{"id":1262,"title":"Domestic Travel Claim Form","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/Claims_Forms_domestic_travel.pdf_bf14575d71.pdf","sha256":"e9f513eed8f614b0c55d8e7d0c409154ae9da76af5f817aac924b7ccd966d6b2","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders to claim benefits for domestic travel insurance covering trip cancellation, trip interruption, travel delay, and accidental medical expenses.","notes":[],"title":"Domestic Travel Claim Form","submit":{"to":"A&H Claims Department, Tata AIG General Insurance Co. Ltd.","how":"post","address":"7 and 8 Floor, Romell Tech Park, Cama Industrial Estate, Western Express Highway, Goregaon(E), Mumbai, Maharashtra 400063"},"purpose":"claim","sections":[{"title":"Trip Cancellation / Trip Interruption","fields":[{"help":"","type":"text","label":"Flight No.","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Departure location","type":"text","label":"From","options":[],"required":null,"pdf_field":""},{"help":"Destination location","type":"text","label":"to","options":[],"required":null,"pdf_field":""},{"help":"Time in hours","type":"text","label":"Scheduled time of Departure:","options":[],"required":null,"pdf_field":""},{"help":"Explain reason for cancellation or interruption","type":"text","label":"Cause for Cancellation/Interruption :","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Whether accomodation & boarding provided by carrier:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Columns: Date, Place, Amount","type":"table","label":"Details of Expense Incurred","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount refunded by Common Carrier and Hotel","options":[],"required":null,"pdf_field":""},{"help":"Total expenses incurred","type":"amount","label":"TOTAL","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Travel Delay","fields":[{"help":"","type":"text","label":"Flight No.","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Scheduled departure time","type":"text","label":"Scheduled time of Departure:","options":[],"required":null,"pdf_field":""},{"help":"Actual departure time","type":"text","label":"Actual time of Departure:","options":[],"required":null,"pdf_field":""},{"help":"Departure location","type":"text","label":"From","options":[],"required":null,"pdf_field":""},{"help":"Destination location","type":"text","label":"to","options":[],"required":null,"pdf_field":""},{"help":"Number of hours delay","type":"number","label":"No. of Hours delayed:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Whether accomodation & boarding provided by carrier:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Columns: Date, Place, Amount","type":"table","label":"Details of Expense Incurred","options":[],"required":null,"pdf_field":""},{"help":"Total expenses incurred","type":"amount","label":"TOTAL","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Accident Medical Benefit","fields":[{"help":"Describe accident details","type":"text","label":"If accident, details of accident i.e. how, when, where it took place:","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Location of accident","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Accidental Medical Expenses","fields":[{"help":"Columns: Details of treatment, In/Out Patient, Charges, Status of Payment (Paid/Outstanding)","type":"table","label":"Details of treatment","options":[],"required":null,"pdf_field":""},{"help":"Total medical expenses","type":"amount","label":"TOTAL","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Whether Assistance Co. was contacted:","options":["Yes","No."],"required":null,"pdf_field":""},{"help":"Reference number from assistance company","type":"text","label":"If Yes, Reference No.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Authorization","fields":[{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of insured :","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Attending Doctor's Report","fields":[{"help":"","type":"text","label":"Patient Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Marital status:","options":["Married","Single"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Office phone number","type":"phone","label":"Phone (O)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Fax","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date of contacted:","options":[],"required":null,"pdf_field":""},{"help":"Select A.M. or P.M.","type":"text","label":"Time:","options":["A.M.","P.M."],"required":null,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"PIN","options":[],"required":null,"pdf_field":""},{"help":"Residence phone number","type":"phone","label":"(R)","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""}],"filled_by":"attending doctor"}],"deadlines":[],"applies_to":"domestic travel insurance claims including trip cancellation, trip interruption, travel delay, and accidental medical benefit","attachments":[],"declarations":["I authorize any hospital, physician, or other person who has attended or examined me to provide medical information to the company or its representative."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"TATA AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana","label":"Claims Submission Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_cis_e7df7ce2ec.pdf","quote":"tion or procedure. Submit claim documents within 15 days of occurrence of incident. Kindly send the claim documents to: TATA AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No 7-1- 6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone-040-66864900 Assistance: 1. Website www.tataaig.com or Call 24*7 Customer Support No.: 022 6489 8282/1800 267 1","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"healthclaimsupport@tataaig.com","label":"Health Claims Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_prospectus_efd23b0ad6.pdf","quote":"al Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone: 040-66864900\nEmail ID | healthclaimsupport@tataaig.com\nCustomer Support Number: | 022 6489 8282 / 1800 267 1955 (nly for senior citizen policy holders)\nWebsite | www.tataaig.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"040-66864900","label":"Claims Administrator Phone","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_prospectus_efd23b0ad6.pdf","quote":"th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone: 040-66864900\nEmail ID | healthclaimsupport@tataaig.com\nCustomer Support Number: | 022 6489 8282 / 1800 267 1955 (nly for senior citi","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/tata-aig-general-insurance/1262-domestic-travel-claim-form"}