Business Travel Insurance Form

(NOT valid for holiday trips)

The University of Manchester
Policy Number - 55UK475502

Area code Standard Activities Hazardous Activities Countries
Area U
26p per person per day 77p per person per day
United Kingdom and Isle of Man (involving Air Travel and/or overnight stays only
Area E
68p per person per day 1.43p per person per day
All European countries (excluding United Kingdom and Isle of Man), including Republic of Ireland, Channel Islands, Madeira, the Canary Islands, the Azores, Iceland, Russia west of the Ural mountains and all countries which border the Mediterranean
Area W
94p per person per day 1.91p per person per day
Worldwide excluding United Kingdom, Isle of Man and Europe

Please indicate in the table below if you are undertaking any hazardous activities (If any part of the trip involves hazardous activities, then the rate for hazardous activities is to be charged for the whole trip)

Hazardous activities includes assault courses, boxing, fencing, football, hand-gliding, hot air ballooning, martial arts, motor cyling, mountaineering, parachuting, parascending, pot holding, rock climbing, rugby, scooter riding, ski-ing, sub aqua diving, trampolining, water ski-ing, winter sports

Start date (dd/mm/yyyy) Activities No of days No of people

Destination

(enter code U, E or W)

Standard

Hazardous

Increased baggage and business equipment options

This option is available to increase the Baggage/Emergency purchases to £2,500/£500 respectively. If you wish to avail yourself of this cover, please show the appropriate premium in the box. Additional Premium £2.75 per person per week or part thereof. For example 5 days = 1 week, 9 days = 2 weeks etc.

This option is available to include business equipment, the limit of cover is £3,000 with a single article limit of £1,500 any one claim. If you wish to avail yourself of this cover, please show the appropriate premium in the box. Additional Premium £2.75 per person per week or part thereof. For example 5 days = 1 week, 9 days = 2 weeks etc.

If either of the above options is required please specify C or D and complete the box below.

Option
Tick to select
Premium   No of people   No of weeks
Increased baggage
 Yes
No 		£2.75 x x
Business equipment
Yes
No 		£2.75 x x

Your details

Name(s) of all persons travelling
Your Faculty
Your Department/School
Contact telephone number
General Ledger Finance Code:
or Project Code

For enquiries about details on this form please contact the Insurance Office, John Owens Building, telephone: 0161 275 2160.