Insurance Coverage Acknowledgement

I Acknowledge reading and understanding the Description of Coverage, Terms and Conditions.

I acknowledge

Do you agree to the terms and conditions?

Yes

No

Choose one of the following options:

I would like to purchase the insurance offered

I decline travel insurance. I will be responsible for loss incurred

By signing this form, I agree that A'Lur-En Mystique has taken the steps to protect my trip. If I should incur financial loss due to unforeseen reasons, I will not hold A'Lur-En Mystique liable.

I agree

Travel Insurance Acknowledgement