Travel Insurance Claim Form
Policyholder Information
Full Name
Policy Number
Email Address
Contact Number
Address
Travel & Claim Details
Travel From
Travel To
Departure Date
Return Date
Type of Claim
Medical
Baggage Loss
Trip Cancellation
Travel Delay
Other
Description of Incident
Bank Details (for Claim Settlement)
Bank Name
Account Holder's Name
Account Number
Bank IFSC/Swift Code
Declaration
I hereby declare that all information provided is true and complete to the best of my knowledge.