Holiday Cancellation Claim Form printable pdf download

HOLIDAY CANCELLATION CLAIM FORM

Certificate number: JLM _____________ or

MO _____________

Claimant's Full Name: ________________________________________________________

Address:

________________________________________________________

Holiday Establishment Name and Address:

________________________________________________________

Date Booking Made ___________________ Booking Cancelled _____________________

Booked Date of Holiday: From ____________________ To ___________________

Amount Already Paid to Accommodation Provider £_____________

Amount Owing to Accommodation Provider

£_____________

(Please supply supporting accounts)

Reason for claim and relationship to claimant:

__________________________________________________________________________

If you have annual travel insurance e.g. as an extension to your Home Insurances or

provided with your Credit Card, please advise us of the name, address and Policy number

of your insurers:

__________________________________________________________________________

If cancelled for medical reasons, please have the Medical Certificate completed. If for any other

reason, please supply documentary evidence to support your claim.

D E C L A R A T I O N

I declare to the best of my knowledge that the above particulars, and any additional information,

are true. I authorise that payment, as appropriate, be made directly to the Accommodation

Provider and/or myself in respect of the deposit, in full and final settlement of this claim.

Signature of Claimant _________________________________ Date _____________

MEDICAL CERTIFICATE

This Certificate to be furnished at the claimant's expense and to be completed by the usual Doctor

of the person requiring medical attention. In the event of death, please attach a copy of the Death

Certificate.

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Holiday Cancellation Claim Form