{"id":2306,"title":"National Overseas Travel Policy Claim Form","purpose":"claim","insurer":{"slug":"national-insurance","name":"National Insurance Company Limited"},"source_pdf":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NOTP%20Claim%20Form.pdf","sha256":"f1a5619cca6258d7b39fe7c349f5a8f020c85b84e2295d9dd1326511dfcc53f8","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person or their legal personal representative to claim benefits under the National Overseas Travel Policy for various covered events during overseas travel.","notes":["All fields are mandatory; write NA if not applicable.","Strike off sections not claimed for.","Use the contact details provided for emergency assistance and claim queries.","Attach original supporting documents as per Annexure I."],"title":"National Overseas Travel Policy Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Trip Details","fields":[{"help":"Enter your policy number exactly as on your policy document","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Enter the date your policy was issued in dd/mm/yyyy format","type":"date","label":"Date of policy issued (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Enter the start date of your trip in dd/mm/yyyy format","type":"date","label":"Date of trip commencement (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the insurance plan purchased","type":"text","label":"Plan name","options":[],"required":true,"pdf_field":""},{"help":"Enter the total number of days of your trip","type":"number","label":"No. of days of trip","options":[],"required":true,"pdf_field":""},{"help":"Enter the scheduled return date of your trip in dd/mm/yyyy format","type":"date","label":"Scheduled Date of Return","options":[],"required":true,"pdf_field":""},{"help":"Enter the country or countries you visited","type":"text","label":"Country of visit","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of the Insured Person","fields":[{"help":"Enter the full name of the insured person as per policy","type":"text","label":"(a) Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the current age in completed years","type":"number","label":"(b) Present age in completed years","options":[],"required":true,"pdf_field":""},{"help":"Enter the occupation of the insured person","type":"text","label":"(c) Occupation","options":[],"required":true,"pdf_field":""},{"help":"Enter the full residential address of the insured person","type":"text","label":"(d) Residential address","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section of policy under which claim is made","fields":[{"help":"Tick all applicable claim sections","type":"checkbox","label":"Please tick the respective boxes as applicable","options":["Emergency Medical Expenses","Emergency Dental Pain Relief","Medical Evacuation","Repatriation of Remains","Death due to accident while on Trip","Disability due to accident","Loss of Checked in Baggage","Trip Cancellation","Trip Curtailment","Bounced Hotel & Flight Booking","Travel Assistance Service","Emergency Medical Reunion","Trip Delay","Missed Connection","Automatic extension up to 7 days","Emergency Cash Advance","Delay of Checked in Baggage","Loss of Passport & Visa","Loss of International DL","Hospitalisation Daily Allowance","Hijack Distress Allowance","Minor Children Care","Pet Care Cover","Personal Liability","Death due to Common Carrier","Home Burglary","Laptop Cover","PA Cover while travelling in Home Country"],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claim Occurrence and Bank Details","fields":[{"help":"Enter the date when the claim event occurred","type":"date","label":"Date of claim occurrence (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Enter the name exactly as in your Indian bank account","type":"text","label":"Name as in bank account in India","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of your bank","type":"text","label":"Bank name","options":[],"required":true,"pdf_field":""},{"help":"Enter the branch name and full address","type":"text","label":"Branch name & address","options":[],"required":true,"pdf_field":""},{"help":"Enter your bank account number","type":"text","label":"Account no.","options":[],"required":true,"pdf_field":""},{"help":"Specify the type of bank account (e.g. Savings, Current)","type":"text","label":"Account type","options":[],"required":true,"pdf_field":""},{"help":"Enter the IFSC code of your bank branch","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"Enter the MICR code of your bank branch","type":"text","label":"MICR code","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 1, 2 & 6: Emergency Medical / Dental / Hospitalisation Daily Allowance","fields":[{"help":"Enter the name of the person who was sick or injured","type":"text","label":"Name of Sick or Injured Person","options":[],"required":true,"pdf_field":""},{"help":"Describe