="ct_220">
<span class="ct_220"></span>
<label for="ct_220">Swaziland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="221" id="ct_221">
<span class="ct_221"></span>
<label for="ct_221">Sweden</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="222" id="ct_222">
<span class="ct_222"></span>
<label for="ct_222">Switzerland</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="223" id="ct_223">
<span class="ct_223"></span>
<label for="ct_223">Syria</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="224" id="ct_224">
<span class="ct_224"></span>
<label for="ct_224">Taiwan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="225" id="ct_225">
<span class="ct_225"></span>
<label for="ct_225">Tajikistan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="226" id="ct_226">
<span class="ct_226"></span>
<label for="ct_226">Tanzania</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="227" id="ct_227">
<span class="ct_227"></span>
<label for="ct_227">Thailand</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="229" id="ct_229">
<span class="ct_229"></span>
<label for="ct_229">Togo</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="231" id="ct_231">
<span class="ct_231"></span>
<label for="ct_231">Tonga</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="232" id="ct_232">
<span class="ct_232"></span>
<label for="ct_232">Trinidad</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="233" id="ct_233">
<span class="ct_233"></span>
<label for="ct_233">Tunisia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="234" id="ct_234">
<span class="ct_234"></span>
<label for="ct_234">Turkey</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="235" id="ct_235">
<span class="ct_235"></span>
<label for="ct_235">Turkmenistan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="240" id="ct_240">
<span class="ct_240"></span>
<label for="ct_240">UAE</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="238" id="ct_238">
<span class="ct_238"></span>
<label for="ct_238">Uganda</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="239" id="ct_239">
<span class="ct_239"></span>
<label for="ct_239">Ukraine</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="244" id="ct_244">
<span class="ct_244"></span>
<label for="ct_244">Uruguay</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="245" id="ct_245">
<span class="ct_245"></span>
<label for="ct_245">Uzbekistan</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="246" id="ct_246">
<span class="ct_246"></span>
<label for="ct_246">Vanuatu</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="104" id="ct_104">
<span class="ct_104"></span>
<label for="ct_104">Vatican City</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="247" id="ct_247">
<span class="ct_247"></span>
<label for="ct_247">Venezuela</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="248" id="ct_248">
<span class="ct_248"></span>
<label for="ct_248">Vietnam</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="313" id="ct_313">
<span class="ct_313"></span>
<label for="ct_313">Wake Island</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="253" id="ct_253">
<span class="ct_253"></span>
<label for="ct_253">Yemen</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="316" id="ct_316">
<span class="ct_316"></span>
<label for="ct_316">Zaire</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="254" id="ct_254">
<span class="ct_254"></span>
<label for="ct_254">Zambia</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="255" id="ct_255">
<span class="ct_255"></span>
<label for="ct_255">Zimbabwe</label>
</div>
<div class="individualCountry">
<input type="checkbox" class="moreCountriesShow" name="CountriesSelected" value="311" id="ct_311">
<span class="ct_311"></span>
<label for="ct_311">Virgin Islands (UK)</label>
</div>
</div>
</div>
<div class="twelve columns" id="selectedCountries" style="display:none;">
<p><strong>Selected Countries</strong></p>
<div id="selectedCountriesList"></div>
</div>
<!-- #endregion -->
<!-- #region StartDates-->
<div id="divStartDates" class="questionBox">
<p class="coverInfo">
<strong>Choose your cover start date</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<p>Annual policies provide cover for 12 months from the start date you choose. It's best to buy the policy in advance of your first trip to give you cancellation cover straight away.</p>
<p></p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">Single Trip</strong>Cancellation cover starts when You purchase this insurance or when You book Your Trip, whichever is the later.</p>
<p><strong class="nH-Sub">Annual Multi Trip</strong>Cancellation cover begins on the start date you choose or, if later, when you book your trip.</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
</div>
<div data-toggle="buttons">
<div class="checkbox">
<input class="datefrom" data-val="true" data-val-required="The Selected field is required." id="df_0" name="StartDates[0].Selected" type="checkbox" value="true"><input name="StartDates[0].Selected" type="hidden" value="false">
<label for="df_0" data-attribute-day="21">Today (21 Dec 2021)</label>
<input data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="StartDates_0__Id" name="StartDates[0].Id" type="hidden" value="0">
