AXA Travel Insurance
Reservation Form

Valid only to GCC Residents and GCC Nationals (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and UAE)
Contact Travel Information
Personal Information
Title: * First Name: * Last Name : *
E-mail Address :
* ( Correspondence E-mail address )
Alternative E-mail : ( Second e-mail address,if any )

Telephone No (Office):

*
Telephone No (Home):
Mobile Number
Fax No :
Complete Postal Address :
Country Residing: *
Date of Birth : *
Nationality : *
* Indicates Mandatory Filed

Travel Details
Number of Days :  *
Number of People Travelling  
  Number of Adult(Age Limit 65 years) *
  Number of Children(Age Limit 16 years):
AXA Product
Travelling To: *
Date of Travel: *
Activities to include Winter Sports, Safari, Diving or other hazardous pursuits:
If yes, then no of days of stay undertaking such activity:
Please check the box to confirm that you are a GCC Resident
or GCC National, you are aged between 16 to 65 years.		 YES
 
*South Travel & Tourism LLC (SouthTravels.com) is an appointed representative of AXA Gulf Insurance.

After you send your reservation you will be answered by our qualified reservation staff as soon as we receive your Reservation or within 24 hours. If you have any difficulty sending your reservation please send e-mail at enquiry@southtravels.com

SouthTravels.com