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Claims
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Policy Information
Policy No.
Invalid Policy No.
Policyholder
Please provide a valid Insured Name.
Contact Information
Contact Person
Please provide a valid Contact Person.
Email
Invalid Email Address.
Mobile No.
Invalid Mobile No.
IMPORTANT:
THIS eCLAIM FORM SHOULD BE SUBMITTED BY THE POLICYHOLDER / INSURED PERSON.
Claims Information
Are you making / Will you make any other insurance claim as a result of this incident?
Yes, please state details
No
Name of the Insurance Company
This field is required
Policy No. / Claim No.
This field is required
*Please send copy of the payment document if other insurance company has already paid the claim.
Claims Type
Medical Expenses
Personal Accident / Permanent Disablement
Loss of / Damage to Personal Property
Travel Delay
Baggage Delay
Trip Cancellation
Trip Curtailment / Trip Re-arrangement
Personal Liability
Golf Protection
Rental Vehicle Excess
Other(s)
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