<input id="StartDates_0__DisplayName" name="StartDates[0].DisplayName" type="hidden" value="Today">
<input class="fromdf_0" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="StartDates_0__Date" name="StartDates[0].Date" type="hidden" value="21/12/2021 00:00:00">
</div>
<div class="checkbox">
<input class="datefrom" data-val="true" data-val-required="The Selected field is required." id="df_1" name="StartDates[1].Selected" type="checkbox" value="true"><input name="StartDates[1].Selected" type="hidden" value="false">
<label for="df_1" data-attribute-day="22">Tomorrow (22 Dec 2021)</label>
<input data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="StartDates_1__Id" name="StartDates[1].Id" type="hidden" value="1">
<input id="StartDates_1__DisplayName" name="StartDates[1].DisplayName" type="hidden" value="Tomorrow">
<input class="fromdf_1" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="StartDates_1__Date" name="StartDates[1].Date" type="hidden" value="22/12/2021 00:00:00">
</div>
<div class="checkbox">
<input class="datefrom" data-val="true" data-val-required="The Selected field is required." id="df_2" name="StartDates[2].Selected" type="checkbox" value="true"><input name="StartDates[2].Selected" type="hidden" value="false">
<label for="df_2" data-attribute-day="23">Thursday (23 Dec 2021)</label>
<input data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="StartDates_2__Id" name="StartDates[2].Id" type="hidden" value="2">
<input id="StartDates_2__DisplayName" name="StartDates[2].DisplayName" type="hidden" value="Thursday">
<input class="fromdf_2" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="StartDates_2__Date" name="StartDates[2].Date" type="hidden" value="23/12/2021 00:00:00">
</div>
<div class="checkbox">
<input class="datefrom" data-val="true" data-val-required="The Selected field is required." id="df_3" name="StartDates[3].Selected" type="checkbox" value="true"><input name="StartDates[3].Selected" type="hidden" value="false">
<label for="df_3" data-attribute-day="24">Friday (24 Dec 2021)</label>
<input data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="StartDates_3__Id" name="StartDates[3].Id" type="hidden" value="3">
<input id="StartDates_3__DisplayName" name="StartDates[3].DisplayName" type="hidden" value="Friday">
<input class="fromdf_3" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="StartDates_3__Date" name="StartDates[3].Date" type="hidden" value="24/12/2021 00:00:00">
</div>
<div id="btnStartDateOverride">
<input value="" class="hasDatepicker" data-val="true" data-val-date="The field StartDateOverride must be a date." id="StartDateOverride" name="StartDateOverride" type="text">
<label class="date-label ">Select Date</label>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<!-- #region ExpireDates-->
<div id="divExpireDates" class="questionBox" style="display:block;">
<p class="coverInfo">
</p>
<div class="coverChoice">
</div>
<p class="coverInfo">
<strong>Choose your cover end date</strong>
</p>
<p></p>
<p>Please ensure the dates you select cover you from the time of leaving home to your return home at the end of the trip. </p>
<p></p>
<p></p>
<div class="coverChoice">
<div data-toggle="buttons">
<div id="divEndDate">
<div class="datetoCheckbox">
<input name="ReturnDates[0].Selected" class="dateto" data-val="true" data-val-required="The Selected field is required." id="dt_0" type="checkbox" value="true"><input name="EndDates[0].Selected" type="hidden" value="false">
<label for="dt_0" data-attribute-day="26">5 Nights (26 Dec 2021)</label>
<input name="ReturnDates[0].Id" data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="EndDates_0__Id" type="hidden" value="0">
<input name="ReturnDates[0].DisplayName" id="EndDates_0__DisplayName" type="hidden" value="5 Nights">
<input name="ReturnDates[0].Date" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="EndDates_0__Date" type="hidden" value="26/12/2021 00:00:00">
</div>
<div class="datetoCheckbox">
<input name="ReturnDates[1].Selected" class="dateto" data-val="true" data-val-required="The Selected field is required." id="dt_1" type="checkbox" value="true"><input name="EndDates[1].Selected" type="hidden" value="false">
<label for="dt_1" data-attribute-day="28">7 Nights (28 Dec 2021)</label>
<input name="ReturnDates[1].Id" data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="EndDates_1__Id" type="hidden" value="1">
<input name="ReturnDates[1].DisplayName" id="EndDates_1__DisplayName" type="hidden" value="7 Nights">
<input name="ReturnDates[1].Date" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="EndDates_1__Date" type="hidden" value="28/12/2021 00:00:00">
</div>
<div class="datetoCheckbox">
<input name="ReturnDates[2].Selected" class="dateto" data-val="true" data-val-required="The Selected field is required." id="dt_2" type="checkbox" value="true"><input name="EndDates[2].Selected" type="hidden" value="false">
<label for="dt_2" data-attribute-day="31">10 Nights (31 Dec 2021)</label>
<input name="ReturnDates[2].Id" data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="EndDates_2__Id" type="hidden" value="2">
