Coverage and Agency Information:
 
Policy Number:   Today's Date:
Person Requesting Change:
Insured's Name:   Insured's Phone:

For your convenience, coverage changes are now available online within 15 business days of submission Monday through Friday. Click here to print your current travel insurance documents. No further confirmation of the change will be sent to you. Thank you for choosing Travel Guard!

Contact Email:

Please select appropriate box to indicate one or more of the following options and enter your information in the fields provided.

Original Dates (MM/DD/YYYY):
to
New Dates (MM/DD/YYYY):
to

A claim cannot be filed regarding any issue that involves the previous travel dates. No change can be made to coverage after the original return date. Trips over 30 days are subject to an additional per day premium.

 
 
Departing Airlines:
Tour Operator:
Cruise Lines:

If this addition increases the trip cost, please remember to increase policy coverage in the section below.

 
 
Primary Insured Original Trip Cost: $
Primary Insured New Trip Cost: $
Additional Insured Original Trip Cost: $
Additional Insured New Trip Cost: $
Credit Card Type:
Credit Card Holder:
Credit Card Number:
Expiration Date (MM/YYYY): /

If customer wishes to pay by check, form should be printed and mailed with payment. Coverage cannot be increased until correct premium is received. Requests for decreases in trip cost will not be processed.

Any additional information such as other insured's names please add in the additional comments section below.

 
 
Reason for Payment:
Credit Card Type:
Credit Card Holder:
Credit Card Number:
Expiration Date (MM/YYYY): /
 
 
  
Original Destination:
New Destination:

Please include city and state for destinations within the USA and country for international destinations.

 
Primary Insured: How name currently appears
Primary Insured: Correct spelling of the name
Additional Insured: How name currently appears
Additional Insured: Correct spelling of the name

Coverage is non-transferable.
 
How address currently appears:
Correct address:
 
 
Names of the Beneficiaries to be added:

All the beneficiaries will be given equal percentage of the benefit.
 
Do not enter any credit card data in the text box below.
 
Policy Refund

Requests must be submitted to Travel Guard in writing, within 15 days of the effective date of the policy, provided it is not past the original departure date. Please click here to submit the request.

 
Questions?
Call us at 1.800.826.4919

Copyright ©2024, Travel Guard.
Non insurance services are provided by Travel Guard.
Coverage available to U.S. residents of the U.S. states and District of Columbia only. This plan provides insurance coverage that only applies during the covered trip. You may have coverage from other sources that provides you with similar benefits but may be subject to different restrictions depending upon your other coverages. You may wish to compare the terms of this policy with your existing life, health, home, and automobile insurance policies. If you have any questions about your current coverage, call your insurer or insurance agent or broker. Coverage is offered by Travel Guard Group, Inc. (Travel Guard). California lic. no.0B93606, 3300 Business Park Drive, Stevens Point, WI 54482, www.travelguard.com. CA DOI toll free number: 800-927-HELP. This is only a brief description of the coverage(s) available. The Policy will contain reductions, limitations, exclusions and termination provisions. Insurance underwritten by National Union Fire Insurance Company of Pittsburgh, Pa., a Pennsylvania insurance company, with its principal place of business at 175 Water Street, 15th Floor, New York, NY 10038. It is currently authorized to transact business in all states and the District of Columbia. NAIC No. 19445. Coverage may not be available in all states. Your travel retailer may not be licensed to sell insurance, and cannot answer technical questions about the benefits, exclusions, and conditions of this insurance and cannot evaluate the adequacy of your existing insurance. The purchase of travel insurance is not required in order to purchase any other product or service from the Travel Retailer.