AMA Travel
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Student Contents
 

AMA Travel

This special travel offer is available to current members of AMA Victoria only. Please complete the form below and one of our brokers will contact you shortly.

Complete All Fields
  • Are you a current AMA member?
    Yes
    No
  • Do you have insurance with Whitbread Insurance Brokers?
    Yes
    No
  • Title of Traveller 1
  • Given Name of Traveller 1
  • Surname of Traveller 1
  • Date of Birth for Traveller 1
  • Title of Traveller 2
  • Given Name for Traveller 2
  • Surname for Traveller 2
  • Date of Birth for Traveller 2
  • Do you require family travel insurance?
    Yes
    No
  • If yes, please provide names and birth dates of dependant children.
  • Address
  • Suburb
  • State
  • Post Code
  • Home Phone Number
  • Mobile Number
  • Email
  • Do any of the travellers have a pre-existing medical condition?
    Yes
    No
  • If yes, provide details.
  • I declare that I have read Whitbread's Financial Services Guide, the Insurer's Product Disclosure Statement and complied with my Duty of Disclosure as per the Insurance Contracts Act 1984.
    Yes
    No
  • Security Code