<input name="ReturnDates[2].DisplayName" id="EndDates_2__DisplayName" type="hidden" value="10 Nights">
<input name="ReturnDates[2].Date" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="EndDates_2__Date" type="hidden" value="31/12/2021 00:00:00">
</div>
<div class="datetoCheckbox">
<input name="ReturnDates[3].Selected" class="dateto" data-val="true" data-val-required="The Selected field is required." id="dt_3" type="checkbox" value="true"><input name="EndDates[3].Selected" type="hidden" value="false">
<label for="dt_3" data-attribute-day="04">14 Nights (04 Jan 2022)</label>
<input name="ReturnDates[3].Id" data-val="true" data-val-number="The field Id must be a number." data-val-required="The Id field is required." id="EndDates_3__Id" type="hidden" value="3">
<input name="ReturnDates[3].DisplayName" id="EndDates_3__DisplayName" type="hidden" value="14 Nights">
<input name="ReturnDates[3].Date" data-val="true" data-val-date="The field Date must be a date." data-val-required="The Date field is required." id="EndDates_3__Date" type="hidden" value="04/01/2022 00:00:00">
</div>
<script type="text/javascript">
$('.dateto, #EndDateOverride').on("click", function() {
$('#EndDateOverride').attr('class', 'hasDatepicker');
$('#EndDateOverride').attr('value', '');
$('#EndDateOverride').next().removeClass('hide-label');
$(".dateto").prop('checked', false);
$(this).prop('checked', true);
});
</script>
</div>
<div id="btnReturnDateOverride">
<input value="" class="hasDatepicker" data-val="true" data-val-date="The field EndDateOverride must be a date." id="EndDateOverride" name="EndDateOverride" type="text">
<label class="date-label ">Select Date</label>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<!-- #region Medical-->
<div id="divMedical" class="questionBox">
<p class="coverInfo">
<strong>Do you or any person travelling who is to be insured have any medical conditions?</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<p>It is important you declare all pre-existing medical conditions for all travellers to be insured on the policy. We do not have the facility to EXCLUDE medical conditions from cover.</p>
<p></p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">Travel insurance policies may differ in their exact wording but generally a medical condition may be any of the following.</strong></p>
<ul>
<li>If you've had any recurrent or chronic conditions</li>
<li>If you've previously sought or recieved treatment for a condition</li>
<li>If you've been in hospital as an in-patient</li>
<li>If you've currently or have been taking medication for a condition</li>
<li>If you've had surgery</li><span class="close">x</span>
</ul>
<p>This list is not exhaustive and if you are unsure please use the screening service which is completely free and designed to ensure you obtain the cover you need.</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
<p>This list is not exhaustive and if you are unsure please use the screening service which is completely free and designed to ensure you obtain the cover you need.</p>
</div>
<input class="medOption" id="selected_" name="IsMedicalRequired" type="hidden" value="">
<div class="medSlider">
<div class="medYes"> Yes <input type="radio" name="medical" id="yesMedical" class="bool-selected_">
</div>
<div class="medSelect ui-draggable ui-draggable-handle"><span class="answerMedical"></span></div>
<div class="medNo"> No <input type="radio" name="medical" id="noMedical" class="bool-selected_">
</div>
</div>
<p>
<b>PLEASE NOTE FAILURE TO SCREEN ALL PRE-EXISTING MEDICAL CONDITIONS FOR ALL NAMED TRAVELLERS WILL INVALIDATE YOUR POLICY.</b>
<span style="display: block;">(For full terms and conditions please check your policy wording or contact our Call Centre)</span>
</p>
</div>
</div>
<!-- #endregion -->
<!-- #region AdditionalOptions-->
<div id="divAdditional" class="questionBox">
<p class="coverInfo">
<strong>Do you need additional cover?</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">Cruise</strong> There is no cruise cover provided under any section of the policy, unless cruise cover (above) is selected and an additional premium paid.</p>
<p><strong class="nH-Sub">Golf</strong> This provides protection to your golf equipment which is up to three years old should it be lost, stolen and/or damaged in any one incident and will be reimbursed up to the amount shown in the schedule
of benefits. (See Policy Wording for full terms).</p>
<p><strong class="nH-Sub">Travel Disruption</strong> Cover for travel disruption offers you protection if your departure is significantly delayed, if alternative travel plans need to be made, or if you are unable to use part of your travel
and/or accommodation bookings. Full terms can be found in the Policy Wording.</p>
<p><strong class="nH-Sub">Airline Failure</strong> Scheduled airline failure insurance (sometimes known as Safi) gives you protection if the airline you are due to fly with goes out of business before your trip. If an airline goes bankrupt,
Safi cover can help to cover the cost of new travel arrangements – such as the fees for a replacement flight home -, or recover lost flight costs if you have to cancel your plans.</p>
