Enrollment Options Meet Your Travel Needs Exclusions & Limitations

LOCATION NUMBER AGENT CODE

COMPANY NAMEAny person who knowingly and with intent to defraud any insurance companyor other person, files an application for insurance or statement of claim containingany materially false information or conceals for the purpose of misleading,information concerning any fact material thereto commits a fraudulent insuranceact, which is a crime and subjects such person to criminal and/or civil penalties.If you reside in: CA, FL, LA, MO, NY, PA, or WA, please call 1-800-819-9004 to obtainfraud wording specific to your state of residence.

Check or Money Order (payable to Travelex Insurance Services)

Visa® MasterCard® Discover® American Express®

Credit Card Number

Credit Card Expiration Date

Print Full Name(As appears on credit card)

Signature(Mandatory for all payment types)

Date

Plan fees are non-refundable after 10 day review period.

MM / YYYY

___ ___ ___ ___ /___ ___ ___ ___ / /___ ___ ___ ___/ /___ ___ ___ ___/

MM / DD / YYYY

Please reference the following when enrolling:

6

Travel MaxMaximum Travel Protection with Cancel for Any Reason Option

MTM-VIR 1008

Exclusive Brochure

5 70109 MTM-VIR 1008MTM VIR 100877

In today’s travel environment it’s important to protect you and your trip investment. Meet your luxury travel needs with our maximum coverage plan and find the peace of mind your trip deserves with these valuable plan highlights:

Primary CoverageReceive reimbursement for your eligible losses from Travelex first, before any other collectible insurance.

Post Departure ProtectionSelect the $0 trip cost level if you don’t need cancellation coverage. Receive all other base plan benefits, including $1,000 in trip interruption coverage!

Identity Theft ServicesTravel securely knowing that Travelex will be there with time-saving ID theft services should the unthinkable occur.

30 Day Pre-Existing WaiverPurchase the plan within 30 days of initial trip deposit and pre-existing medical conditions are eligible for coverage.

Satisfaction GuaranteeIf you are not completely satisfied within 10 days of purchasing this plan, Travelex will refund your premium cost, if you have not departed on your trip or filed a claim.

Underwritten by Nationwide Mutual Insurance Company and affiliated companies.This product may not be available to residents of all states. This brochure is apartial description of benefits. Certain terms, conditions, exclusions and limitationsapply. Please visit our website at www.travelexinsurance.com and refer to theCertificate of Insurance for full details. © 2008 Travelex Insurance Services, Inc.

The following exclusions apply to Trip Cancellation & Trip Interruption, Trip Delay,Missed Connection, Emergency Accident & Sickness Medical Expense, EmergencyEvacuation & Repatriation of Remains, Accidental Death & Dismemberment, andOptional Flight Accidental Death & Dismemberment. Loss caused by or resulting from:

Pre-Existing Conditions, as defined in the Definitions section (except EmergencyEvacuation and Repatriation of Remains) unless the insurance is purchased withinthirty (30) days of the initial Covered Trip deposit; Suicide, attempted suicide orany intentionally self-inflicted injury while sane or insane (in Missouri, sane only)unless results in the death of a non-traveling immediate Family Member; War,invasion, acts of foreign enemies, hostilities between nations (whether declared ornot), civil war; Participation in any military maneuver or training exercise; Pilotingor learning to pilot or acting as a member of the crew of any aircraft; Mental oremotional disorders, unless hospitalized; Participation as a professional in athletics;Participation in underwater activities (does not include recreational swimming); Being under the influence of drugs or intoxicants, unless prescribed by a Physician or unlessresults in the death of a non-traveling immediate Family Member; Commission or theattempt to commit a criminal act; Participating in bodily contact sports; skydiving;hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; andspeed contest (speed contest shall not include any of the regatta races); scuba diving (unless accompanied by a dive master and not deeper than 50 feet); spelunking orcaving; heliskiing or extreme skiing. Exclusion does not apply to Trip Cancellation.Bodily contact sports means any sport where the objective is to physically render anopponent unable to continue with the competition such as boxing and full contactkarate; Dental treatment except as a result of an injury to sound natural teeth limitedto $750; Any non-emergency treatment or surgery, routine physical examinations,hearing aids, eyeglasses or contact lenses; Pregnancy and childbirth (except forcomplications of pregnancy) except if hospitalized; Traveling for the purpose ofsecuring medical treatment; Services not shown as covered; Directly or indirectly, theactual, alleged or threatened discharge, dispersal, seepage, migration, escape, releaseor exposure to any hazardous biological, chemical, nuclear radioactive material, gas,matter or contamination; Care or treatment that is not medically necessary; Injury orSickness when traveling against the advice of a Physician; Cosmetic surgeryexcept for: reconstructive surgery incidental to or following surgery for trauma, orinfection or other covered disease of the part of the body reconstructed, or to treat acongenital malformation of a child.

