COVER-PRO
SM
APPLICATION
TRAVEL AGENT SUPPLEMENT
1. Full name of the Applicant Firm:
2. Please provide a breakdown of the most re
cent twelve (12) months gro
ss annual revenue:
Description Percentage of Operations
Individual Bookings %
Groups %
Corporate %
Foreign %
Domestic Travel %
Cruises %
3. Does the Applicant acts as a
Travel Agent Tour Operator Tour Operator / Guide?
4. Is the Applicant involved in marketing and / or selling any of the following types of tours?
Commercial travel:
Yes No
Foreign tours: Yes No
Student / Adventure: Yes No
Cruise lines operations: Yes No
5. Conference in which the Applicant hol
ds appointments. Check all that apply:
ARC TPPC IATAN ASTA AMTRAK IATA
CLIA
6. Do any of the Applicant’s age
nts hol
d the designation of Certified T
ravel Counselor? Yes No
7. Has the Applicant ever defaulted or h
ave any of the Owners, Partners or Officers of the Ap
plicant ever been
associated with any agency which has defaulted to a carrier, conference, or supplier? Yes No
8. Does the Applicant arrange adventure trips that involve high-risk activities? Yes No
9. Does the Applicant run a specialty travel agency? (i.e.: cruises, honeymoons, adventure trips) Yes No
10. Does the Applicant sell sports or event tickets in conjunc
tion with travel? Yes
No
11. Do any of the Applicant’s employees accompany c
lients on trips?
Yes No
12. How often does the Applicant consult the U.S. State Depa
rtment’s advisories rega
rding which foreign countries
are deemed safe for travel?
13. Does your agency offer travel insurance? Yes No If yes, through which companies?
PI-PLSP-TASUPP 08/
10 Page 1 of 2
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PI-PLSP-TASUPP 08/10 Page 2 of 2
A
DDITIONAL INFORMATION
This section may be used to provide additional information to
an
y question on this application. Please
identify the question number to which you are referring
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cov
er-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal,
Partner or Officer)
__________________________________________
Signature Date
Agency Name: Agency Number:
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