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Civitatis travel insurance

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Name *

Town *

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Email *

Check-In *

Check-Out *

Arrival Time * ---- 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 24:00

N.People * ---- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Accommodation Type *

Single Room x 1 person ---- 1 2 3 4 5

Double use Single x 1 person ---- 1 2 3 4 5

Twin Beds Room x 2 people ---- 1 2 3 4 5

Double Room with French Bed x 2 people ---- 1 2 3 4 5

Double Room x 2 people ---- 1 2 3 4 5

Triple Room x 3 people ---- 1 2 3

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