TRIP CANCELLATION

PERSONAL DETAILS

*required

Travel Insurance Policy Number^*

Surname^*

Email Address^*

Mobile Number^*

*required

Country of Destination^*

Incident Date^*

Insurance Purchase Date^*

Date at which the cancellation became required^*

Date of Cancellation^*

Exact Cause of Cancellation^*

*required

Total Journey Cost^*

Have you made a claim and received compensation from any other third parties (e.g airlines, hotel) for trip cancellation^*

Total Amount Claimed^*

if nothing is attached, documents will be requested at a later date

Copy of Passport (identification page)

Upload a file

Files Only (.jpg, .pdf, .png, .jpeg )

Residency proof

Upload a file

Visa/ Entering-Exist Stamp from visited country

Upload a file

Copy of Travel Tickets

Upload a file

Files Only (.jpg, .pdf, .png, .jpeg )

Proof of Trip Cancellation

Upload a file

Files Only (.jpg, .pdf, .png, .jpeg )

Document to support the trip cancellation reason e.g. medical report, police report, etc

Upload a file

Files Only (.jpg, .pdf, .png, .jpeg )

Airline / Agenty confirmation with the un-used expenses cancelled and cancellation charges

Upload a file

Files Only (.jpg, .pdf, .png, .jpeg )

*required

Claimant Name^*

I have read and accepted the personal data collection consent