the injury or illness","type":"text","label":"Nature of Injury / Illness","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of injury or illness","type":"date","label":"Date of Injury / Illness","options":[],"required":true,"pdf_field":""},{"help":"Enter the place where injury or illness occurred","type":"text","label":"Place of Injury / Illness","options":[],"required":true,"pdf_field":""},{"help":"Explain how the injury happened or name the illness","type":"text","label":"Circumstances of Injury/ name of illness","options":[],"required":true,"pdf_field":""},{"help":"Indicate if the illness was declared when policy was taken","type":"yes-no","label":"Was the illness declared at the time of taking policy?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"State if Emergency Assistance was contacted and if not, explain why","type":"text","label":"If claim was due to hospitalisation, was the Emergency Assistance Departmental contacted (YES/NO). If not, please advice why?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Enter hospitalisation start and end dates and times","type":"date","label":"Date of Hospitalisation: From: ___/___/_____ Time: ___:___ To: ___/___/_____ Time: ___:___","options":[],"required":true,"pdf_field":""},{"help":"Enter the total claim amount","type":"amount","label":"Claim amount","options":[],"required":true,"pdf_field":""},{"help":"Provide details if any third parties were involved","type":"text","label":"Details of any third parties involved in accidental injury or death of insured person.","options":[],"required":false,"pdf_field":""},{"help":"Provide details of other health insurance if any","type":"text","label":"Details of any other health insurance cover by the insured","options":[],"required":false,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Telephone number of other insurer","type":"phone","label":"Tel. No.","options":[],"required":false,"pdf_field":""},{"help":"List all claimed expenses with provider names, amounts, and payment status","type":"table","label":"Details of Claimed Expense, Providers Name, Prescription Charges, etc. (Table with columns: Details of Claimed Expense, Amount Charged in Local Currency of Country visited, Has Bill Been Paid by You? YES / NO)","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Sum of all claimed expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or claimant's legal personal representative"},{"title":"Section 3: Medical Evacuation","fields":[{"help":"Provide full details of the medical evacuation","type":"text","label":"Full Details of Evacuation including Date, Time & Place","options":[],"required":true,"pdf_field":""},{"help":"Enter total evacuation expenses","type":"amount","label":"Total Amount incurred in Evacuation","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or claimant's legal personal representative"},{"title":"Section 4: Repatriation of Remains","fields":[{"help":"Enter date and place of death","type":"text","label":"Date and Place of Death","options":[],"required":true,"pdf_field":""},{"help":"Describe cause or circumstances of death","type":"text","label":"Cause/ Circumstances of death","options":[],"required":true,"pdf_field":""},{"help":"Provide details of expenses incurred","type":"text","label":"Expenses incurred for repatriation of Remains to India/ Cost of local cremation/ burial","options":[],"required":true,"pdf_field":""},{"help":"Sum of all repatriation expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or claimant's legal personal representative"},{"title":"Section 5: Emergency Medical Reunion","fields":[{"help":"Enter name of visitor","type":"text","label":"Name of the person visiting Insured","options":[],"required":true,"pdf_field":""},{"help":"State relationship to insured","type":"text","label":"Relation with the Insured","options":[],"required":true,"pdf_field":""},{"help":"Describe journey details","type":"text","label":"Details of journey of the visit","options":[],"required":true,"pdf_field":""},{"help":"Provide accommodation details","type":"text","label":"Details of Accommodation","options":[],"required":true,"pdf_field":""},{"help":"Sum of all expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or claimant's legal personal representative"},{"title":"Section 7: Trip Delay","fields":[{"help":"Enter airline or carrier name","type":"text","label":"Name of carrier","options":[],"required":true,"pdf_field":""},{"help":"Enter flight number","type":"text","label":"Flight No","options":[],"required":true,"pdf_field":""},{"help":"Enter date of flight","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Departure location","type":"text","label":"From","options":[],"required":true,"pdf_field":""},{"help":"Arrival location","type":"text","label":"To","options":[],"required":true,"pdf_field":""},{"help":"Scheduled departure