<p><strong class="nH-Sub">Winter Sports</strong> For single trips you are covered when taking part in winter sports if you have paid the additional premium. For annual multi-trips there is a limit of 17 days winter sports cover per policy
year. It will cover your participation in a number of winter sports such as air boarding, downhill skiing, on a non-competitive and non-professional basis, subject to the terms and conditions of the policy. The full list can be found in the
policy wording. If you have any queries regarding cover for a particular activity, please contact us.</p>
<p><strong class="nH-Sub">Business</strong> It covers any equipment you use for your business, trade or profession, as declared to the insurers and used for the sole purpose of your business trip but not for the purposes of manual work will
be covered subject to the policy terms. (See Policy Wording for full terms).</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
</div>
<div data-toggle="buttons">
<div class="checkbox option_1">
<input data-val="true" data-val-required="The Selected field is required." id="op_1" name="Options[0].Selected" type="checkbox" value="true"><input name="Options[0].Selected" type="hidden" value="false">
<label for="op_1">Cruise</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_0__OptionTypeId" name="Options[0].OptionTypeId" type="hidden" value="1">
<input id="Options_0__OptionName" name="Options[0].OptionName" type="hidden" value="Cruise">
</div>
<div class="checkbox option_2">
<input data-val="true" data-val-required="The Selected field is required." id="op_2" name="Options[1].Selected" type="checkbox" value="true"><input name="Options[1].Selected" type="hidden" value="false">
<label for="op_2">Golf</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_1__OptionTypeId" name="Options[1].OptionTypeId" type="hidden" value="2">
<input id="Options_1__OptionName" name="Options[1].OptionName" type="hidden" value="Golf">
</div>
<div class="checkbox option_3">
<input data-val="true" data-val-required="The Selected field is required." id="op_3" name="Options[2].Selected" type="checkbox" value="true"><input name="Options[2].Selected" type="hidden" value="false">
<label for="op_3">Travel Disruption</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_2__OptionTypeId" name="Options[2].OptionTypeId" type="hidden" value="3">
<input id="Options_2__OptionName" name="Options[2].OptionName" type="hidden" value="Travel Disruption">
</div>
<div class="checkbox option_4">
<input data-val="true" data-val-required="The Selected field is required." id="op_4" name="Options[3].Selected" type="checkbox" value="true"><input name="Options[3].Selected" type="hidden" value="false">
<label for="op_4">Airline Failure</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_3__OptionTypeId" name="Options[3].OptionTypeId" type="hidden" value="4">
<input id="Options_3__OptionName" name="Options[3].OptionName" type="hidden" value="Airline Failure">
</div>
<div class="checkbox option_5">
<input data-val="true" data-val-required="The Selected field is required." id="op_5" name="Options[4].Selected" type="checkbox" value="true"><input name="Options[4].Selected" type="hidden" value="false">
<label for="op_5">Winter Sports</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_4__OptionTypeId" name="Options[4].OptionTypeId" type="hidden" value="5">
<input id="Options_4__OptionName" name="Options[4].OptionName" type="hidden" value="Winter Sports">
</div>
<div class="checkbox option_7">
<input data-val="true" data-val-required="The Selected field is required." id="op_7" name="Options[5].Selected" type="checkbox" value="true"><input name="Options[5].Selected" type="hidden" value="false">
<label for="op_7">Business</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_5__OptionTypeId" name="Options[5].OptionTypeId" type="hidden" value="7">
<input id="Options_5__OptionName" name="Options[5].OptionName" type="hidden" value="Business">
</div>
<div class="checkbox option_14">
<input data-val="true" data-val-required="The Selected field is required." id="op_14" name="Options[6].Selected" type="checkbox" value="true"><input name="Options[6].Selected" type="hidden" value="false">
<label for="op_14">Additional / Child Carer</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_6__OptionTypeId" name="Options[6].OptionTypeId" type="hidden" value="14">
<input id="Options_6__OptionName" name="Options[6].OptionName" type="hidden" value="Additional / Child Carer">
</div>
<div class="checkbox option_15">
<input data-val="true" data-val-required="The Selected field is required." id="op_15" name="Options[7].Selected" type="checkbox" value="true"><input name="Options[7].Selected" type="hidden" value="false">
<label for="op_15">Denial of Boarding (in-bound)</label>
<input data-val="true" data-val-number="The field OptionTypeId must be a number." data-val-required="The OptionTypeId field is required." id="Options_7__OptionTypeId" name="Options[7].OptionTypeId" type="hidden" value="15">
<input id="Options_7__OptionName" name="Options[7].OptionName" type="hidden" value="Denial of Boarding (in-bound)">
</div>
<div class="checkbox option_activities">
<label>Sports & Activities</label>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<div id="divActivities" class="questionBox">