Some exclusions may not be valid or wording may differ in your state ofresidence. For full details, please consult the Certificate of Insurance atwww.travelexinsurance.com or call 1-800-504-7883.Please refer to the Certificate of Insurance for Baggage/Baggage Delay and OptionalCollision Damage Waiver exclusions.

DEFINITIONS:Pre-Existing Condition means any injury, sickness or condition of You, or YourTraveling Companion for which within the sixty (60) day period prior to the EffectiveDate of Trip Cancellation coverage under the Policy (a) first manifested itself orexhibited symptoms which would have caused one to seek diagnosis, care ortreatment; (b) required taking prescribed drugs or medicine, unless the conditionfor which the prescribed drug or medicine is taken remains controlled without anychange in the required prescription; or (c) required medical treatment or treatmentwas recommended by a Physician.

Payment Details

Travel Agenttact your local travel agent.

Internetus at www.travelexinsurance.com to get a

te, learn more or to purchase.

Phoneak with an experienced customer service esentative available at 1-800-504-7883,

M-F 8:00 am to 7:00 pm CST, to answer questions, receive a quote or to enroll.

Fax or Mailboth sides of enrollment form to 1-800-867-9531

mail to: Travelex Insurance Services, PO Box 641070, Omaha, NE 68164-7070.

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4

Benefit Highlights Optional Upgrades Enrollment Form Benefits & Rates

Primary Traveler Full Name

Birth Date Trip Cost

Second Traveler Full Name

Birth Date Trip Cost

Third Traveler Full Name

Birth Date Trip Cost

Fourth Traveler Full Name

Birth Date Trip Cost

Please print clearly for accurate processing. Pl i t l l f t i MTM-VIR 1008

MM / DD / YYYY $

Traveler Details

Premium Calculation

MM / DD / YYYY $

MM / DD / YYYY $

MM / DD / YYYY $

Address

City State Zip

Daytime Phone

Beneficiary Name(Estate designated if left blank)

Primary Traveler Email(Provide to receive Confirmation of Coverage via email)

For questions, quotes or to enroll, visit www.travelexinsurance.com

or call 1-800-504-7883

For quvisit w

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Trip Cancellation & InterruptionProtecects ts travel invesvestmem nts if a trip is cancelled or intinterrerruptupteded. Recover preprepaid trip costs for the following covered rd reaseasonson :• Sickness, AccA ideidentantal Il Injunjury or Death • Weather• Trip Delay of 50% or more • Strike• Bankruptcy/Default • Terrorist Incident• Residence/Destination Uninhabitable • Quarantine• Traffic Accident en Route • Hijacking• Employmoymoymymy entenenen Termination/Transfer • Jury Duty• F• F Felonioousus s AssAsssssssA aulaulauaua tt • Subpbpoenoenoennnaaaaa• D• D Deaeateatth/h/Hh/Hoospospspitaitalizlizatiatiatiatitia onon on onon of of DesDestination Host • M• MMMMMMiliiliiliiliiliiliilitartartartartartary Dy Dy Dyyy Dututyutyutytyu• B• B• Busiusiusinesnessss Rs Rs Rs Reeaseasea onsons • Burglary

