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Country of Residence 
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1 Travel Description
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 Country of Departure    Country of Arrival
 *    *
 Date of Departure  
 Date of Return
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 No of Adults (18-64)    No of Children (2-17)    No of Infant (-2)
What can I do if I am older than the maximum age limit for the policy?
You may be able to obtain an alternative travel insurance policy by contacting: 
Free Spirit:  www.freespirit4aga.co.uk quote code EXP 1000 Tel: 0845 609 8864 (Lines open 08.00am – 6.00pm Monday to Friday) or
British Insurance Brokers Association: www.biba.org.uk  Tel:  0870 950 1790 (Lines open 9.00am – 5.00pm Monday to Friday)
 * I confirm that I have purchased a flight or holiday through Expedia