<p class="coverInfo">
<strong>Please add any additional Sports & Activities that you or anyone in your party will be participating in to the box below.</strong>
</p>
<div class="activities-box">
<select id="ActivitiesSelected" multiple="" name="ActivitiesSelected" style="width:100%;" data-select2-id="ActivitiesSelected" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true"></select><span
class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="1" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="none" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="Find your activities..." style="width: 500px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</div>
<br>
<link href="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.7/css/select2.min.css" rel="stylesheet">
<script src="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.7/js/select2.min.js"></script>
<script type="text/javascript" src="/content/scripts/activities.js"></script>
<script>
</script>
</div>
<!-- #region TravellerTypes-->
<div id="divTravellerType" class="questionBox">
<h2>Who is travelling?</h2>
<p class="coverInfo">
<strong>Who do you wish the insurance to cover?</strong>
<span class="newInfo"><i class="fa fa-question" aria-hidden="true"></i></span>
</p>
<div class="coverChoice">
<div class="tooltip">
<p><strong class="nH-Sub">Individual</strong> Between 1 and 8 individuals travelling who are not a couple or family.</p>
<p><strong class="nH-Sub">Couple</strong> You and your spouse/common law partner liviing at the same address.</p>
<p><strong class="nH-Sub">Family</strong> You, your spouse/common law partner living at the same address, and/or yours or their dependent children, foster children, legal wards, or grandchildren under 18 years old of age (in full-time
education and /or residing with them)</p>
<p><strong class="nH-Sub">Group</strong> Between 2 and 8 individuals can travel on a policy together, they do not need to reside at the same address.</p>
<p><strong class="nH-Sub">Young Person Travelling Alone</strong> Individual young person policy (travelling with a responsible adult)</p>
<span class="close"><i class="fa fa-times-circle" aria-hidden="true"></i></span>
</div>
<div data-toggle="buttons">
<div class="checkbox travtype_1">
<input data-val="true" data-val-number="The field TravellerTypeSelected must be a number." data-val-range="Please select a traveller type" data-val-range-max="100" data-val-range-min="1"
data-val-required="The TravellerTypeSelected field is required." id="tt_1" name="TravellerTypeSelected" type="radio" value="1">
<label for="tt_1">Individual</label>
</div>
<div class="checkbox travtype_4">
<input id="tt_4" name="TravellerTypeSelected" type="radio" value="4">
<label for="tt_4">Couple</label>
</div>
<div class="checkbox travtype_5">
<input id="tt_5" name="TravellerTypeSelected" type="radio" value="5">
<label for="tt_5">Family</label>
</div>
<div class="checkbox travtype_6">
<input id="tt_6" name="TravellerTypeSelected" type="radio" value="6">
<label for="tt_6">Group</label>
</div>
<div class="checkbox travtype_7">
<input id="tt_7" name="TravellerTypeSelected" type="radio" value="7">
<label for="tt_7">YoungPersonTravellingAlone</label>
</div>
</div>
<div class="travellerNumber questionBox">
<div>
<p>
<strong>Number of travellers</strong>
</p>
</div>
<div class="two columns BL-RemoveML">
<select class="BL-FullWidth" data-val="true" data-val-number="The field NumberTravellersSelected must be a number." data-val-range="Sorry, you must be between 1 and 10 to continue." data-val-range-max="10" data-val-range-min="1"
data-val-required="The NumberTravellersSelected field is required." id="NumberTravellersSelected" name="NumberTravellersSelected">
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
</select>
</div>
</div>
<div id="divDOB" class="questionBox">
<div class="twelve columns">
<p><strong>Traveller's date of birth</strong></p>
<div class="two columns BL-RemoveML">
<select name="DateOfBirths[0].BirthDate" class="BL-FullWidth" data-val="true" data-val-number="The field BirthDate must be a number." id="DateOfBirths_0__BirthDate">
<option value="">Day</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
<div class="two columns BL-RemoveML">
<select name="DateOfBirths[0].BirthMonth" class="BL-FullWidth" data-val="true" data-val-number="The field BirthMonth must be a number." id="DateOfBirths_0__BirthMonth">
<option value="">Month</option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
<div class="two columns BL-RemoveML ">
<select name="DateOfBirths[0].BirthYear" class="BL-FullWidth" data-val="true" data-val-number="The field BirthYear must be a number." id="DateOfBirths_0__BirthYear">
<option value="1921">1921</option>
<option value="1922">1922</option>
<option value="1923">1923</option>
<option value="1924">1924</option>
<option value="1925">1925</option>
<option value="1926">1926</option>
<option value="1927">1927</option>
<option value="1928">1928</option>
<option value="1929">1929</option>
<option value="1930">1930</option>
<option value="1931">1931</option>
<option value="1932">1932</option>
<option value="1933">1933</option>
<option value="1934">1934</option>
