Travel Assure

Tell Us more about the travellers

Traveller 1
This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters.

Please enter valid Passport number. Passport number already exist for other traveller.

Please enter a valid Pincode

This field is required. Changes in DOB may affect the premium amount.

Please enter correct Phone number.

Please enter valid email address.

Gender

Male

Female

Others

This field is required.

Nominee Details

This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters

Relationship with Proposer

Aunt

Brother

Brother-in-law

Daughter

Daughter-in-law

Employee

Emp Daughter

Emp Son

Emp Spouse

Father

Father-in-law

Fiancée

Granddaughter

Grandfather

Grandmother

Grandson

Karta

Member

Mother

Mother-in-law

Nephew

Niece

Others

Sister

Sister-in-law

Son

Son-in-law

Spouse

Uncle

This field is required.

Proposer Details

Relationship with Proposer

Relationship with Proposer

Self

Father

Father-in-law

Mother

Mother-in-law

Spouse

Son

Daughter

This field is required.

This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters

Gender

Male

Female

Others

This field is required.

Please enter correct Phone number.

This field is required. Proposer age should be equal to or more than 18 years.

Please enter valid email address.

Please enter a valid Pincode

This field is required.

This field is required.

Do you have any pre-existing medical conditions?

Select YES if you any health issue for which you need to take regular medication as part of the long - term treatment.

Yes No
This field is required.

Do you suffer from any of this disease?

Cancer/ Leukemia/ Malignant Tumour

Major organ failure (Kidney, Liver, Heart, Lungs, etc)

Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lungs Disease

Any anaemia other than iron deficiency anaemia

Cardiac Ailments

Neurological disorder/ Stroke/ Paralysis

Hepatitis B or C, Chronic liver disease, Crohns disease,Ulcerative colitis

Yes No
This field is required.

This plan does not cover mentioned disease.

This field is required.

KYC

Please Enter Valid Pan Number

Upload Passport Document

Please Upload Passport Document

Do You have e-Insurance account?

Yes No
This field is required.

Please enter your EIA Number Please Enter Valid EIA Number

Select your IR Name
Traveller 2
This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters.

Please enter valid Passport number. Passport number already exist for other traveller.

Please enter a valid Pincode

This field is required. Changes in DOB may affect the premium amount.

Please enter correct Phone number.

Please enter valid email address.

Gender

Male

Female

Others

This field is required.

Relationship with Proposer

Relationship with Proposer

Self

Father

Father-in-law

Mother

Mother-in-law

Spouse

Son

Daughter

This field is required.

Do you have any pre-existing medical conditions?

Select YES if you any health issue for which you need to take regular medication as part of the long - term treatment.

Yes No
This field is required.

Do you suffer from any of this disease?

Cancer/ Leukemia/ Malignant Tumour

Major organ failure (Kidney, Liver, Heart, Lungs, etc)

Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lungs Disease

Any anaemia other than iron deficiency anaemia

Cardiac Ailments

Neurological disorder/ Stroke/ Paralysis

Hepatitis B or C, Chronic liver disease, Crohns disease,Ulcerative colitis

Yes No
This field is required.

This plan does not cover mentioned disease.

This field is required.
Traveller 3
This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters.

Please enter valid Passport number. Passport number already exist for other traveller.

Please enter a valid Pincode

This field is required. Changes in DOB may affect the premium amount.

Please enter correct Phone number.

Please enter valid email address.

Gender

Male

Female

Others

This field is required.

Relationship with Proposer

Relationship with Proposer

Self

Father

Father-in-law

Mother

Mother-in-law

Spouse

Son

Daughter

This field is required.

Do you have any pre-existing medical conditions?

Select YES if you any health issue for which you need to take regular medication as part of the long - term treatment.

Yes No
This field is required.

Do you suffer from any of this disease?

Cancer/ Leukemia/ Malignant Tumour

Major organ failure (Kidney, Liver, Heart, Lungs, etc)

Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lungs Disease

Any anaemia other than iron deficiency anaemia

Cardiac Ailments

Neurological disorder/ Stroke/ Paralysis

Hepatitis B or C, Chronic liver disease, Crohns disease,Ulcerative colitis

Yes No
This field is required.

This plan does not cover mentioned disease.

This field is required.
Traveller 4
This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters.

Please enter valid Passport number. Passport number already exist for other traveller.

Please enter a valid Pincode

This field is required. Changes in DOB may affect the premium amount.

Please enter correct Phone number.

Please enter valid email address.

Gender

Male

Female

Others

This field is required.

Relationship with Proposer

Relationship with Proposer

Self

Father

Father-in-law

Mother

Mother-in-law

Spouse

Son

Daughter

This field is required.

