{"id":2010,"title":"INDUSIND TRAVEL CARE POLICY - EXTENSION REQUEST FORM","purpose":"service","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/indusind-travel-care-policy-extension-request-form","sha256":"3692bc6de725ccadcdaa4c9cca7f7c122c8a9dd48a5665392ef9ff9e6f8b5589","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to request an extension of their IndusInd Travel Care insurance policy for a single insured individual.","notes":["No extension will be permitted if any claim has been reported under the Medical Expenses section of the Policy."],"title":"INDUSIND TRAVEL CARE POLICY - EXTENSION REQUEST FORM","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Insured Person Details","fields":[{"help":"Select the appropriate title and write full name in the spaces provided","type":"choice","label":"Name of Insured/Insured Person o Mr.  o Ms. o Mrs.","options":["Mr.","Ms.","Mrs."],"required":null,"pdf_field":""},{"help":"Write the name of the insurance company","type":"text","label":"Name of Insurance Company","options":[],"required":null,"pdf_field":""},{"help":"Specify the policy or plan type","type":"text","label":"Type of Policy/Plan","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the start and end dates of the current insurance period","type":"date","label":"Period of Insurance From D D / M M / Y Y Y Y To D D / M M / Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth of Insured Person D D / M M / Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"Enter age in years","type":"number","label":"Age","options":[],"required":null,"pdf_field":""}],"filled_by":"insured person"},{"title":"Extension Details","fields":[{"help":"Enter the requested extension start and end dates","type":"date","label":"Required Extension Period From D D / M M / Y Y Y Y To D D / M M / Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"Enter the number of days for extension","type":"number","label":"Days","options":[],"required":null,"pdf_field":""},{"help":"Explain the reason for requesting extension","type":"text","label":"Reason for Extension:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured person"},{"title":"Claim and Health Information","fields":[{"help":"Select yes or no","type":"yes-no","label":"Have you made any claim during the current Policy period?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide claim details and approximate amount if applicable","type":"text","label":"If YES, details of claim made with approximate amount","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Are you in good health?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Have you undergone any treatment/medication, diagnosed with any illness/condition or suffered from any injury during the Policy period","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured person"},{"title":"Policy History","fields":[{"help":"Enter the start date of the first policy","type":"date","label":"Start date of first policy with us on which continuous Extension is being sought","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Has any extension being made to the policy before this request? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter total duration in days","type":"number","label":"If YES, please mention the total duration of the Policy as on expiry of the last extension","options":[],"required":null,"pdf_field":""}],"filled_by":"insured person"},{"title":"Break in Insurance Details","fields":[{"help":"Explain the reason for delay","type":"text","label":"Reason for delay in approaching the Insurer for extension","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Any Pre-existing Disease?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Any Hospitalisation during the period when there was no cover?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Insured has undergone any treatment/medication or suffered any injury during the same period","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if any above questions are answered yes","type":"text","label":"Where the Insured answers YES to any of the above questions, please provide details:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured person"},{"title":"Declaration","fields":[{"help":"Enter the date of signing","type":"date","label":"Date: D D / M M / Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign and print your name","type":"signature","label":"Name and Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured person"}],"deadlines":[],"applies_to":"IndusInd Travel Care Policy","attachments":[],"declarations":["The information provided is true to the best of the insured's knowledge and understanding.","IndusInd Insurance is not liable for claims related to disease, illness, injury, or loss occurring during any break in insurance coverage."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"+91 22 48903009","label":"Customer Care Paid Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"whatsapp","value":"+91 7400422200","label":"WhatsApp Support","level":null,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/about-us/grievance-redressal","quote":"ndinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:\nIndusInd General Insurance, 6th Floor, Commerz I, Oberoi Gard","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"services@indusindinsurance.com","label":"services email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/about-us/grievance-redressal","quote":"nce Claim\nTravel Insurance Claim\nCommercial Insurance Claim\nSupport\nSign In\nSelf Help\nVideo Chat\nContact Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91 22 48903009","label":"Paid Number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/about-us/grievance-redressal","quote":"Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievances@indusindinsurance.com","label":"Nodal Officer Email","level":2,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/about-us/grievance-redressal","quote":"m\nCommercial Insurance Claim\nSupport\nSign In\nSelf Help\nVideo Chat\nContact Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"headgrievances@indusindinsurance.com","label":"Head Grievances Email","level":3,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/about-us/grievance-redressal","quote":"s@indusindinsurance.com.\nStep 3\nIf the issue remains unresolved after Step 2, please escalate to:\n​Head Grievances\n​at ​headgrievances@indusindinsurance.com.​\nStep 4\nIf your concern remains unresolved after completing Steps 1, 2, and 3, you may approach the\nInsurance Ombudsma","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"022 4890 3009","label":"Grievance Redressal Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.indusindinsurance.com/downloads/commercial-care-package-policy-pw-retail","quote":"hall not be liable to pay or contribute more than its rateable proportion of such loss or damage.\nindusindinsurance.com 022 4890 3009 (Paid) 74004 22200 (WhatsApp) IRDAI Registration No. 103 IndusInd General Insurance Company Limited (Formerly known as","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/indusind-general-insurance/2010-indusind-travel-care-policy-extension-request-form"}