Travel Insurance Quote

Max Insurances

 

D1, 27-29 William Pickering Drive,
Rosedale, 0632

 

Phone  0508 629 5626

 

Tel: 09 913 3011
Fax: 09 913 3012

Tell us a bit more and we will be in touch

Your Name

Date of Birth

Your Address

Contact Number

Your Email

Where are you travelling to

Who will be travelling & their ages

Date of Departure

Date of Arrival

Are you a NZ resident

YesNo

Do you understand that travel insurance does not cover any pre-existing medical conditions

YesNo

Comments & any other relevant information that may affect the insurance cover

Declaration: I/WE HEREBY DECLARE AND WARRANT that the answers given above are in every respect true and correct, and that I/We have not withheld any information within My/Our knowledge likely to affect the decision of the Company as to My/Our eligibility for insurance. This request and declaration shall be the basis of the quote request.

YesNo