{"id":2222,"title":"VOYAGER GROUP TRAVEL INSURANCE CLAIM FORM","purpose":"claim","insurer":{"slug":"icici-lombard-general-insurance","name":"ICICI LOMBARD General Insurance Company Limited"},"source_pdf":"https://www.icicilombard.com/docs/default-source/default-document-library/4168-voyager-group-travel-insurance-claim.pdf","sha256":"fcf21a09f00c55acf0c1ec98f24ac13cca3057834d5bae9751da355c25dfbc16","pages":20,"collected":"2026-10-20","instructions":{"about":"This form is used by insured persons or claimants to file claims under the Voyager Group Travel Insurance policy for various types of coverage including medical, baggage, trip cancellation, personal accident, and other travel-related incidents.","notes":["Use original bills only.","Every claim must be accompanied by original ticket/boarding pass or copy of passport indicating travel dates.","Failure to immediately inform the helpline may reduce claim admissibility to 75%.","No expenses beyond US$ 1000 shall be incurred without prior approval.","Answer all questions completely; attach additional sheets if needed.","Cashless treatment facility is at the sole discretion of the company and cannot be demanded as a right.","For adventure sports claims, additional documents such as medical fitness certificate and correspondence with sports authority are required.","In case of baggage claims, property irregularity reports and police FIRs are required.","In case of trip cancellation, proof of cancellation and refund receipts must be submitted.","For financial emergency cash allowance, police report and confirmation of foreign currency carried are required."],"title":"VOYAGER GROUP TRAVEL INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"INSURED DETAILS","fields":[{"help":"","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Policy Start Date:","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Policy End Date","options":[],"required":null,"pdf_field":""},{"help":"Enter full name with title","type":"text","label":"Full Name Mr./ Ms./ Dr.:","options":["Mr.","Ms.","Dr."],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Sex: Male           Female","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Full current address","type":"text","label":"Current Address:","options":[],"required":null,"pdf_field":""},{"help":"Address in country of residence","type":"text","label":"Address in Country of Residence:","options":[],"required":null,"pdf_field":""},{"help":"Include country code","type":"phone","label":"Phone No. Overseas:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone No. India:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"As per passport","type":"text","label":"Passport No.:","options":[],"required":null,"pdf_field":""},{"help":"If provided by insurer","type":"text","label":"Claims Ref No.:(As provided)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"CLAIMANT INFORMATION","fields":[{"help":"If different from insured","type":"text","label":"Full Name:","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Sex:  Male Female","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Relationship to insured","type":"text","label":"Relationship with the Policyholder:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claimant's Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone No. (Off):","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone No. (Res):","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"Explain your role in claim","type":"text","label":"In what capacity are you making this claim?","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"OUT PATIENT TREATMENT","fields":[{"help":"Start date of treatment","type":"date","label":"Dates of Treatment: From","options":[],"required":null,"pdf_field":""},{"help":"End date of treatment","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of onset of Symptoms:","options":[],"required":null,"pdf_field":""},{"help":"Attach doctor's report","type":"attachment","label":"Attending Doctor's Report:","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date Doctor Contacted:","options":[],"required":null,"pdf_field":""},{"help":"Time of contact (HH:MM)","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Describe ailment","type":"text","label":"Nature of Ailment","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State diagnosis and nature of treatment provided","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"When did patient's symptoms first appear?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Describe any other disease or infirmity affecting present condition:","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the ailment due to Pregnancy: Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain if yes","type":"text","label":"Was the ailment aggravated due to any pre-existing condition? 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Yes/No. If Yes, please give details (How many points were used, which card was used, name on card)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Did the customer opt for ‘Event Cancellation’ Cover? Yes/No. If Yes, please provide details of the event (Where, purpose of the event, no. of people attending, reason of cancellation of event, dates and duration of event)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Did the customer opt for ‘Reimbursement of Cancellation charges of pre-booked events’ cover? Yes/No. If Yes, please provide details of the event (Where, purpose of the event, no. of people attending, reason of cancellation of event, dates and duration of event)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Columns: Sr. No., Loss/ Expenses Details, Amount","type":"table","label":"Details of Losses/ Expenses Incurred:","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Total:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"TRIP CANCELLATION DUE TO VISA REJECTION","fields":[{"help":"","type":"date","label":"Visa Appointment Date & Time:","options":[],"required":null,"pdf_field":""},{"help":"AM/PM","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Visa Appointment Place:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country of Travel:","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Duration of Travel: To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Type of Visa applied to","options":[],"required":null,"pdf_field":""},{"help":"Explain if yes","type":"text","label":"Any Past / Current criminal history? Yes/No, If Yes, please give details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for visa rejection","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Trip Cancellation Date:","options":[],"required":null,"pdf_field":""},{"help":"If not insured","type":"text","label":"Person Affected and Relationship with the Insured:","options":[],"required":null,"pdf_field":""},{"help":"Columns: Sr. No., Loss Details, Amount","type":"table","label":"Details of Losses Incurred:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Group travel insurance claims for various coverages as per the annexures selected by the insured","attachments":["Original ticket/boarding pass or copy of passport indicating travel dates","Doctor's Report as per format for Accident & Medical Section claims","Original bills, receipts, credit card slips pertaining to claim","Discharge summary for Daily Allowance and Child Care Expenses claims","Cancelled cheque or document mentioning account details for certain claims","Medical reports and transportation details for Medical Evacuation claims","Police First Incidence Report (FIR) for road traffic accident or third-party involvement","Post-mortem report if applicable","Property irregularity report for baggage claims","Photocopy of death certificate for repatriation claims","Official Declaration by embassy for Political Risk and Catastrophe Evacuation","Statement of claim and police report for Personal Liability claims","Certificate of Hijack from Common Carrier for Hijack Distress Allowance","Copy of report to police authorities for Financial Emergency Cash Allowance","Confirmation of cancellation and refund receipts for Trip Cancellation claims"],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having an interest in the property are disclosed as per the proposal or policy endorsement.","No material information relevant to the claim has been withheld or undisclosed.","False or fraudulent statements or concealment of material information voids the policy and claim rights.","Receipt of claim form or documents does not constitute admission of liability by the company.","Authorization is given to International Subrogation Management (ISM) to inquire and obtain information regarding the accident.","The company may call for additional documents for claim assessment.","Authorization is given to insurance companies, physicians, hospitals, or other entities to release information for claim evaluation.","Photographic or facsimile copies of authorization are as valid as originals.","Authorization is valid for the duration of the claim.","Filing a fraudulent claim may lead to prosecution for insurance fraud."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/icici-lombard-general-insurance/2222-voyager-group-travel-insurance-claim-form"}