travel-insurance-flight-form-integration

Are you an individual or are you submitting on behalf of a guest?

Individual

Travel agent

If a travel agent, please provide your IATA number:

Guest information

First name:

Last name:

Address line 1:

Address line 2 (optional):

City:

State / province:

Zip / postal code:

Example: A1A1A1

Country:

Email address:

Example: john@email.com

Confirm email address:

Example: john@email.com

Phone number:

Example: 5554443333

Flight and claim information

Reservation number:

Flight number for interrupted flight:

Departure date:

Departure City:

Arrival City:

WestJet Rewards ID:

Insurance company name:

Insurance company email/fax:

Insurance claim number:

Purpose for the letter:

Additional guests

Guests travelling together on the same reservation can be included on the same form.

Additional guest 1:

Additional guest 2:

Additional guest 3:

Additional guest 4:

Additional guest 5:

Additional guest 6:

Additional guest 7: