{"id":1140,"title":"Travel Insurance (Travelsure-Group) Claim Form","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/SBIGI_Travelsure_Group_Claim_Form_26060801_fef9bbd3ae.pdf","sha256":"2153adb9ef1e7c71695bf14c4b68f372abfdc97f0a1881debfb7533dc612b144","pages":20,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a travel insurance claim under the Travelsure-Group policy. It collects details about the insured, travel itinerary, incident, and claim specifics.","notes":["Issuance of this form does not admit liability or waive policy terms.","Use original cancelled cheque; photocopies are not accepted.","Attach relevant annexures and checklist along with first three pages of the claim form.","If any claim is fraudulent, benefits under the policy shall be void and forfeited.","If insured returns alive after claim payment for disappearance, claim amount must be refunded."],"title":"Travel Insurance (Travelsure-Group) Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant and Insured Details","fields":[{"help":"","type":"text","label":"Name of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Birth of Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender         Male           Female","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Employee No.","options":[],"required":false,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address\nPlot No/Door No.\nBuilding Name\nRoad\nArea\nCity\nDistrict\nState\nPincode","options":[],"required":null,"pdf_field":""},{"help":"Provide phone and mobile numbers","type":"phone","label":"Contact Details\nPhone No.\nMobile","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Travel and Incident Details","fields":[{"help":"DD/MM/YYYY","type":"date","label":"Date Trip Commenced","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"From and To dates in DD/MM/YYYY format","type":"date","label":"Period of Insurance   From                                                       To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Scheduled Return","options":[],"required":null,"pdf_field":""},{"help":"Provide flight details and dates/times with AM/PM","type":"text","label":"Travel Itinerary Details (to be filled by claimant / Insured)\nName of Airline:\nFlight no:\nFrom:\nTo:\nScheduled Departure date\nScheduled Arrival date\nActual Departure date\nActual Arrival date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Corporate","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Location of Corporate","options":[],"required":false,"pdf_field":""},{"help":"As per passport","type":"text","label":"Passport Number","options":[],"required":null,"pdf_field":""},{"help":"Date when incident occurred","type":"date","label":"Date of loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Purpose of Travel","options":[],"required":false,"pdf_field":""},{"help":"Describe the incident","type":"text","label":"Incident Details","options":[],"required":null,"pdf_field":""},{"help":"Select applicable geographical coverage","type":"choice","label":"Geographical Boundaries:\n1) Worldwide including USA and Canada\n2) Worldwide excluding USA and Canada","options":["Worldwide including USA and Canada","Worldwide excluding USA and Canada"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the same claim covered under any other insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Country where incident occurred","type":"text","label":"Country of Loss","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Details of bills enclosed","fields":[{"help":"Number of hospital main bills enclosed","type":"number","label":"Hospital Main Bill","options":[],"required":false,"pdf_field":""},{"help":"Number of pre-hospitalization bills enclosed","type":"number","label":"Pre-hospitalization Bills:    Nos","options":[],"required":false,"pdf_field":""},{"help":"Number of post-hospitalization bills enclosed","type":"number","label":"Post-hospitalization Bills:  Nos","options":[],"required":false,"pdf_field":""},{"help":"Number of pharmacy bills enclosed","type":"number","label":"Pharmacy Bills","options":[],"required":false,"pdf_field":""},{"help":"Number of other bills enclosed","type":"number","label":"Others","options":[],"required":false,"pdf_field":""},{"help":"Number of outpatient bills enclosed","type":"number","label":"Out patient Bills","options":[],"required":false,"pdf_field":""},{"help":"Total amount claimed in INR","type":"amount","label":"Total Claimed Amount","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Claim Benefit Selection","fields":[{"help":"Tick the benefits you are claiming and specify amounts in INR","type":"checkbox","label":"FOR WHICH BENEFIT DO YOU CLAIM? [PLEASE TICK () THE APPROPRIATE BOX]\nSECTION: A - Base Covers","options":["Medical Expenses - Accident & Sickness","Emergency Medical Evacuation and Transportation","Repatriation of Mortal Remains","Dental Expenses"],"required":null,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Payee Details","fields":[{"help":"Name of bank for claim payment","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Branch