Chima Travel Insurance Opt-out Form

​I am refusing travel insurance for my trip.

The risks for declining coverage have been explained to me by my Travel Advisor. I understand that declining travel insurance means I will lose all benefits of coverage and I fully accept that risk.

I am aware that my own medical insurance may not cover me on this trip.

I UNDERSTAND THAT I WILL NOT BE COVERED FOR:

  • Lost luggage

  • Missed connections or train delays

  • Emergency air lift assistance

  • Emergency medical and/or dental assistance

  • Emergencies at home affecting me and/or my immediate family (children, grandchildren, aunts, uncles, brothers, sisters, nephews, nieces) 

  • Death of myself and/or my immediate family (children, grandchildren, aunts, uncles, brothers, sisters, nephews, nieces)

  • Supplier default and/or bankruptcy

  • Any other covered circumstances as outlined in the offered travel insurance policy


I understand that I may lose up to 100% of the cost of my cruise / vacation package and travel arrangements, plus any cancellation fees from Chima Travel and / or other suppliers, if my trip is cancelled or delayed.

I hereby release Chima Travel, its administration, personnel, and my Travel Advisor from responsibility for any consequences, both known and unknown, resulting from my refusal of trip cancellation insurance.

I understand that Chima Travel has advised me of the importance of such insurance and I will not hold them responsible for any risks or lost funds. By filling out this form below I agree to all of these stated matters. 

55 Merz Boulevard
Akron, OH 44333

330-867-4770

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