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Destination:

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Return Date:

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Would you like cover for a pre‑existing medical condition

Your Resident Country:

Medical Details:

Have any travellers had a Medical Condition that (a) has been diagnosed or where the initial onset of symptoms has occurred within the last 3 months or (b) has required any change in medication (any increase in dose or an increase in medication) within the last 3 months.

Have any travellers EVER received any treatment, investigations or tests for any cardiovascular or circulatory condition?

Travellers Details:

Traveller 1 Age:

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