of bank","type":"text","label":"Bank Branch","options":[],"required":true,"pdf_field":""},{"help":"Account number for payment","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"IFSC code of bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"MICR number of bank branch","type":"text","label":"MICR No.","options":[],"required":true,"pdf_field":""},{"help":"PAN number of payee","type":"text","label":"PAN No.","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Declaration and Authorization","fields":[{"help":"Consent to share information for claim processing","type":"checkbox","label":"I/We, above named hereby authorise any hospital, physician, Police & statutory authorities, relevant witnesses and /or relatives or other person who has attended or examined the insured, to disclose when requested to do so by SBI General Insurance Co. Ltd. or its permitted and authorised representatives, any and all information including any medical records or other relevant information.","options":["I agree"],"required":true,"pdf_field":""},{"help":"Declaration of truthfulness and fraud consequences","type":"checkbox","label":"I/We, the above named, do hereby, to the best of my/our knowledge and belief, warrant the truth of the foregoing statements in every respect; and I/We agree that if I/We have made, or make in any further declaration, the Company may require in respect of the said accident, any false or fraudulent statement, or any suppression or concealment, my/our claim shall be absolutely forfeited.","options":["I agree"],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Print full name","type":"text","label":"Name of Insured/Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Annexures for Specific Claims","fields":[{"help":"Doctor to certify injury details, treatment, and disability","type":"text","label":"Medical Certificate - To be filled by Treating Doctor","options":[],"required":null,"pdf_field":""},{"help":"Number of days hospitalized and amount claimed","type":"number","label":"Annexure 2 - Hospital Daily Cash","options":[],"required":null,"pdf_field":""},{"help":"Details of accident, injury, police report, and claim amount","type":"text","label":"Annexure 3 - Personal Accident Including Disappearance","options":[],"required":null,"pdf_field":""},{"help":"Details of accident, loss, nominee, and claim amount","type":"text","label":"Annexure 4 - Accidental Death & Dismemberment (Common Carrier)","options":[],"required":null,"pdf_field":""},{"help":"Details of sport, injury, hospital, and claim amount","type":"text","label":"Annexure 5 - Adventure Sports Coverage","options":[],"required":null,"pdf_field":""},{"help":"Details of accident, hospitalization, and reinstatement claim","type":"text","label":"Annexure 6 - Reinstatement of SI in case of Accidental Hospitalisation","options":[],"required":null,"pdf_field":""},{"help":"Details of baggage loss/delay, reports, and claim amount","type":"text","label":"Annexure 7 & 8 - Loss of Checked Baggage / Delay of Checked Baggage","options":[],"required":null,"pdf_field":""},{"help":"Details of delay, flight, cause, and claim amount","type":"text","label":"Annexure 9 & 10 - Trip Delay / Missed Connection","options":[],"required":null,"pdf_field":""},{"help":"Hospital and trip cancellation details with claim amount","type":"text","label":"Annexure 11 - Trip Cancellation due to Hospitalisation","options":[],"required":null,"pdf_field":""},{"help":"Trip cancellation details, reason, and claim amount","type":"text","label":"Annexure 12 - Trip Cancellation for Any Reason","options":[],"required":null,"pdf_field":""},{"help":"Details of trip interruption, medical info, and claim amount","type":"text","label":"Annexure 13 - Trip Interruption","options":[],"required":null,"pdf_field":""},{"help":"Details of bounced booking, expenses, and claim amount","type":"text","label":"Annexure 14 - Bounced Bookings of Airlines and Hotel","options":[],"required":null,"pdf_field":""},{"help":"Details of hijack event and claim amount","type":"text","label":"Annexure 15 - Hijack Distress Allowance","options":[],"required":null,"pdf_field":""},{"help":"Date of loss, police report, fees, and claim amount","type":"text","label":"Annexure 16 - Loss of Passport","options":[],"required":null,"pdf_field":""},{"help":"Details of loss, police report, and claim amount","type":"text","label":"Annexure 17 - Loss of International Driving License","options":[],"required":null,"pdf_field":""},{"help":"Medical certificate and travel details for business class upgrade claim","type":"text","label":"Annexure 18 - Up-gradation to Business Class","options":[],"required":null,"pdf_field":""},{"help":"Details of family member visit and accommodation claim","type":"text","label":"Annexure 19 - Compassionate Visit","options":[],"required":null,"pdf_field":""},{"help":"Details of minor children return due to insured hospitalization","type":"text","label":"Annexure 20 - Return of Minor Child","options":[],"required":null,"pdf_field":""},{"help":"Details of evacuation event and claim amount","type":"text","label":"Annexure 21 - Political Risk and Catastrophe Evacuation","options":[],"required":null,"pdf_field":""},{"help":"Details of liability claim and third party info","type":"text","label":"Annexure 22 - Personal Liability","options":[],"required":null,"pdf_field":""},{"help":"Details of offense, detaining authority, and bailability","type":"text","label":"Annexure 23 - Bail Bond Insurance","options":[],"required":null,"pdf_field":""},{"help":"Details of burglary loss, police report, and insurance","type":"text","label":"Annexure 24 - Home Burglary Insurance","options":[],"required":null,"pdf_field":""},{"help":"Details of fire loss, property, and claim amount","type":"text","label":"Annexure 25 - Fire Cover For Building (Home in India)","options":[],"required":null,"pdf_field":""},{"help":"Details of contents loss and claim amount","type":"text","label":"Annexure 26 - Fire Cover For Contents (Home in India)","options":[],"required":null,"pdf_field":""},{"help":"Details of lost funds and police report","type":"text","label":"Annexure 27 - Emergency Cash Assistance","options":[],"required":null,"pdf_field":""},{"help":"Details of maternity event and claim amount","type":"text","label":"Annexure 28 - Maternity Cover","options":[],"required":null,"pdf_field":""},{"help":"Details of incident, police report, and claim amount","type":"text","label":"Annexure 29 - Loss of Portable Equipment","options":[],"required":null,"pdf_field":""},{"help":"Loan details and claim amount","type":"text","label":"Annexure 30 - Travel Loan Secure","options":[],"required":null,"pdf_field":""},{"help":"Visa application and rejection details with claim amount","type":"text","label":"Annexure 31 - Visa Fees Protection","options":[],"required":null,"pdf_field":""},{"help":"Details of chiropractic treatment and claim amount","type":"text","label":"Annexure 32 - Chiropractic Treatment","options":[],"required":null,"pdf_field":""},{"help":"Hospitalization details in country of residence and claim amount","type":"text","label":"Annexure 33 - Extended Cover In the Country of Residence","options":[],"required":null,"pdf_field":""},{"help":"Details of fraudulent card use and claim amount","type":"text","label":"Annexure 34 - Fraudulent Card Payment","options":[],"required":null,"pdf_field":""},{"help":"Details of travel rescheduling and claim amount","type":"text","label":"Annexure 35 - Travel Date Change Cover","options":[],"required":null,"pdf_field":""},{"help":"Details of deportation and claim amount","type":"text","label":"Annexure 36 - Deportation Expenses","options":[],"required":null,"pdf_field":""},{"help":"Details of tuition fee claim due to insured hospitalization","type":"text","label":"Annexure 37 - Tuition Fee","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant / insured / treating doctor (where specified)"}],"deadlines":[],"applies_to":"travel insurance claims under the Travelsure-Group policy","attachments":["Cancelled cheque pertaining to the bank account","Police Report / FIR / Incident Report (if applicable)","Medical certificates and hospital bills as per claim type","Death Certificate (if applicable)","Post-Mortem Report (if applicable)","Legal Heir Certificate / Succession Proof (if no nominee registered)","Photocopy of authorization (for information disclosure)","Other documents as per annexure requirements"],"declarations":["Authorize hospital, physician, police, and others to disclose information to SBI General Insurance or its representatives.","Declare that all statements are true and understand that fraudulent claims will be forfeited."],"dropped_labels":5},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customer.care@sbigeneral.in","label":"Motor Claims Email","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"m\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journeys, always\nDownload SBIG App\nRegister or Tra","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"sbig.health@sbigeneral.in","label":"Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"ailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th Floor, Westport, Pan Card","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"seniorcitizen.health@sbigeneral.in","label":"Senior Citizen Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 102 1111","label":"Motor Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"e Claim\nFAQs\nDownload Claim Form\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journ","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 3366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"e simple click\nCheck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 6366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"heck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"561612","label":"Health Claims SMS 'HEALTHCLAIM'","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"y Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/sbi-general-insurance/1140-travel-insurance-travelsure-group-claim-form"}