PERSONAL DETAILS

*required

Travel Insurance Policy Number^*

Surname^*

Email Address^*

Mobile Number^*

Claim Details

*required

Please explain the reasons of your claim^*

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 )

Copy of the Invoice/Bill

Upload a file

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

*required

Claimant Name^*

Date of Claim Opening^*

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