Enrollment Options

Before you leave home, consider the unexpected. It’s importantto protect you and your trip investment in today’s travelenvironment. Meet your essential travel needs with ourvalue-driven plan and find the peace of mind your tripdeserves with these important plan highlights:

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

Family Friendly CoverageTravel Basic offers great value to traveling families of anysize! Children under age 18 are protected at no additionalcost when accompanied by a covered adult family member.

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

Foreign CurrencyOne more way Travelex meets your travel needs! Contactyour travel agent or visit www.travelexinsurance.com toorder foreign currency before your departure.

Meet Your Travel Needs

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

Pre-Existing Conditions, as defined in the Definitions section (except Emergency Evacuation and Repatriation of Remains); Suicide, attempted suicide or any 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 or not), civil war; Participation in any military maneuver or training exercise; Piloting or learning to pilot or acting as a member of the crew of any aircraft; Mental or emotional 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 unless results in the death of a non-traveling immediate Family Member; Commission or the attempt to commit a criminal act; Participating in bodily contact sports; skydiving; hang-gliding; parachuting; mountaineering; any race; bungee cord jumping; and speed 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 or caving; heliskiing or extreme skiing. Exclusion does not apply to Trip Cancellation. Bodily contact sports means any sport where the objective is to physically render an opponent unable to continue with the competition such as boxing and full contact karate; Dental treatment except as a result of an injury to sound natural teeth limited to $750; Any non-emergency treatment or surgery, routine physical examinations, hearing aids, eyeglasses or contact lenses; Pregnancy and childbirth (except for complications of pregnancy) except if hospitalized; Traveling for the purpose of securing medical treatment; Services not shown as covered; Directly or indirectly, the actual, alleged or threatened discharge, dispersal, seepage, migration, escape, release or exposure to any hazardous biological, chemical, nuclear radioactive material, gas, matter or contamination; Care or treatment that is not medically necessary; Injury or Sickness when traveling against the advice of a Physician; Cosmetic surgery except for: reconstructive surgery incidental to or following surgery for trauma, or infection or other covered disease of the part of the body reconstructed, or to treat a congenital malformation of a child.

Some exclusions may not be valid or wording may differ in your state of residence. For full details, please consult the Certificate of Insurance atwww.travelexinsurance.com or call 1-800-228-9792.

Please refer to the Certificate of Insurance for Baggage/Baggage Delay and Optional Collision Damage Waiver exclusions.

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

Exclusions & Limitations

LOCATION NUMBER AGENT CODE

COMPANY NAMEUnderwritten 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.

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 1-800-228-9792,

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.

IntVisit quot

TraCont

PhSpeareprM-F

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Payment Details

Any 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

01090109 MTB 1008MTB 1008

Please reference the following when enrolling:

6

Travel BasicBasic Travel Protection with Cancel for Any Reason Option

MTB 10087

4

Benefit Highlights Optional Upgrades Enrollment Form

Base Plan Benefits Coverage Per Person

Trip Cancellaatationo 100% of trip cost ($10,000 limit)

Trip Interruptiioonn 100% of trip cost - return air onlyrr (y $10,000(( limit)

Trip Delaay/My/Missed e Connection $500

BagBaggaggage/Be agaggage Delay $500 / $100

EmeEmergencycy Accident Medical Exppense e $15,000

EmEmEmmemergggggeerg ncy Sicknnessess MMMMMeMediddical ExpExpExpxpxppExpense $15,000

Emeeergergergegrgencyncyncy Me M MMeM dicd alal al al l EEvacuation/Reeppapapapaatritrit atiation on $10$10$1 0,00,00, 0000

TraTraTravvelvelel As AsAsAsAsssissistananannta cececece e & Concierge InInInclucluluudeddeededed

Optional Upgrades

Coverage Per Person

CanCa cel for Any Reason Pak 8080%% of trip cost

TraTranspportatition on PakPak• • Flight Accident AD&DD&D

• Collision Damage age WaWaiver • RRoadside Assistance

Coverage Per Plan $200,000 $35,5,000 InIncluc dedded

Trip Cost(use full cost per person)

Base Plan Rates Per Person

Ages 0-34 Ages 35-50 Ages 51-60

$0 $0 0 excluexclucludes tdes tdes trip rip ripcanccancecanc llatillatiion/inon/in/i terrueterruptionptionptio

