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PERSONAL DETAILS
description
Claim Details
attach_file
Supporting documents
create
Signature
PERSONAL DETAILS
*required
Travel Insurance Policy Number
*
Surname
*
Forename
*
Title
*
Mr.
Mrs.
Miss.
Date of Birth of the Claimant
*
Postal Address
*
Email Address
*
Mobile Number
*
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Claim Details
*required
Please explain the reasons of your claim
*
Supporting documents (Max 10MB)
if nothing is attached, documents will be requested at a later date
The files you have uploaded have exceeded the maximum amount (10 MB).
Copy of Passport (identification page)
*
Copy of Passport (identification page)
Upload a file
Copy of the Invoice/Bill
Copy of the Invoice/Bill
Upload a file
Signature
*required
Claimant Name
*
Date of Claim Opening
*
I have read and accepted the
personal data collection consent
You should approve Privacy and Policy terms