Trip DelayProvvides esreireimbumburseemennent ft or or unuun sed, prepaid, non-refundable expexppeensenses anand ad additditd ionional al coscosts ts sucsuch ah s accommodations, traratranspnspsportatiatioon, and mealeals is if aaf tr tripip p iss i delelaayeayeay d 5d 5d 5d ho hours or more forfor a a ccovcovovereered rd reaseasonon.

Missed ConnectionIncIn ludes es reireimbumbursemene t for uununuseded, , nnon-on-refundable exppenensnses es andan adadditditionional al ccosts ts such ah s s aaccoccoccommmmodatdationio s,transpnsp rortortatiiat on,onn and mealeals ts to ro re-je-joinn a a crucruiseise if if a a fliflightght dedelaylay cauc sesses yo yourur conco nection tto bo be me mississeded by byy 3 h3 hourours os oor mr morere.

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Base Plan Benefits Coverage Per Person

Trip Cancelllatatia on n 100% of trip cost ($100,000 limit)

Trip Interruptiion on 150% of trip cost ($150,000 limit)

Trip Delay/My/Misseded Connection $1,000

Bagaggaggage/Be/Baggag age Delay $2,500 / $600

EmeEmergergencyncy AcAccidentent & Sickness Medical Expense $100,000

EEmeEmememergrgegergrgrgg ncy Medical Evavaaaaaacuacuacuacuacuacuacuatiotiotiotiotiotiotion/Rn/Rn/Rn/Rn/Rn/Rn/ epepaee triation $1,000,000

2424 HHoHoHououour Ar Ar Ar AAD&DD&DD&& $25$25,00,0000

CComCommomonmon CaaCaarrirririrrr erer AAADADAD&D $50$50$5050,00,00,00,000 0

TraTraTraTraTravelvelelelvel Assistance & Concierge IncncI ludl ededdd

Optional Upgrades

Coverage Per Person

CanC cel for Any y Reasoson Pakk 80%80 ofof trip ip cocost

Traransposp rtatioi n PPakak • Flight Accident AAD&DD&D • Collision Damage g WWaiver • R • Roadsoadside Assissistanstancee

Coverage Per Plan$20$ 0,00,00000

$35$3 ,00000IncIncludludeded

Trip Cost(use full cost per person)

Base Plan Rates Per Person

Ages0-34

Ages35-50

Ages51-60

Ages 61-70

Ages 71-79

Ages 80+

$0 $0$ excluexcluexclucludes tdes tdes tdes td rip crip crip cancelancelan latiolatiot nn $24$24$24 $30$30$30 $35$35$$35 $51$51$51 $65$656 $134$134$134

$1 - $500 $35 $41 $43 $61 $78 $210

$50 $50 $50$501 111 - - - $1,0$1,0$1,0,0$ 000000 $62$62$62$ $72$72$72227 $76$76$76$ $104$104$104104 $139$139$1391339 $338338$338$3388

$1,001 - $1,500 $89 $103 $107 $146 $198 $502

$1,5$1,511$1,5$1,5$1 5$1,501 01 01 01 01 - $- $- $- $- $2,002,002,002,002,00000000 $111$111$111$11$111 $140$140$140$140$1401401401 $147$147$147$147$147$$1 $186$186$186$186$186 $259$259$259$259$259 $666$666$666$666666

$2,001 - $2,500 $142 $176 $183 $230 $331 $833

$2,5$2,501 01 - $- $- 3,003,00000 $167$1677 $207$207$2 $220$220$220 $268$268$268$268$268 $391$391$391$ $998$998$998$99$

