Group Tour Travel Insurance Claim Form
Policy Information
Policy Number
Group/Tour Name
Travel Dates
Contact Person Name
Contact Phone
Contact Email
Insured Members Details
Name
Passport No.
Date of Birth
Claim Type
Claim Details
Date of Incident
Type of Claim
Medical Expense
Baggage Loss/Delay
Trip Cancellation
Other
Description of Incident
Amount Claimed
Bank Account Details
Account Holder Name
Bank Name
Account Number
Branch
Declaration
I declare that all information given above is true and correct to the best of my knowledge.