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="">Year</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
</select>
</div>
</div>
</div>
</div>
</div>
<!-- #endregion -->
<!-- #region UK Resident -->
<div class="questionBox confirm-uk-resident" id="uk-resident">
<!-- Keep STRONG for styling, remove later -->
<strong>
<label for="TravellerConfirm">
<input data-val="true" data-val-range="Please confirm all travellers meet requirements." data-val-range-max="True" data-val-range-min="True" data-val-required="The TravellerConfirm field is required." id="TravellerConfirm"
name="TravellerConfirm" type="checkbox" value="true"><input name="TravellerConfirm" type="hidden" value="false"> Please confirm all travellers to be named on the policy are: </label>
</strong>
<ul>
<li>*Permanently resident in the United Kingdom (England,Scotland, Wales, Northern Ireland and Isle of Man).</li>
<li>*You have been in the United Kingdom for a minimum of 6 months in the year prior to purchasing your insurance policy.</li>
<li>Registered with a GP in the UK</li>
<li>Hold a UK National Insurance number (where aged 16 years of age or older)</li>
<li>Are not travelling against medical advice or with the intention of receiving medical treatment.</li>
<li>*Are travelling out from and returning to the United Kingdom and the trip is yet to commence.</li>
</ul>
<p class="nH-Sub">Before proceeding with your quotation please tick to confirm the above statement is true.</p>
<div class="divNonResident">
<p>*If you are a UK resident and you have already travelled or are an EEA resident of one of the following countries - Cyprus, France, Germany, Italy, Malta, The Netherlands, Portugal, Republic of Ireland & Spain and are looking for travel
insurance we may be able to help <a href="https://www.voyagerinsurance.com/BrokerSure/index.html?campaign=costco" target="_blank">click here</a> to find out more.</p>
</div>
</div>
<!-- #endregion -->
<!-- #region PromoCode -->
<div id="divPromocode" class="questionBox">
<p><strong>Promocode</strong></p>
<p>If you have a promotional code or tracking number please enter it here</p>
<div class="three columns BL-RemoveML">
<input class="BL-FullWidth" id="TrackingCode" name="TrackingCode" type="text" value="">
</div>
</div>
<!-- #endregion -->
<input type="submit" class="BL-Btn blueButton" value="Continue">
</form>Text Content
IMPORTANT NEWS CORONAVIRUS (COVID-19) COVER IS NOW AVAILABLE - We can confirm all of our policies now provide cover for Medical and other Expenses outside of the United Kingdom if you contract Coronavirus (COVID-19) whilst abroad. Some of our policies now also offer other additional Coronavirus (COVID-19) benefits. The policies that offer the additional cover are clearly marked where we display our prices along with the full terms and conditions. All our policies will only provide cover, if prior to your trip commencing, the Foreign, Commonwealth & Development Office has NOT advised against all (or all but essential) travel to your chosen destination. If you unsure about the cover we offer please contact our friendly team. We can assist you via telephone Mon - Fri 9am - 5pm, Sat 8.30am - 4pm or alternatively email enquiries@brokersure.com. If your query is regarding a claim please click here for further details. 0330 606 2559 * Trip Details Step 1 - This is where you will fill in the details of your trip. * Your Quotes Step 2 - This is where you select the quote you wish to proceed with. * Contact Details Step 3 - This is where you will fill in your contact details. * Card Payment Step 4 - This is where you fill in your card details & confirm payment. IMPORTANT INFORMATION Important Information Coronavirus (COVID-19) Update: We can confirm all of our policies now provide cover for Medical and other Expenses outside of the United Kingdom if you contract Coronavirus (COVID-19) whilst abroad. Some of our policies now also offer other additional Coronavirus (COVID-19) benefits. The policies that offer the additional cover are clearly marked where we display our prices along with the full terms and conditions. All our policies will only provide cover, if prior to your trip commencing, the Foreign, Commonwealth & Development Office (FCDO) has NOT advised against all (or all but essential) travel to your chosen destination. If you are unsure about the cover available please call our friendly team on the number above for more information. Please select your type of cover Single TripCover for a single trip starting in the UK and ending in the UK. Annual Multi TripAnnual cover for any number of trips starting and ending in the UK (limited to a maximum number of days for each trip unless a trip extension additional cover is purchased.) Single Trip Annual Multi-Trip Where are you going to? UKUnited Kingdom - England, Scotland, Wales, Northern Ireland and the Isle of Man. Europe 1 - Albania, Algeria, Armenia, Austria, Azerbaijan, Azores, Belarus, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark (including Faroe Islands), Estonia, Finland, France (including Corsica), Georgia, Germany, Gibraltar, Greenland, Guernsey (including Alderney, Sark and Herm), Hungary, Iceland, Ireland, Italy (including Aeolian