$3,001 - $3,500 $200 $259 $266 $310 $460 $1,167

$3,5$3 5$$3 01 01 - $$- $4,004,0000 $222$222 $296$296 $301$301 $355$355 $537 $1,3, 3434343444

$4,001 - $4,500 $248 $333 $338 $393 $625 $1,500

$4,5$4,5$4,5$4,501 01 - $- $5,005,005,05,000000 $272$272272272722722 $3$377$377$37737$37$33$ $387$38788 $431$431$431$431$431$4 $702$702$70$$7$$$$ $1,6$1,61,61,,, 6060

$5,001 - $5,500 $321 $442 $449 $520 $755 $1,762

$5,5$5,55,5,$5,5$5,55$5,5$5,5$5,501 0101 01001 01 - $- $- $- $- $- $ $ $6,006,006,006,006,006,006,6, 0000000 $345$345$345$34545$345$345$345$34 $475$475$475$475$475$475$475475 $489$489$489$489$48$48$489$48989 $564$564$564$564$56$56$564564 $799$799$799$7999$799$799$799$799799$7999 $$1$1$1,$1,8$1,8$1,8060606

$6,001 - $6,500 $377 $530 $544 $623 $894 $2,032

$6,5$6 5$6,501 0101011 - $- $- $- $- $$$$7,007,007,007,007,0007,00,00, 000000 $404$404$404$404$404$404$404$40404$404 $565$565$565$565$565$5$56$56 $589$5$ 9 $656$656$65$656$656$6566$66 $948$9484$948948948$948$94 $2,1$2,12 85855588

$7,001 - $8,000 $472 $635 $656 $748 $1,071 $2,479

$8,0$8 0$8$8,0$8,0$8,0$8,0$8$8,0$ 0101 001 01 01 01 0 - $- $- $-- $$- $9,009,09 009 009 009,009,009,0 00000 $539 $737$737 $757$7577 $8$84$848$8$8 $1,2$1$1,2$1,2$1,21,2$$1 060606060606 $2 8$2 8$2 88$2,8$2 8$ 88881515151

$9,001 - $10,000 $615 $826 $851 $954 $1,342 $3,184

• For rar tes on trip costs above ve e $10,$10,$10,$10,0$10,000000000 000 pleaeapleapleapleapleapleapleapleasese cse cse cse all ala 1-80-8000-500-50-50-5 4-78-788787887883.8383.83.83.838• Maximuximum m trm trip lip engtengtgth alh alh alaah allowelowelowelowelowelowed 18d 18d 188888881880 da0 da0 da0 da0 da0 da0 dada0 days. ys For For trippipps 31-1800 dayday daydaydaydaydayyaydaydayays ins ins ins ininins ins in len lenlele lenlee gth gthgthgth add add $5 p$5 p$5 p$5 p$5 p5 p5 pper der dder der dder ddday.ay.ayay.ayayayaayaa• An• An $8 processiessiessiessiss ngng fng fng fg fee wee ill l applapplpplappapplapplppp y per plp an.• Ra• Raates estes teses areareareare re a subjsubject ec to cto cto coto ccto coto hhhanghanghange.e.eeee.

Cancel for Any Reason PakProPrototectiion aoon an aagaingainga st tst tthe ue uunexpnexpppecteected, wd, whateateverver verver erer it mit mitiii ay bay bay bay by by eee! Pe! Purchurchasase ththis pakak an andndd eve eve e ryonrryone onon th thethethe pla plaplapla plan ren ren n ceivceivceivceiveives ts theheseese two tw benefitts:s:• CaCancelcel a t a rip rip pprior totoo 2 2 2 days of the shehehe chedd l duled dep dep de arturturture dre dre d tate ateand nd reecoover ver upup tto 8o 80o 80% of trip cost.• Pl• Plus Cus Canceanceel fol fol for TrT ip Dip Delayelay ReaReassons - This addeddeed bed bebenefifinefitt allowsws cancancellaellatiotion due to to 30% 30% or mor more oreore of of ao trip bebeiingng missmissmissed from aa cocovered d dedelay any and red covcover upupup to to 100%100%00% of trtriptrip co cost.MustMust be be purcpurchasehas d wwithinhin 21 21 21 ddaysdays of of thethe initial ial al triptritripp dep depdepposito t. Availablble foe forr addititidi onalonal 50% 5 of totattotall bal b se pse planlan rateratee..