time (hh:mm)","type":"text","label":"Scheduled time of departure","options":[],"required":true,"pdf_field":""},{"help":"Actual departure time (hh:mm)","type":"text","label":"Actual time of departure","options":[],"required":true,"pdf_field":""},{"help":"Number of hours delayed","type":"number","label":"No. of hours delay","options":[],"required":true,"pdf_field":""},{"help":"Explain reason for delay","type":"text","label":"Cause of delay","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 8 & 9: Trip Cancellation / Curtailment","fields":[{"help":"Enter date of loss causing cancellation or curtailment","type":"date","label":"Date of loss, leading to trip cancellation/ curtailment","options":[],"required":true,"pdf_field":""},{"help":"Explain reason for cancellation or curtailment","type":"text","label":"Reason for trip cancellation/ curtailment","options":[],"required":true,"pdf_field":""},{"help":"Name and relation of affected person if applicable","type":"text","label":"Name of person affected (if reason is death/ sickness) & relation","options":[],"required":false,"pdf_field":""},{"help":"Address of affected person","type":"text","label":"Address of affected person","options":[],"required":false,"pdf_field":""},{"help":"Describe details of cancellation or curtailment","type":"text","label":"Details of trip cancellation/ curtailment","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 10: Missed Connection","fields":[{"help":"Provide details of the missed flight","type":"text","label":"Details of Missed Flight","options":[],"required":true,"pdf_field":""},{"help":"Enter total hours delayed by previous flight","type":"number","label":"Total Hours delayed by previous connecting Flight","options":[],"required":true,"pdf_field":""},{"help":"Explain reason for delay with supporting documents","type":"text","label":"Reason of delay (supported by documents)","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 11: Minor Children Care","fields":[{"help":"Enter name of hospitalized person","type":"text","label":"Name of the person hospitalized","options":[],"required":true,"pdf_field":""},{"help":"Enter names and relations of accompanying persons","type":"text","label":"Name & Relation of the persons accompanying the insured in hospital","options":[],"required":true,"pdf_field":""},{"help":"State relationship of minor children to hospitalized person","type":"text","label":"Relationship of the Minor Child/ Children with hospitalized person","options":[],"required":true,"pdf_field":""},{"help":"Describe journey details","type":"text","label":"Details of journey","options":[],"required":true,"pdf_field":""},{"help":"Sum of all expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 12: Hijack Distress Allowance","fields":[{"help":"Enter name of carrier","type":"text","label":"Name of carrier","options":[],"required":true,"pdf_field":""},{"help":"Enter total hours of hijack","type":"number","label":"Total no. of Hours hijacked","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 13: Bounced Hotel & Flight Booking","fields":[{"help":"Explain reason for bounced booking","type":"text","label":"Reason for Bounced Hotel/ Flight Booking","options":[],"required":true,"pdf_field":""},{"help":"Enter date of bounced booking","type":"date","label":"Date of Bounced Booking","options":[],"required":true,"pdf_field":""},{"help":"Sum of all charges","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 14: Pet Care Cover","fields":[{"help":"Enter date and place where pet was treated","type":"text","label":"Date and Place of treatment","options":[],"required":true,"pdf_field":""},{"help":"Enter name of pet care facility","type":"text","label":"Name of the Crèche/ Kennel (where Pet is kept)","options":[],"required":true,"pdf_field":""},{"help":"Describe accident or disease affecting pet","type":"text","label":"Details of accident/ disease","options":[],"required":true,"pdf_field":""},{"help":"Provide vet or hospital details","type":"text","label":"Name and address of the authorized Veterinary doctor/ Hospital","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or claimant's legal personal representative"},{"title":"Section 15: Home Burglary","fields":[{"help":"Enter date and time of burglary incident","type":"text","label":"Date & Time of Incident","options":[],"required":true,"pdf_field":""},{"help":"Describe the loss briefly","type":"text","label":"Brief description of loss","options":[],"required":true,"pdf_field":""},{"help":"Provide FIR details","type":"text","label":"Details of FIR (Date & FIR No.)","options":[],"required":true,"pdf_field":""},{"help":"Sum of all losses and expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 16, 17 & 18: Death/ Disability due to Accident or Death while travelling in a Common Carrier","fields":[{"help":"Enter name of injured person","type":"text","label":"Name