Pilgrimage Travel Insurance Application
Personal Information
Full Name
Date of Birth
Gender
Male
Female
Other
Passport Number
Nationality
Email Address
Phone Number
Address
Pilgrimage Details
Pilgrimage Destination
Religion
Departure Date
Return Date
Traveling with Group/Organization
Insurance Coverage
Insurance Plan
Basic
Standard
Premium
Pre-existing Medical Conditions
Beneficiaries Name(s)
Additional Notes