$14$14$14 $19$191 $23$23$23

$1 - $500 $17 $25 $34

$5 $5 $5$501 01 01 0101 - - - -- $1,$1,$1,$1,$1,00000000000000 $25$25$25$2525 $34$34$34$34$34$344 $42$42$42$422

$1,001 - $1,500 $34 $48 $51

$1,$1,$ 501501 - -- $ $2,02,000000 $46$46$46 $60$60$6600 $68$68$68

$2,001 - $2,500 $60 $77 $86

$2,$2,501501 - $ $3,03 00000 $72$72 $9191 $10$10$100$1001033333

$3,001 - $3,500 $92 $107 $125

$3,$3$3$3$3,$33$ 50101501501501501015015 10 -- - -- $$$$$$$$$$$$$$4 04 04 04 04 04,04 04 04,04,0000000000000000000000 $12$12$12$12$12$$12$12$12$1200000000 $13$13$13$131$13$13666666 $15$15$15$15$15$15$$$1 66666

$4,001 - $4,500 $134 $155 $184

$4,$4,$4,$$4,$ 501501501501000 - - - - - $$ $ $ $ $ $ $ $5 05,05 05 05 05 05,05 05,0000000000000000000 $15$15$15$15$15$15$15$15$15$15$ 000000 $17$17$17$17$17$17$17$172222222 $20$20$20$$ 0$ 55

Benefits & Rates

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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 MTB 1008

MM / DD / YYYY $

Departure Date Return Date

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)

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

MM / DD / YYYY

Country of Destination

Tour Operator

MM / DD / YYYY

Cruise Line Airline

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

or call 1-800-228-9792

For quvisit w

or

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T i P k

Trip Cancellation & InterruptionProProtectects ts tratr vel invesstmetm nts if a trip is cancelled orintterruptpted.ed. Re Recovc er er up up to 100% of trip cost for the following cooververed ed reareasons s:

• Sickness, Accidental Injury or Death • Weather• Bankruptcy/Default • Strike• Residence Uninhabitable • Quarantine• Trafficicccc Ac Ac Ac Ac Accidcc ent en Route • Hijacking• E• E• EEmplmplm ooyymymmmentntnttente Te Tee Te Te Termirr nation/Transfer • Juryuryy Du DuDuDuutytytytyty• F• F• F• Feloeloelonionionioniouus us Assaulault t t t t ••••• S• S• Subpoenoenenaaaa• DDDeateateaeae h//HHh oospitatit lizizatation on oof of o DesDestintinatiation on HosHost t • Burglary

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Travel Assistance & ConciergeIncIncccludlududdddudes es esese a wa wa wa a wa aa ideideideididd ra rararaangengengegegg of of of of of se sese sese sess rvirvrvirrrrv cescesscescesesscc bebe bebebeeforforfore ae ae ae aee nd nd nd durdudurduduu ingingingggggg trtripssipsp thrthrthrhrougougugougougoough ah ah ah ahh 24 2424 24242244/7 /7 /7 /7 7/7 toltoltoltoltolll fl fl fl fll reereereeereereee nununumbembembemmbembember. r IncInIIncI lududududududes eee asss istance withtt medmedmedme icaicacal el eemermermermmmm gengengengengeng cieciecieciees, s, s, ss losloslost dt dt dddocuoocuoo menmenments ts or o bagbaggaggagage, e eveevent ntticcccketketinging, b, bbusiusiusis nesnesnesnesn s ss ss sss s erverververrr iceiceiceececccecc s, s, s, andandandaaa mumuch ch mororore.e.e.

Total Base Plan Rate (calculate below for all travelers)

Optional Cancel for Any Reason Pak (Base Plan Total x 50%)

Optional Transportation Pak ($49.00)

Processing Fee

Total Amount Due(and authorized as payment)

$ 8.00

$

$ $ $ $ + + + $ =

$

$

Primary Traveler Second Traveler Third Traveler Fourth Traveler Base Plan Total

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 1-800-228-9792, 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

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

54

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. MTB 1008

MM / DD / YYYY $

Departure Date Return Date

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)

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)

Optional Cancel for Any Reason Pak (Base Plan Total x 50%)

Optional Transportation Pak ($49.00)

Processing Fee

Total Amount Due(and authorized as payment)

$ 8.00

$

$ $ $ $ + + + $ =

$

$

Primary Traveler Second Traveler Third Traveler Fourth Traveler Base Plan Total

Enrollment Options Enrollment Form