{"id":2387,"title":"Zuno Comprehensive Group Overseas Travel Claim Form","purpose":"claim","insurer":{"slug":"zuno-general-insurance","name":"Zuno General Insurance Ltd"},"source_pdf":"https://cms.hizuno.com/uploads/Zuno_Comprehensive_Group_Overseas_Travel_Claim_Form_V_1_2_01f4656413.pdf?updated_at=2025-04-17T08:54:45.092Z","sha256":"fab26b4c712b33169667857c70c2489ebb0b55504260da3721c67bd3a1185271","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the Zuno Comprehensive Group Overseas Travel Insurance policy for various covered events during overseas travel.","notes":["Claim Form is to be filled in capital letters and duly signed by insured / claimant.","Please attach copy / original bills, receipts, Credit Card slips pertaining to your claim. Originals must be submitted wherever applicable.","Copy of visible Photo ID Proof like Pan card, Voter ID cards, Passport Copy is mandatory.","If there is insufficient space, kindly use a separate sheet which can be attached to this form.","Submit the claim form with required documents to the address provided including OSP’s address (service provider and location).","Use original ticket/boarding pass or passport copy indicating travel dates with the claim.","Medical statements from relations or spouse will not be accepted for study interruption and sponsor protection claims.","Please complete the appropriate section of the claim form and read carefully the instructions relating to supporting documents required."],"title":"Zuno Comprehensive Group Overseas Travel Claim Form","submit":{"to":"Zuno General Insurance Limited or its authorized representatives","how":"post or as per instructions","address":"Zuno General Insurance Limited, 2nd Floor, Tower 3, Wing B, Kohinoor City Mall, Kohinoor City, Kirol Road, Kurla (West), Mumbai - 400 070"},"purpose":"claim","sections":[{"title":"Details of Insured and Claimant","fields":[{"help":"","type":"text","label":"Name of the insured:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Current address of the insured:","options":[],"required":null,"pdf_field":""},{"help":"Use format DD MM YYYY","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"Age in completed years","type":"number","label":"Completes years of age of the insured:","options":[],"required":null,"pdf_field":""},{"help":"Specify self-employed or salaried","type":"text","label":"Whether self-employed /salaried:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Sex: Male        Female           Others","options":["Male","Female","Others"],"required":null,"pdf_field":""},{"help":"Primary mobile number","type":"phone","label":"*Mobile No1:","options":[],"required":true,"pdf_field":""},{"help":"Secondary mobile number (optional)","type":"phone","label":"Mobile No2:","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email address:","options":[],"required":false,"pdf_field":""},{"help":"Country or countries of travel","type":"text","label":"Trip destination:","options":[],"required":null,"pdf_field":""},{"help":"Use format DD MM YYYY","type":"date","label":"Date trip commenced:","options":[],"required":null,"pdf_field":""},{"help":"Use format DD MM YYYY","type":"date","label":"Scheduled return date:","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Does the insured have any other travel or health / accident insurance? If yes, please give details below","options":[],"required":null,"pdf_field":""},{"help":"Other insurer's name if any","type":"text","label":"Name of insurer:","options":[],"required":null,"pdf_field":""},{"help":"Other policy number if any","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"Sum insured:","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed under this policy","type":"amount","label":"Claimed amount:","options":[],"required":null,"pdf_field":""},{"help":"Policy start date","type":"date","label":"Policy period: From","options":[],"required":null,"pdf_field":""},{"help":"Policy end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Passport number of insured","type":"text","label":"Passport No:","options":[],"required":null,"pdf_field":""},{"help":"If different from insured","type":"text","label":"Name of the claimant /nominee:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claimant’s address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"Relationship of claimant to insured","type":"text","label":"Relationship with the policy holder:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email address:","options":[],"required":false,"pdf_field":""},{"help":"Claimant's passport number if different","type":"text","label":"Passport No:","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Claim Details and Policy Information","fields":[{"help":"Claim number if already assigned","type":"text","label":"Claim No:","options":[],"required":false,"pdf_field":""},{"help":"Date when claim was informed","type":"date","label":"Date of intimation:","options":[],"required":false,"pdf_field":""},{"help":"Time