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AMA Travel

This special travel offer is available to current members of AMA Victoria only. Complete the form below and one of our brokers will contact you shortly. Please note: This offer is only applicable to insurance policies placed through Whitbread Insurance Brokers by AMA Victoria members and terms and conditions apply. This is an annual policy with a commencement date of 15/01/2012. No pro-rata premium is applicable. Travel insurance is arranged by Whitbread Associates Pty Ltd ABN 69 005 490 228 AFSL 229092 trading as Whitbread Insurance Brokers and issued and managed by AGA Assistance Australia Pty Ltd (ABN 52 097 227 177, AFSL 245631) for the insurer Allianz Australia Insurance Limited (ABN 15 000 122 850, AFSL 234708). Allianz do not provide any advice on this insurance based on any consideration of your objectives, financial situation or needs. Before making a decision please refer to the Product Disclosure Statement PDS POL526BA 12/11, available from Whitbread Insurance Brokers at www.whitbread.com.au or by calling 03 8646 0222. AGA Assistance Australia Pty Ltd pays Whitbread Insurance Brokers commission which is a percentage of your premium. For details ask us before we provide you with any services on these products. * Conditions Apply. Family cover is also available at an additional premium

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