of Injured Person","options":[],"required":true,"pdf_field":""},{"help":"Select the nature of loss or injury","type":"choice","label":"Nature of Loss/ Injury: (please tick) Death/ Permanent Total Disablement/ Total and irrecoverable loss of both eyes or two limbs or of one eye and one limb","options":["Death","Permanent Total Disablement","Total and irrecoverable loss of both eyes or two limbs or of one eye and one limb"],"required":true,"pdf_field":""},{"help":"Indicate if death occurred while travelling in a common carrier","type":"yes-no","label":"Whether Death occurred while travelling in a Common Carrier: Yes/ No (Please tick)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter date of loss or injury","type":"date","label":"Date of Loss/ Injury","options":[],"required":true,"pdf_field":""},{"help":"Enter place where accident occurred","type":"text","label":"Place of Accident","options":[],"required":true,"pdf_field":""},{"help":"Describe accident details","type":"text","label":"Details of Accident","options":[],"required":true,"pdf_field":""},{"help":"Enter hospitalisation start and end dates","type":"date","label":"Dates of Hospitalisation: From: ___/___/_____ To: ___/___/_____","options":[],"required":true,"pdf_field":""},{"help":"Provide hospital or doctor details","type":"text","label":"Name, Address and Contact No. of the Hospital/ Doctor","options":[],"required":true,"pdf_field":""},{"help":"Provide police report details if available","type":"text","label":"Police Investigation/ Report, if any","options":[],"required":false,"pdf_field":""},{"help":"Provide details of third parties involved if any","type":"text","label":"Details of any third parties involved in accidental injury or death of insured person.","options":[],"required":false,"pdf_field":""},{"help":"Provide other personal accident insurance details if applicable","type":"text","label":"Is the claim being made under any other Personal Accident Insurance? If so, please state the name and address of the insurance Company along with its Policy Number","options":[],"required":false,"pdf_field":""},{"help":"List all claimed expenses with provider names, amounts, and payment status","type":"table","label":"Details of Claimed Expense, Providers Name, Prescription Charges, etc. (Table with columns: Details of Claimed Expense, Amount Charged in Local Currency, Has Bill Been Paid by You? YES / NO)","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Sum of all claimed expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or claimant’s legal personal representative"},{"title":"Section 19 & 20: Delay/ Loss of Checked in Baggage","fields":[{"help":"Enter time, date and place where baggage was lost or delayed","type":"text","label":"Time, Date and Place of Loss / Delay","options":[],"required":true,"pdf_field":""},{"help":"Describe circumstances of loss or delay","type":"text","label":"Full Circumstances of Loss / Delay","options":[],"required":true,"pdf_field":""},{"help":"State loss or total hours delayed while baggage was with airline","type":"text","label":"Loss / Total Hours Delay occurred in the custody of an airline","options":[],"required":true,"pdf_field":""},{"help":"Enter date when loss/delay was reported to carrier","type":"date","label":"Date reported to Carrier","options":[],"required":true,"pdf_field":""},{"help":"Enter carrier's name and address","type":"text","label":"Name and address of carrier","options":[],"required":true,"pdf_field":""},{"help":"Enter PIR number issued by airline","type":"text","label":"Property Irregularity Report (PIR) number from Airline/Common Carrier","options":[],"required":true,"pdf_field":""},{"help":"Provide name and position of authority person reported to","type":"text","label":"Name and Position of any other person in authority to whom the matter was reported","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for baggage loss or delay","type":"amount","label":"Amount claimed","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 21: Loss of Passport & Visa","fields":[{"help":"Enter date when passport or visa was lost","type":"date","label":"Date of loss","options":[],"required":true,"pdf_field":""},{"help":"Provide police station name, report or diary number and date","type":"text","label":"Name of police station, report/ general diary no. & date reported","options":[],"required":true,"pdf_field":""},{"help":"Explain reason if police was not informed","type":"text","label":"If police not informed, give reason","options":[],"required":false,"pdf_field":""},{"help":"Provide details of lost passport or visa","type":"text","label":"Details of Passport/ Visa lost","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 22: Loss of International Driving License","fields":[{"help":"Enter place and date of loss","type":"text","label":"Place & Date of