Islands, Sardinia, Sicily), Jersey, Kosovo, Lapland, Latvia, Liechtenstein, Lithuania, Luxembourg, Macedonia, Madeira, Moldova, Monaco, Montenegro, Netherlands, Norway (including Jan Mayen, Svalbard Is), Poland, Portugal, Romania, Russia (west of Ural mountains), San Marino, Sardinia, Serbia, Slovakia, Slovenia, Sweden, Ukraine and Vatican City. Europe 2- Those countries listed above and including: Andorra, Cyprus, Greece (including Greek Isles), Malta, Spain (including Balearic and Canary Islands), Switzerland and Turkey. Australia and New Zealand Australia and New Zealand Worldwideincluding Canada, Caribbean and the USA. Worldwide Excexcluding Canada, Caribbean and the USA. Please note: No cover is provided under this policy for any trip in, to, or through Afghanistan, Liberia or Sudan. No cover is provided for claims arising as a direct result of a situation highlighted by the Foreign and Commonwealth Office where you have travelled to a specific country or to an area where, prior to your trip commencing, the Foreign and Commonwealth Office have advised against all (but essential) travel. Europe 1 Europe 2 Australia New Zealand Worldwide Exc USA/Canada/Caribbean/Mexico Worldwide Where are you going to? UKUnited Kingdom - England, Scotland, Wales, Northern Ireland and the Isle of Man. Europe 1 - Albania, Algeria, Armenia, Austria, Azerbaijan, Azores, Belarus, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark (including Faroe Islands), Estonia, Finland, France (including Corsica), Georgia, Germany, Gibraltar, Greenland, Guernsey (including Alderney, Sark and Herm), Hungary, Iceland, Ireland, Italy (including Aeolian Islands, Sardinia, Sicily), Jersey, Kosovo, Lapland, Latvia, Liechtenstein, Lithuania, Luxembourg, Macedonia, Madeira, Moldova, Monaco, Montenegro, Netherlands, Norway (including Jan Mayen, Svalbard Is), Poland, Portugal, Romania, Russia (west of Ural mountains), San Marino, Sardinia, Serbia, Slovakia, Slovenia, Sweden, Ukraine and Vatican City. Europe 2- Those countries listed above and including: Andorra, Cyprus, Greece (including Greek Isles), Malta, Spain (including Balearic and Canary Islands), Switzerland and Turkey. Australia and New Zealand Australia and New Zealand Worldwideincluding Canada, Caribbean and the USA. Worldwide Excexcluding Canada, Caribbean and the USA. Please note: No cover is provided under this policy for any trip in, to, or through Afghanistan, Liberia or Sudan. No cover is provided for claims arising as a direct result of a situation highlighted by the Foreign and Commonwealth Office where you have travelled to a specific country or to an area where, prior to your trip commencing, the Foreign and Commonwealth Office have advised against all (but essential) travel. France Spain Usa United Kingdom Australia More Countries Please enter the country name or select from the list below: Clear/Show All Hide Countries Afghanistan Aland Islands Albania Algeria Andorra Angola Isle of Man Greek Islands Anguilla Antigua Argentina Armenia Aruba Ascension Island Austria Azerbaijan Azores Bahamas Bahrain Balearics Bali Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Colombia Comoros Congo Costa rica Cote DIvoire Croatia Cuba Curacao Cyprus Cyprus - North Czech Republic Dem Rep Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Holland Honduras Hong kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Madeira Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia (east of urals) Russia (west of urals) Rwanda Saint Barthelemy Saint Kitts Saint Lucia Saint Vincent Samoa San Marino Sao Tome Sardinia Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Sri Lanka St Helena St Martin Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad Tunisia Turkey Turkmenistan UAE Uganda Ukraine Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wake Island Yemen Zaire Zambia Zimbabwe Virgin Islands (UK) Selected Countries Choose your cover start date Annual policies provide cover for 12 months from the start date you choose. It's best to buy the policy in advance of your first trip to give you cancellation cover straight away. Single TripCancellation cover starts when You purchase this insurance or when You book Your Trip, whichever is the later. Annual Multi TripCancellation cover begins on the start date you choose or, if later, when you book your trip. Today (21 Dec 2021) Tomorrow (22 Dec 2021) Thursday (23 Dec 2021) Friday (24 Dec 2021) Select Date Choose your cover end date Please ensure the dates you select cover you from the time of leaving home to your return home at the end of the trip. 5 Nights (26 Dec 2021) 7 Nights (28 Dec 2021) 10 Nights (31 Dec 2021) 14 Nights (04 Jan 2022) Select Date Do you or any person travelling who is to be insured have any medical conditions? It is important you declare all pre-existing medical conditions for all travellers to be insured on the policy. We do not have the facility to EXCLUDE medical conditions from cover. Travel insurance policies may differ in their exact wording but generally a medical condition may be any of the following. * If you've had any recurrent or chronic conditions * If you've previously sought or recieved treatment for a condition * If you've been in hospital