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Group Travel Insurance

Journey Information:

Select Travel Region *

Select trip coverage / insurance sum insured* : ($ represents USD)

Cover Start Date *

Cover End Date *

Rider Information:

Select Rider:

Refund Of Visa Fees

Pre-Existing Disease Cover

Adventure Sports injury

Traveller Details:

Mobile No *

First Name *

Last Name *

Date of Birth *

Gender *

Email *

Pan No

Passport *

Do you have any Pre-Existing Diseases?*

Permanent Address

Address Line 1 *

Address Line 2 *

Pincode*

State*

City*

Communication Address
Same as above

Add More Traveller

Nominee Details:

Nominee Name *

Nominee DOB *

Nominee Gender *

Nominee Relation *

Your Proposal Review:

Plan Details
Insurance Region	Sum Insured	Proposal Number	Total Premium (Inclusive of 18% GST)	Rider

Coverage Details
Start Date	End Date	Number of days

Traveller Details
First Name	Last Name	Date of Birth	Email	Gender	Relation	Mobile Number	Passport	Address Line 1	Address Line 2	Pincode	State	City

Declaration

I confirm that I have reviewed and understood the terms and conditions of this travel insurance policy, including its inclusions and exclusions. I am also aware of the freelook cancellation period, during which I can cancel the policy without providing any reason. For detailed terms and conditions, click here.To view the key features document, please click here.

Group Travel Insurance

Permanent Address

Communication Address Same as above

Communication Address
Same as above