Travel and Client InformationCompany Name* ABN* Company Suburb* Nature of Business* Nature of Travel* Private Travel for Directors: Please complete travel declaration for all trips required to be covered under this policyBusiness Travel(for insured persons based outside of Australia, please provide a separate declaration)Trips are per person, per trip: i.e. Family of 4 travelling to USA = 4 trips*Trip LocationsNumber of Trips (per person)Average Trip DurationMaximum Trip DurationApprox % of Blue Collar activities:Notes/additional information (if blue collar trips included, please provide details e.g. duties performed, tools used, etc.) Select RegionAfricaAsiaEuropeMiddle EastNorth AmericaOceaniaSouth AmericaAntarcticaInterstateIntrastate Private Travel Declaration(declare as 1 person = 1 trip)For Nominated Persons, please advise names, D.O.B, relationship to the company & activities*Trip LocationsNumber of TripsAverage Trip DurationMaximum Trip DurationAdditional information: cruise, skiing, sports, recreational activities, etc. Select RegionAfricaAsiaEuropeMiddle EastNorth AmericaOceaniaSouth AmericaAntarcticaInterstateIntrastate Charter Flights(declare per flight i.e. 1 return trip = 2 flights)Type of FlightNumber of FlightsMax Persons per Flight Select FlightDomestic Single EngineDomestic Twin EngineDomestic HelicopterOverseas Single EngineOverseas Twin EngineOverseas Helicopter Destination and purpose of flights:Additional InformationMaximum number of persons traveling together at any one time Details of blue‐collar activities(if declared above)CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