when claim was informed (HH MM)","type":"text","label":"Time of intimation:","options":[],"required":false,"pdf_field":""},{"help":"Policy number under which claim is made","type":"text","label":"Policy No:","options":[],"required":true,"pdf_field":""},{"help":"Policy start date","type":"date","label":"Policy start date:","options":[],"required":true,"pdf_field":""},{"help":"Policy end date","type":"date","label":"Policy end date:","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Claim Type Selection","fields":[{"help":"Tick all applicable claim types","type":"checkbox","label":"Please indicate whether claim is in respect of (Tick Boxes)","options":["Accident & sickness medical expense benefit","Repatriation of remains","Reinstatement of SI in case of Accidental hospitalization","Sickness dental relief","Accidental death and dismemberment benefit (24 hrs)","Accidental death and dismemberment benefit (common carrier)","Continued medical treatment in India","Daily allowance in case of hospitalisation","Compassionate visit","Emergency hotel extension","Return of minor child(ren)","PreExisting disease coverage in life threatening condition","Out patient treatment","Adventure sports cover","Loss of passport benefit","Flight delay (trip delay)","Study interruption","Childcare benefits","Physiotherapy","Automatic extension of policy","Assistance services","Hijack/kidnap distress compensation","Emergency cash advance","Trip cancellation","Trip interruption","Missed connection/missed departure","Bounced hotel/airline booking","Denied carrier","Political risk and catastrophe evacuation","Lounge access - new benefit","Up-gradation to business class","Checked baggage delay benefit","Checked baggage loss benefit","Damage baggage","Personal liability benefit","Home burglary (in Rs.)","Emergency medical termination of pregnancy","Felonious assault (accidental death and dismemberment)","Vision care","Emergency medical evacuation","Fire cover for building","Fire cover for home content","Bail bond","Loss or damage to sporting equipment","Self drive cover: excess/ deductible","Self drive cover - loss of international driving license - inconvenience fee","Self drive cover - for hired vehicle","Cover for valuables","Event reimbursement","Pet care (death cover for pet)","Fraudulent card payment benefit","Zero deductible","Mugging benefit","Loss of gadgets","Sponsor protection","Cancer screening and mammography expenses","Ambulance charges","Self inflicted injury"],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Accident & Medical Details","fields":[{"help":"Date of accident or illness onset","type":"date","label":"Date of accident:","options":[],"required":null,"pdf_field":""},{"help":"Time of accident (HH MM)","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Location where accident occurred","type":"text","label":"Place of accident:","options":[],"required":null,"pdf_field":""},{"help":"Explain how the injury or illness happened","type":"text","label":"Please describe in details the circumstances of injury / illness / accident:","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries sustained","type":"text","label":"Please describe the nature of injures:","options":[],"required":null,"pdf_field":""},{"help":"Name of hospital where treated","type":"text","label":"Hospital name:","options":[],"required":null,"pdf_field":""},{"help":"Name of treating doctor","type":"text","label":"Doctor’s name:","options":[],"required":null,"pdf_field":""},{"help":"Address of hospital","type":"text","label":"Hospital address:","options":[],"required":null,"pdf_field":""},{"help":"Hospital phone number","type":"phone","label":"Hospital telephone No:","options":[],"required":false,"pdf_field":""},{"help":"Hospital fax number","type":"text","label":"Fax No:","options":[],"required":false,"pdf_field":""},{"help":"Doctor's mobile number","type":"phone","label":"Mobile No of treating doctor:","options":[],"required":false,"pdf_field":""},{"help":"Hospital admission date","type":"date","label":"Date of admission:","options":[],"required":false,"pdf_field":""},{"help":"Hospital discharge date","type":"date","label":"Date of discharge:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes if recommended","type":"yes-no","label":"Has up-gradation to business class is recommended by treating physician considering the medical condition.