J. L. Morris (Insurance Brokers) Ltd.  
  Manor House, 1 Macaulay Road, Broadstone, BH18 8AS. Tel: (01202) 642840 Fax: (01202) 658815  
 
 
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Jayne Bailey
Larraine Rowlands
Eileen Roberts
Steve Cole
Stan Maddams
 

Holiday Cancellation Insurance Application

NOTE: This insurance is available for holidays within the United Kingdom,
the Isle of Man and the Channel Islands only.

For a quotation, please complete the form below and click the "Next" button. On the next page, click the "Print" button to print it and then sign it and post it to us at the address above with your cheque. You can also call us on (01202) 642840, or fax to (01202) 658815. Our email address is info@jlmorris.co.uk

Premiums

(Valid for holidays before 31st December 2013)
Total cost of booked holiday accommodation for all members of your party:
Total Cost of Booking Premium *
Minimum to £100 £16.00
£101 to £150 £22.00
£151 to £200 £26.00
£201 to £250 £30.00
£251 to £300 £33.00
£301 to £350 £38.00
£351 to £400 £41.00
£401 to £450 £45.00
£451 to £500 £49.00
£501 to £550 £51.00
£551 to £600 £59.00
£601 to £650 £61.00
£651 to £700 £66.00
£701 to £800 £70.00
£801 to £900 £85.00
£901 to £1,000 £93.00
       
plus £6.00 for each additional £100.00 in excess of £1,000. For total Cost
of Booking in excess of £5,000, please refer to J. L. Morris for a quotation.
 
* All premiums include Insurance Premium Tax.
 
YOUR DETAILS
  YOUR NAME  
  YOUR ADDRESS  
  YOUR E-MAIL ADDRESS  
  YOUR TELEPHONE  
HOLIDAY DETAILS
  INCLUSIVE DATES OF HOLIDAY  
  NAME & ADDRESS OF
HOLIDAY ESTABLISHMENT/AGENCY		  
  NAMES OF INSURED PERSONS
(ALL members of the party) 		 

1.  
2.  
3.  
4.  
5.  
6.  
7.  
8.  
9.  
10.

  SUM INSURED
  £
  PREMIUM
(See table above) 		  £
DECLARATION
  I declare to the best of my knowledge that I am not aware of any reason why the holiday should be cancelled and agree that this application form shall be the basis of the contract of insurance. I also declare that the insured persons are not taking this holiday against the advice of any medical practitioner.

NB. All material facts should be declared. Material facts are those which an Insurer would regard as likely to influence the assessment and acceptance of the proposal. If you are in any doubt about any of the facts, please declare them, as failure to do so may invalidate your cover.
 

NOTE: The information you have provided will be used in connection with this Holiday Cancellation Application and any claim only. It will not be used for marketing purposes.

If you are not happy with your Holiday Cancellation Policy you may return it to us within 14 days of issue and we will refund your payment in full provided you have not travelled and no claim has been made.
       
     
 
     
  Registered in England No. 1012552. Consumer Credit Licence No. 052347. Registered Office: Manor House, 1 Macaulay Road, Broadstone, BH18 8AS
Authorised and Regulated by the Financial Conduct Authority. Firm Register Number 306499		  
 
J. L. Morris (Insurance Brokers Ltd., Manor House, 1 Macaulay Road, Broadstone, Dorset, BH18 8AS
Tel: (01202) 642840 Fax: (01202) 658815