Do you have any pre-existing medical conditions?

Select YES if you any health issue for which you need to take regular medication as part of the long - term treatment.

Yes No
This field is required.

Do you suffer from any of this disease?

Cancer/ Leukemia/ Malignant Tumour

Major organ failure (Kidney, Liver, Heart, Lungs, etc)

Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lungs Disease

Any anaemia other than iron deficiency anaemia

Cardiac Ailments

Neurological disorder/ Stroke/ Paralysis

Hepatitis B or C, Chronic liver disease, Crohns disease,Ulcerative colitis

Yes No
This field is required.

This plan does not cover mentioned disease.

This field is required.
Traveller 5
This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters.

Please enter valid Passport number. Passport number already exist for other traveller.

Please enter a valid Pincode

This field is required. Changes in DOB may affect the premium amount.

Please enter correct Phone number.

Please enter valid email address.

Gender

Male

Female

Others

This field is required.

Relationship with Proposer

Relationship with Proposer

Self

Father

Father-in-law

Mother

Mother-in-law

Spouse

Son

Daughter

This field is required.

Do you have any pre-existing medical conditions?

Select YES if you any health issue for which you need to take regular medication as part of the long - term treatment.

Yes No
This field is required.

Do you suffer from any of this disease?

Cancer/ Leukemia/ Malignant Tumour

Major organ failure (Kidney, Liver, Heart, Lungs, etc)

Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lungs Disease

Any anaemia other than iron deficiency anaemia

Cardiac Ailments

Neurological disorder/ Stroke/ Paralysis

Hepatitis B or C, Chronic liver disease, Crohns disease,Ulcerative colitis

Yes No
This field is required.

This plan does not cover mentioned disease.

This field is required.
Traveller 6
This field is required. Please enter valid name. Name should have minimum 2 characters and Maximum 70 characters.

Please enter valid Passport number. Passport number already exist for other traveller.

Please enter a valid Pincode

This field is required. Changes in DOB may affect the premium amount.

Please enter correct Phone number.

Please enter valid email address.

Gender

Male

Female

Others

This field is required.

Relationship with Proposer

Relationship with Proposer

Self

Father

Father-in-law

Mother

Mother-in-law

Spouse

Son

Daughter

This field is required.

Do you have any pre-existing medical conditions?

Select YES if you any health issue for which you need to take regular medication as part of the long - term treatment.

Yes No
This field is required.

Do you suffer from any of this disease?

Cancer/ Leukemia/ Malignant Tumour

Major organ failure (Kidney, Liver, Heart, Lungs, etc)

Chronic Obstructive Pulmonary Disease (COPD) / Progressive Lungs Disease

Any anaemia other than iron deficiency anaemia

Cardiac Ailments

Neurological disorder/ Stroke/ Paralysis

Hepatitis B or C, Chronic liver disease, Crohns disease,Ulcerative colitis

Yes No
This field is required.

This plan does not cover mentioned disease.

This field is required.

This plan is only for Indian Nationals

All fields must be filled

Payable Premium:

Rs 523

Travel Assure Details

Total Sum Insured : -

Travel Details : -

Duration : -

Travel Destinations : -

No Of Travellers : -
Cost Breakup

TravelAssure Pro

Gross Premium : -

Discount : -

Net Premium : -

GST -

Final Premium : -

By proceeding, you accept that the information provided above is true and if found to be false, may impact claims.

TRAVELLER DETAILS

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PERSONAL DETAILS

PAYMENT

Tell Us more about the travellers

Traveller 1

Gender

Nominee Details

Relationship with Proposer

Proposer Details

Relationship with Proposer

Relationship with Proposer

Gender

Do you have any pre-existing medical conditions?

Do you suffer from any of this disease?

KYC

Upload Passport Document

Traveller 2

Gender

Relationship with Proposer

Relationship with Proposer

Do you have any pre-existing medical conditions?

Do you suffer from any of this disease?

Traveller 3

Gender

Relationship with Proposer

Relationship with Proposer

Do you have any pre-existing medical conditions?

Do you suffer from any of this disease?

Traveller 4

Gender

Relationship with Proposer

Relationship with Proposer

Do you have any pre-existing medical conditions?

Do you suffer from any of this disease?

Traveller 5

Gender

Relationship with Proposer

Relationship with Proposer

Do you have any pre-existing medical conditions?

Do you suffer from any of this disease?

Traveller 6

Gender

Relationship with Proposer

Relationship with Proposer

Do you have any pre-existing medical conditions?

Do you suffer from any of this disease?

Travel Assure Details

Cost Breakup

TravelAssure Pro