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide police or authority report details if applicable","type":"text","label":"Where police or any other authorities informed about the accident? If yes, please provide us with the details","options":[],"required":false,"pdf_field":""},{"help":"Total amount claimed","type":"amount","label":"Total claim amount:","options":[],"required":null,"pdf_field":""},{"help":"Write the claim amount in words","type":"text","label":"(in words:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Other Specific Claim Sections","fields":[{"help":"Describe incident in detail","type":"text","label":"Incident narration:","options":[],"required":false,"pdf_field":""},{"help":"Provide travel mode details","type":"text","label":"Mode of travel and its details:","options":[],"required":false,"pdf_field":""},{"help":"Provide authority report details if applicable","type":"text","label":"Was the Loss reported to the appropriate authority? If yes, please provide us with the details:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Police report lodged:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Carrier name for baggage or travel claims","type":"text","label":"Name of the carrier:","options":[],"required":false,"pdf_field":""},{"help":"Flight number if applicable","type":"text","label":"Flight No:","options":[],"required":false,"pdf_field":""},{"help":"Scheduled flight times","type":"text","label":"Scheduled arrival / departure date & time:","options":[],"required":false,"pdf_field":""},{"help":"Explain reason for trip issues","type":"text","label":"Reason for Trip Cancellation or Interruption / Missed Connection / Missed Departure/Trip Delay / Event Reimbursement","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Has the customer opted for Lounge Access/Recreation Cover for Common Carrier/Public Carrier:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Name if different from insured","type":"text","label":"Name of the person hospitalized (if not the Insured):","options":[],"required":false,"pdf_field":""},{"help":"Relationship to insured","type":"text","label":"Relationship with the insured:","options":[],"required":false,"pdf_field":""},{"help":"Hospital or clinic details","type":"text","label":"Provide name, address & telephone number of hospital/ clinic:","options":[],"required":false,"pdf_field":""},{"help":"Doctor's office and mobile numbers","type":"phone","label":"Treating doctor's telephone No: (Off) / (M)","options":[],"required":false,"pdf_field":""},{"help":"Hospital admission and discharge dates","type":"date","label":"Dates of hospitalisation: From / To","options":[],"required":false,"pdf_field":""},{"help":"When symptoms first appeared","type":"date","label":"Date of onset of symptoms:","options":[],"required":false,"pdf_field":""},{"help":"Summary or attach report","type":"text","label":"Treating doctor’s report:","options":[],"required":false,"pdf_field":""},{"help":"Date doctor was first contacted","type":"date","label":"Date on which doctor was contacted:","options":[],"required":false,"pdf_field":""},{"help":"Time doctor was contacted (HH MM)","type":"text","label":"Time:","options":[],"required":false,"pdf_field":""},{"help":"Describe illness or injury","type":"text","label":"Nature of ailment:","options":[],"required":false,"pdf_field":""},{"help":"Diagnosis and treatment details","type":"text","label":"State diagnosis and nature of treatment provided:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Was the ailment due to pregnancy:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Was the ailment aggravated due to any pre-existing condition?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Explain pre-existing condition","type":"text","label":"If yes, please give details:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Can the patient be evacuated back to the Republic of India?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide estimated duration","type":"text","label":"Estimated time the patient would continue to be in the hospital?","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Is medical evacuation back to Republic of India needed?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Explain reasons for evacuation","type":"text","label":"Please give detailed reasons of the ailment and reason for transportation:","options":[],"required":false,"pdf_field":""},{"help":"For bail bond claims","type":"text","label":"Name and contact details of the detaining authority:","options":[],"required":false,"pdf_field":""},{"help":"Describe offense","type":"text","label":"The offense for which the insured is in custody:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Is this offense bailable as per the laws of the country?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"For self drive cover - lost international driving license","type":"text","label":"Licence No:","options":[],"required":false,"pdf_field":""},{"help":"Date of loss or incident","type":"date","label":"Date of loss:","options":[],"required":false,"pdf_field":""},{"help":"Location of loss","type":"text","label":"Place of loss:","options":[],"required":false,"pdf_field":""},{"help":"Describe incident briefly","type":"text","label":"Brief description of incident:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no and attach report if yes","type":"yes-no","label":"Whether report to police if yes please provide us with the report","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"For fraudulent card payment