Foreign Travel Underwriting

Research FoundationUniversity Foundation

Must be completed and submitted
at least 45 days prior to travel. / FOREIGN TRAVEL REQUEST AND
QUESTIONNAIRE

The following insurance coverage and assistance is provided for individuals traveling on Foundation business using Foundation funds or CSU, Chico students participating inFoundation related activities in a foreign country. In order for the California State University Foreign Travel Liability Insurance Program to cover travel to countries deemed war risks or high hazardous by the U.S. State Department, Foundation may be required to obtain written approval from CSU, Chico’s President and CSU’s Chancellor prior to travel to those territories. It is more costly to provide insurance for travel to high hazard or war risks countries therefore; principal investigators and project staff should incorporate the additional costs associated with insuring travel to unsafe territories into their travel budgets. Students are not allowed to travel on Foundation business to countries listed as a war risk or high hazardous. For more information on travel planning please go to: and click on the Travel Warning and Travel Alert links.

Foreign Workers’ Compensation
Worldwide Travel Assistance

Foreign Travel Accident & Sickness

Foreign General Liability

Foreign Excess Automobile Liability – when renting a vehicle in a foreign country on RF business you MUST purchase all vehicle coverages (liability and auto physical damage) offered by the rental agency.

Please answer the following questions print, sign, obtain all signatures belowand return this request/questionnaire along with your travel itinerary to RESP. A questionnaire must be completed for each trip and traveler and a copy of each traveler’s itinerary must be provided with each Travel Questionnaire.

1. Traveler’s name / Traveler’s contact info during travel:
2. E-address / 8. Destination
3. Phone number / 9. E-address
4. Department / 10. Mobile phone
5. Departure Date / 11. Lodging name
6. Return Date / 12. Lodging phone
7. Purpose of travel: / Emergency Contact Info:
13. Name
14. Phone #
15. Relationship
Total Cost Estimate / $
No. Business Days: No. Personal Days
16. Source of funding for travel expense claims
Source of funding for insurance / FoundationProject #
FoundationProject #
17. Explain any High Hazardous activities you may encounter i.e., scuba diving, sailing, rock climbing, working in extreme temperatures, remote locations, volatile political situations, etc.
18. Will CSU, Chico students be traveling? No Yes(# of students ) If yes complete form for each student.

FOR YOUR INFORMATION:

Depending on the destination country, the underwriter may require additional time and information to provide a quote and coverage.
Variations from planned itinerary could jeopardize coverage.
Any emergency situation including any injury or illness incurred abroadMUST BE REPORTEDIMMEDIATELY to the number found on the Travel Assistance Card provided by the California State University Foreign Travel Liability Insurance Program. This insurance program will not cover pre-existing illnesses or injuries.
Only laptops loaded with the typical Microsoft Office suite or similar commercially available software should be taken out of the United States. If you are unsure whether your laptop has controlled technology or encryption software loaded, please contact the Office of Research and Sponsored Programs or Foundation Administration.

Approval

Signatures:

Traveler SupervisorDean/Unit Admin.

Provost (for Academic Affairs travel)President (required for all foreign travel)Foundation

Return Signed Form RESP—ZIP 870rev 9/19/2013