Corporate Travel Delay Insurance Claim Form
1. Policyholder Details
Company Name
Contact Person
Email Address
Contact Phone Number
Policy Number
2. Traveller Details
Traveller Name
Employee ID
Department
3. Trip Details
Origin
Destination
Scheduled Departure Date & Time
Scheduled Arrival Date & Time
Actual Departure Date & Time
Actual Arrival Date & Time
4. Details of Delay
Total Delay Duration (hours)
Reason for Delay
5. Expenses Incurred Due to Delay
Expense Details (e.g. meals, accommodation)
Total Amount Claimed
6. Supporting Documents
List of Attached Documents
7. Declaration
I declare that the information provided is true and correct to the best of my knowledge.
Signature
Date