as an in-patient * If you've currently or have been taking medication for a condition * If you've had surgery x This list is not exhaustive and if you are unsure please use the screening service which is completely free and designed to ensure you obtain the cover you need. This list is not exhaustive and if you are unsure please use the screening service which is completely free and designed to ensure you obtain the cover you need. Yes No PLEASE NOTE FAILURE TO SCREEN ALL PRE-EXISTING MEDICAL CONDITIONS FOR ALL NAMED TRAVELLERS WILL INVALIDATE YOUR POLICY. (For full terms and conditions please check your policy wording or contact our Call Centre) Do you need additional cover? Cruise There is no cruise cover provided under any section of the policy, unless cruise cover (above) is selected and an additional premium paid. Golf This provides protection to your golf equipment which is up to three years old should it be lost, stolen and/or damaged in any one incident and will be reimbursed up to the amount shown in the schedule of benefits. (See Policy Wording for full terms). Travel Disruption Cover for travel disruption offers you protection if your departure is significantly delayed, if alternative travel plans need to be made, or if you are unable to use part of your travel and/or accommodation bookings. Full terms can be found in the Policy Wording. Airline Failure Scheduled airline failure insurance (sometimes known as Safi) gives you protection if the airline you are due to fly with goes out of business before your trip. If an airline goes bankrupt, Safi cover can help to cover the cost of new travel arrangements – such as the fees for a replacement flight home -, or recover lost flight costs if you have to cancel your plans. Winter Sports For single trips you are covered when taking part in winter sports if you have paid the additional premium. For annual multi-trips there is a limit of 17 days winter sports cover per policy year. It will cover your participation in a number of winter sports such as air boarding, downhill skiing, on a non-competitive and non-professional basis, subject to the terms and conditions of the policy. The full list can be found in the policy wording. If you have any queries regarding cover for a particular activity, please contact us. Business It covers any equipment you use for your business, trade or profession, as declared to the insurers and used for the sole purpose of your business trip but not for the purposes of manual work will be covered subject to the policy terms. (See Policy Wording for full terms). Cruise Golf Travel Disruption Airline Failure Winter Sports Business Additional / Child Carer Denial of Boarding (in-bound) Sports & Activities Please add any additional Sports & Activities that you or anyone in your party will be participating in to the box below. * WHO IS TRAVELLING? Who do you wish the insurance to cover? Individual Between 1 and 8 individuals travelling who are not a couple or family. Couple You and your spouse/common law partner liviing at the same address. Family You, your spouse/common law partner living at the same address, and/or yours or their dependent children, foster children, legal wards, or grandchildren under 18 years old of age (in full-time education and /or residing with them) Group Between 2 and 8 individuals can travel on a policy together, they do not need to reside at the same address. Young Person Travelling Alone Individual young person policy (travelling with a responsible adult) Individual Couple Family Group YoungPersonTravellingAlone Number of travellers 1 2 3 4 5 6 7 8 9 10 Traveller's date of birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 Year1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Please confirm all travellers to be named on the policy are: * *Permanently resident in the United Kingdom (England,Scotland, Wales, Northern Ireland and Isle of Man). * *You have been in the United Kingdom for a minimum of 6 months in the year prior to purchasing your insurance policy. * Registered with a GP in the UK * Hold a UK National Insurance number (where aged 16 years of age or older) * Are not travelling against medical advice or with the intention of receiving medical treatment. * *Are travelling out from and returning to the United Kingdom and the trip is yet to commence. Before proceeding with your quotation please tick to confirm the above statement is true. *If you are a UK resident and you have already travelled or are an EEA resident of one of the following countries - Cyprus, France, Germany, Italy, Malta, The Netherlands, Portugal, Republic of Ireland & Spain and are looking for travel insurance we may be able to help click here to find out more. Promocode If you have a promotional code or tracking number please enter it here * Terms & Conditions * Travel Insurance Privacy * MaPS Directory Call Us: 0330 606 2559, Opening Times: Mon to Fri 9am - 5pm © Copyright 2018 Costco Travel Insurance All rights reserved. Digital House, Threshelfords Business Park, Feering, CO5 9SE Costco Travel Insurance is arranged and administered by Brokersure Ltd who are authorised and regulated by the Financial Conduct Authority. FCA No: 501719