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Trip Details

Departure Date Return Date

Location Number / Agent Code(on pg 7 of brochure)

MM / DD / YYYY

Country of Destination

Tour Operator

MM / DD / YYYY

Cruise Line Airline

Total Base Plan Rate (calculate below for all travelers)

Trips 31-180 days in length (include arrival and departure days) # travelers # days

Optional Cancel for Any Reason Pakk (Base Plan + Extra Days x 50%)

Optional Transportation Pakk ($49)

Processing Fee

Total Amount Due(and authorized as payment)

$ 8.00

$

$ $ $ $ + + + $ =

x x $5 $ =

$

$

Primary Traveler Second Traveler Third Traveler Fourth Traveler Base Plan Total

Extra Days Total

54

Enrollment Options Enrollment Form

Primary Traveler Full Name

Birth Date Trip Cost

Second Traveler Full Name

Birth Date Trip Cost

Third Traveler Full Name

Birth Date Trip Cost

Fourth Traveler Full Name

Birth Date Trip Cost

Please print clearly for accurate processing. MTM-VIR 1008

MM / DD / YYYY $

Trip Details

Traveler Details

Premium Calculation

MM / DD / YYYY $

MM / DD / YYYY $

MM / DD / YYYY $

Address

City State Zip

Daytime Phone

Beneficiary Name(Estate designated if left blank)

Primary Traveler Email(Provide to receive Confirmation of Coverage via email)

Departure Date Return Date

Location Number / Agent Code(on pg 7 of brochure)

MM / DD / YYYY

Country of Destination

Tour Operator

MM / DD / YYYY

Cruise Line Airline

Total Base Plan Rate (calculate below for all travelers)

Trips 31-180 days in length (include arrival and departure days) # travelers # days

Optional Cancel for Any Reason Pak (Base Plan + Extra Days x 50%)

Optional Transportation Pak ($49)

Processing Fee

Total Amount Due(and authorized as payment)

$ 8.00

$

$ $ $ $ + + + $ =

x x $5 $ =

$

$

Primary Traveler Second Traveler Third Traveler Fourth Traveler Base Plan Total

Extra Days Total

Payment Details

Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and/or civil penalties.If you reside in: CA, FL, LA, MO, NY, PA, or WA, please call 1-800-819-9004 to obtain fraud wording specific to your state of residence.

Check or Money Order (payable to Travelex Insurance Services)

Visa® MasterCard® Discover® American Express®

Credit Card Number

Credit Card Expiration Date

Print Full Name

(As appears on credit card)

Signature (Mandatory for all payment types)

Date

Plan fees are non-refundable after 10 day review period.

MM / YYYY

___ ___ ___ ___ /___ ___ ___ ___ /___ ___ ___ ___ /___ ___ ___ ___

MM / DD / YYYY

Travel AgentContact your local travel agent.

InternetVisit us at www.travelexinsurance.com to get a quote, learn more or to purchase.

PhoneSpeak with an experienced customer service representative available at 1-800-504-7883, M-F 8:00 am to 7:00 pm CST, to answer questions, receive a quote or to enroll.

Fax or MailFax both sides of enrollment form to 1-800-867-9531 or mail to: Travelex Insurance Services, PO Box 641070, Omaha, NE 68164-7070.

InteVisit quote

TraCont

PhoSpearepreM-F

FaxFax bor m6410

Don’t forget to order foreign currency! Contact your local travel agent or visit www.travelexinsurance.com.