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Local Travel Insurance Claim
Policy Owner Details
Name (Surname)
*
Name (First Name)
*
Policy Number
*
Phone No
*
Email Address
*
Address
*
City
*
State
*
Departure
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Destination
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Details of Incident
Date of Incident (yyyy-mm-dd)
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Time of Incident
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Where Did the Incident Occur?
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Brief Details of Incident
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Upload Supporting Documents(if any)
All Attachments Must be In PDF or JPEG Format
Purchase Receipt of Lost Items
*
Copy of Travel Ticket
*
Any Document From The Airline/Carrier/Transporter Accepting Liability
Estimate Of Claim
*
Statement of Authenticity/Truth of Details Given Above (Please Tick Box).
*
Submit