InsureMyTrip - Policy Change Request Form

All of this information is required to process your request policy change request. If all of the information is not included, then it may delay your request. Someone from our Customer Care team may reach out to gather the missing information.

If you have any questions about this form, or unable to complete it as requested, please contact us at customercare@insuremytrip.com.

1. Policy Number

2. Primary Traveler's Name

3. Primary Traveler's Phone Number

4. Email Used to Purchase the Plan *This question is required. This question requires a valid email address.

5. Have you already sent an email to InsureMyTrip about this request?

6. In order to process this change request, we must have documented proof that your travel suppliers (cruise, tour operator, travel agent) have either fully refunded your original trip or had it transferred over to a new trip. Please add the files here.

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7. In order to process this change request, we must have documentation from your travel suppliers (cruise, tour operator, travel agent) showing your new itinerary which includes the new dates for your trip. Please add the files here.

File: {{filename}} delete

You can attach up to 10 files. Each file must be under 2MB. If you have files that are larger than these requirements, you can send them to customercare@insuremytrip.com or fax it to (401) 921-4530.

Below please enter any changes to your trip details. If any of changes in additional premium, we will contact you for your permission before we proceed with the request.

8. Did your trip destination change? If yes, please enter the new destination.

Please enter an 'other' value for this selection.

9. Did your travel dates change? If yes, please enter your new departure and return date like this: MM/DD/YYYY to MM/DD/YYYY.
Tentative dates are acceptable and can be adjusted at a later time if necessary.

Please enter an 'other' value for this selection.

10. Did your total trip cost change? If yes, please enter the new amount.

Please enter an 'other' value for this selection.

11. Were you already informed of any additional premium due to your policy change?

We will reach out to you via email to obtain authorization if there is any change in premium.

Please enter the amount you were quoted in this box. By doing so you are providing us authorization to charge your previous payment method with this amount.

12. Confirmation of No Claims
By adding your digital signature below, you are acknowledging that you have not submitted a claim under this policy and do not plan to file a claim against the currently insured trip in the future.

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