Loss","options":[],"required":true,"pdf_field":""},{"help":"Enter driving license number","type":"text","label":"License Number","options":[],"required":true,"pdf_field":""},{"help":"Enter expenses incurred due to loss","type":"amount","label":"Expenses incurred","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 23: Emergency Cash Advance","fields":[{"help":"Enter date of cash loss","type":"date","label":"Date of loss","options":[],"required":true,"pdf_field":""},{"help":"Enter total cash amount before accident","type":"amount","label":"Total Amount possessed before accident","options":[],"required":true,"pdf_field":""},{"help":"Enter amount of cash lost","type":"amount","label":"Amount lost","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section 24: Personal Liability","fields":[{"help":"Enter time, date and place of accident","type":"text","label":"Time, date and place of accident resulting to liability","options":[],"required":true,"pdf_field":""},{"help":"Describe accident circumstances","type":"text","label":"Full circumstances of accident","options":[],"required":true,"pdf_field":""},{"help":"Enter amount claimed for liability","type":"amount","label":"Amount claimed","options":[],"required":true,"pdf_field":""},{"help":"Provide name and address of third party or property damaged","type":"text","label":"Name of the third party person/ Address of third party property damaged","options":[],"required":true,"pdf_field":""},{"help":"Enter contact number of third party","type":"phone","label":"Contact no. of third party person","options":[],"required":true,"pdf_field":""},{"help":"Provide police report details","type":"text","label":"Name of police station, report/ general diary no. & date reported","options":[],"required":true,"pdf_field":""},{"help":"Explain detailed circumstances of loss","type":"text","label":"Detailed circumstances of loss","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Optional Covers: Laptop Cover","fields":[{"help":"Enter date and place of laptop loss or damage","type":"text","label":"Date and place of accident resulting to Loss or Damage","options":[],"required":true,"pdf_field":""},{"help":"Describe accident details","type":"text","label":"Full details of accident","options":[],"required":true,"pdf_field":""},{"help":"Select nature of loss or damage","type":"choice","label":"Nature of Loss/ Damage: Total/ Partial","options":["Total","Partial"],"required":true,"pdf_field":""},{"help":"Enter replacement cost","type":"amount","label":"Cost of replacement of the equipment by new equipment","options":[],"required":true,"pdf_field":""},{"help":"Provide repairer details","type":"text","label":"Name and Address of the Repairer","options":[],"required":true,"pdf_field":""},{"help":"Sum of all expenses","type":"amount","label":"TOTAL AMOUNT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Optional Covers: PA cover (while travelling in Home Country)","fields":[{"help":"Enter time, date and place of accident","type":"text","label":"Time, Date and Place of accident","options":[],"required":true,"pdf_field":""},{"help":"Describe accident details","type":"text","label":"Details of accident","options":[],"required":true,"pdf_field":""},{"help":"Enter departure time from India","type":"text","label":"Departure Time from India","options":[],"required":true,"pdf_field":""},{"help":"Enter arrival time to India","type":"text","label":"Arrival Time to India","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Additional Information","fields":[{"help":"Provide any extra information supporting your claim","type":"text","label":"Additional information you may wish to give in support of your claim under any section of the policy (Please mention section number)","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"claims under the National Overseas Travel Policy for events such as emergency medical expenses, trip cancellation, baggage loss, repatriation, and other listed sections","attachments":["Required documents as mentioned in Annexure I to support claims for the section"],"declarations":["The statements and particulars given are true and complete to the best of the claimant's knowledge.","The information provided forms the basis of the insurance policy and the policy is effective only after full premium payment.","The claimant will notify any change in occupation or health after proposal submission but before risk acceptance.","Consent is given to the company to seek medical information from doctors, hospitals, employers, and other insurers for underwriting and claim settlement.","Authorization is given to share proposal and medical information with government and regulatory authorities for underwriting and claims."],"dropped_labels":9},"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/national-insurance/2306-national-overseas-travel-policy-claim-form"}