Declaration: Single Trip Travel From UGM Magenta Ltd.

It is declared that:

All insured persons:

No insured person:

It is understood that any claims arising directly or indirectly from any existing medical condition will only be covered as long as:

Signed:_________________________

Name:_________________________

Capacity:_________________________

Date:_________________________

Explanatory Note

There is no cover for undisclosed existing conditions;

  1. that have been diagnosed within the last 12 months, OR
  2. that were diagnosed earlier but are not effectively controlled through regular medication, diet or treatment OR
  3. for which the medication, diet or treatment has changed in the last 6 months.

UGM Magenta Ltd. | 112A Market Street, Chorley, Lancashire PR7 2SL | Tel: 0800 9159225 | Fax: 0844 555 1066 | Email: travel@ugm.co.uk