benefit","type":"text","label":"Date, Time and place of Fraudulent activity:","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no and attach reports if yes","type":"yes-no","label":"Whether reported to Police and Bank authorities if yes: kindly share the both the reports","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"For outpatient treatment and other medical claims","type":"text","label":"Date, time and place of visit to hospital / GP:","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Authorization and Declaration","fields":[{"help":"Signature of claimant or authorized person","type":"signature","label":"Sign (Claimant or authorised person)","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or authorized person"}],"deadlines":[],"applies_to":"Comprehensive Group Overseas Travel Insurance claims for overseas travel incidents including medical expenses, repatriation, accidental death, baggage loss, trip delays, and other optional covers as listed.","attachments":["Original ticket/ boarding pass or copy of the passport indicating the travel dates","Copy / original bills, receipts, Credit Card slips pertaining to your claim","Copy of visible Photo ID Proof like Pan card, Voter ID cards, Passport Copy","Medical reports, statements from the treating doctor and death certificate (for study interruption and sponsor protection claims)","Court order stipulating the required amount as bail bond (for bail bond claims)","Police and bank reports (for fraudulent card payment benefit)","Receipts of the university fees paid (for study interruption claims)"],"declarations":["The issue of this form is not to be taken as admission of liability","I hereby authorize the insurance company, physician, hospital, or other healthcare provider or any other organization, institution or person that may have records, documents or knowledge regarding the insured to release any information requested regarding this claim and the loss reported.","I understand this information will be used by Zuno General Insurance Limited or its authorized representatives for the purpose of evaluating or determining the coverage of this claim.","I know that I have the right to receive the copy of this authorization upon request and agree that a photographic or facsimile copy of this authorization is as valid as the original.","I agree that this authorization shall be valid for the duration of this claim.","I also authorise the service providers to Zuno General Insurance Limited to provide medical information or records to process this claim.","I understand that any person knowingly and with intent to defraud or deceive any insurance company files a claim containing any material false, incomplete or misleading information may be subject to prosecution for insurance fraud.","I/We hereby understand, declare, consent and authorize the company that personal health details, medical history and financial information, as provided to the company may be utilised, for processing the claim made under this policy.","I/We hereby also understand, declare and consent that the company shall have the right to retain and disseminate the same to any service provider for providing services related to insurance.","I hereby authorize Zuno General Insurance / Zuno authorized TPA to collect the relevant medical documents for purpose of my claim from the provider where I have taken the treatment."],"dropped_labels":3},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"support@hizuno.com","label":"Health claims support email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.hizuno.com/health-insurance/health-claim","quote":"ls, you will need to submit a reimbursement claim. For cashless services at a common network hospital, you can write to\nsupport@hizuno.com\n, call us at 1800 12000, or connect with your TPA as mentioned on your card.\nWhen you’re covered by a health insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 12000","label":"Health claims toll free number","level":null,"hours":null,"applies_to":"health","source_url":"https://www.hizuno.com/health-insurance/health-claim","quote":"imbursement claim. For cashless services at a common network hospital, you can write to\nsupport@hizuno.com\n, call us at 1800 12000, or connect with your TPA as mentioned on your card.\nWhen you’re covered by a health insurance policy and need to be ho","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 423 12000","label":"Paid Landline","level":null,"hours":null,"applies_to":"all","source_url":"https://www.hizuno.com/contact-us","quote":"uote\nHome\nContact us\nReach out to us for any Query/ Request or Grievance\nCall us\nToll free - 1800 12000\nPaid Landline -\n022 423 12000\nSenior citizen -\n022 423 12001\nEmail address\nsupport@hizuno.com\nsenior.citizen@hizuno.com\nGrievance Redressal Officer\nM","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/zuno-general-insurance/2387-zuno-comprehensive-group-overseas-travel-claim-form"}