Volunteer Travel Program Change

This e-mail request is intended to allow Adams & Associates International® (A&AI) to begin processing your change. Please note that changes to insurance coverage can not be effective until a written acknowledgement is issued from A&AI. It may be necessary to obtain additional information to complete the processing of your change. Please complete as many of the fields as you can to expedite your change request.

First Name

Last Name

Your Address

Address 2

City

State Zip:

Mission Organization

Policy Number
(if known)

Country of Origin
(if applicable)

Email Address

Phone

Fax

Your Destination:

IMB Project Number:

Original Policy Effective Date:

Requested Effective Date of Change:

Original Date of Departure:

Original Expected Date or Return:

Change in Departure Date:

Change in Return Date:

Add the Following Persons to this Trip:

Add

Delete the Following Persons to this Trip:

Delete

Give a full description of other requested changes:

Other Changes:

Additional or return premium generated by this change, if other than the original payer, should be sent to: (please explain)

Send To:

Adams and Associates International® - Missionary Insurance Services is our Specialty

Telephone: (803) 758-1400 | Toll Free Client Services Line: (800)922-8438 | Fax: (803) 252-1988

Please note that insurance coverage for any line or class of business can not be effective until a written acknowledgment is issued from Adams & Associates International�. This site is presented as a brief overview of our programs and services. For coverage specifics, please refer to the actual policy.
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