Thank you for getting in touch about your insurance for your trip to New Zealand! In order for us to provide you with a quote for your insurance, we need a little bit of information first. Please complete the below boxes with as much information as you can and we'll be in touch with a quote for you to check out within 5 business days.

Before you fill in this form please note the following:
- Unfortunately, the insurer we work with does not provide cover for people over 70 years of age. If anyone in your travelling party will be over the age of 70 at the time of travel, we recommend you get travel insurance with your usual provider back home.
- Our insurance provider can only provide quotes for trips that are within 18 months of travel. If your trip is more than 18 months away, please request your quote once you are within 18 months of travel.
- Our insurance can only be provided if you spend more time in New Zealand than any other country on your trip. If you are spending more time in other countries than in New Zealand, we recommend you get travel insurance with your usual provider back home.

If you have any questions please email us at yourfriends@newzealandtrails.com :)

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* 1. What are your full name(s)? Please include your Title (Mr, Mrs, Miss etc)

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* 2. What is the best email address to send your quote to?

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* 3. What are your date(s) of birth?
Please list as Day Month Year e.g. 25 November 1963 and indicate whose date of birth is whose. Please note that unfortunately we can only quote insurance if all travellers are under the age of 70 at time of travel.

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* 4. What is your full home address?

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* 5. What are your dates of travel from your home country?
E.g. What date do you leave your HOME and what date do you arrive HOME in your local time?

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* 6. If you are traveling to any other countries other than your home country and New Zealand, how long will you be in the other countries for?
Our insurance can only be provided if you spend more time in New Zealand than any other country on your trip.

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* 7. Please advise if you have any pre-exisiting medical conditions. Please note that there is a list of medical conditions that we automatically cover. If your conditions fall outside the listed criteria, the standard policy excludes existing medical conditions.

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* 8. In order to provide you with a suitable cancellation cover, please outline the total cost of your pre-paid expenses that you would like covered. Please indicate the currency.
(E.g My pre-paid expenses (flights, tour, extra accommodation) costs US$25,000 for 2 Adults)

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* 9. Do you require additional cover for Adventure or Adventure + activities. Please see the below table for what is covered under each optional add-on and then select the cover required.

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* 10. Do you require additional cover for Motorcycle/Moped riding? Please see the below table for what is covered. Note that motorcycles/moped under 250cc are automatically covered as per the auto-covered option below and you cannot exclude this to decrease your premium.

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* 11. Do you require additional cover for a multi-night cruise? Claims directly or indirectly related to a multi-night cruise are specifically excluded from your policy unless you add cruise cover.

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* 12. What level of excess would you like on your policy? Please note: the lower your excess, the higher your premium will be.

Thanks for taking the time to complete this insurance request form! We will then be in touch soon with a quote or if we need any further information to provide you with a quote. To submit this form, please click the below "DONE" button, you will then be taken to a thank you screen. If you do not see this screen then we did not receive your request. If you have any questions, please e-mail yourfriends@newzealandtrails.com :)

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