Travel Insurance Form

Name*:

Destination*:

SelectASEANAsia PacificWorldwide

Duration*:

To

Number of Pax*:

Adult(s):

012345678910

Child:

01234

Footnote: WhatsApp

Contact Number*:

Email*:

Your Message to us:

I consent to Wazup GI Agency Pte Ltd and its employees to use my personal data for insurance quotations represented by the company, processing of renewals and to contact me via Emails/Voice Calls/SMS at contact information provided or registered in their database.*