{"id":569,"title":"INDUSIND INLAND TRAVEL CARE POLICY - MAIN - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/indusind-inland-travel-main-claim-form","sha256":"6a9da2119ac4cfc83408c7e0a6c4ba389d5308ab50517075ff9eab063bc8bcc7","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the IndusInd Inland Travel Care Policy - Main. The policyholder or claimant fills it to provide details about the insured, patient, claim, and bank information for claim processing.","notes":["Fill all details in BLOCK LETTERS.","Issuance of the form is not an admission of liability or waiver of policy terms and conditions.","Answer all questions completely; attach additional sheets if space is insufficient.","Failure to call Emergency Assistance Service Provider invalidates the claim.","Use original bills only.","Attach all required documents as listed.","Payments will be made only via electronic transfer to the bank account provided.","PEP means individuals entrusted with prominent public functions as defined under PMLA Rules."],"title":"INDUSIND INLAND TRAVEL CARE POLICY - MAIN - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"Select title and write full name in block letters","type":"text","label":"*Name of the Insured","options":["Mr.","Mrs.","Ms.","M/S."],"required":true,"pdf_field":""},{"help":"Fill full address including Flat/Building/Door/Block No., Road/Street/Sector, Area, Taluka/Village/District/City, Pin Code, State, Country","type":"text","label":"*Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"Enter Aadhaar number","type":"text","label":"Aadhar (UIDAI) No.","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN No.","options":[],"required":false,"pdf_field":""},{"help":"Select one","type":"choice","label":"Profession/Occupation","options":["Business","Profession","Salary","Agricultural Income","Savings","Others"],"required":false,"pdf_field":""},{"help":"Select one","type":"choice","label":"Monthly Income","options":["Upto ` 20,000","` 20,001 to ` 50,000","` 50,001 to ` 1,00,000","` 1,00,001 and above"],"required":false,"pdf_field":""},{"help":"Select one","type":"choice","label":"Relationship of the Patient/Insured Person with the Insured","options":["Self","Spouse","Son","Daughter"],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Details of Patient/Insured Person","fields":[{"help":"Select title and write full name in block letters","type":"text","label":"Name of the Patient/Insured Person","options":["Mr.","Mrs.","Ms.","M/S."],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date Of Birth","options":[],"required":false,"pdf_field":""},{"help":"Select one","type":"choice","label":"Sex","options":["M","F"],"required":false,"pdf_field":""},{"help":"Fill full address including Flat/Building/Door/Block No., Road/Street/Sector, Area, Taluka/Village/District/City, Pin Code, State, Country","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"If available","type":"text","label":"Claim No.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Claim Details","fields":[{"help":"Enter flight number","type":"text","label":"Fight No.","options":[],"required":false,"pdf_field":""},{"help":"Enter PNR number","type":"text","label":"PNR No.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has the Emergency Assistance Service Provider been intimated ?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide reference number if Emergency Assistance Service Provider was intimated","type":"text","label":"If yes, please provide the reference number","options":[],"required":false,"pdf_field":""},{"help":"Enter passport number","type":"text","label":"Passport No.","options":[],"required":false,"pdf_field":""},{"help":"Tick all applicable claim types","type":"checkbox","label":"Please indicate whether claim is respect of","options":["Accidental Death","Hospitalization due to accident / Emergency medical expenses","Loss of total checked in baggage","Trip Cancellation & Interruption","Missed connection","Flight delay"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Proposer's Bank Details","fields":[{"help":"Select title and write full name","type":"text","label":"Name of the Bank Account Holder","options":["Mr.","Ms.","Mrs."],"required":false,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.:","options":[],"required":false,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account:","options":["Saving","Current"],"required":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the Bank","options":[],"required":false,"pdf_field":""},{"help":"Enter branch name","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"Enter 9 digit MICR code","type":"text","label":"MICR Code (9 digit MICR code number of the bank and branch appearing on the cheque issued by the bank)","options":[],"required":false,"pdf_field":""},{"help":"Enter 11 character IFSC code","type":"text","label":"IFSC Code (11 character code appearing on your cheque leaf)","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm understanding","type":"checkbox","label":"I understand that any refund due on the premium payment / any payment / claims to be directly credited to my aforesaid Bank Account.*","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Aadhaar Based Payment (For Reimbursement claims)","fields":[{"help":"Enter Aadhaar number and submit self-attested copy","type":"text","label":"Aadhaar Card No.:","options":[],"required":false,"pdf_field":""},{"help":"Tick if you want claim credited to Aadhaar linked bank account","type":"checkbox","label":"I wish to collect claim reimbursement directly in my Bank account linked with my aforementioned Aadhaar Card.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"PEP Declaration","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are you a Politically Exposed Person (PEP)?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide position if PEP","type":"text","label":"If yes, please mention the position held","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is any of your close relation or family member a PEP?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please mention the name and relation and the position held by such close relative/family member.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Declarations and Signatures","fields":[{"help":"DD/MM/YYYY format","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 here","type":"signature","label":"Signature of Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder or claimant"}],"deadlines":[],"applies_to":"IndusInd Inland Travel Care Policy - Main claims","attachments":["All bills, receipts, credit card slips pertaining to your claim","Doctor's Report as per format (for Accident & Sickness Section claims)","Original cancelled cheque for bank verification","Copy of PAN card for verification","Self attested Aadhaar card copy (if opting for Aadhaar based payment)"],"declarations":["The details given are true and correct to the best of my knowledge and belief.","I agree to provide additional information if required and indemnify the company for any loss due to misstatement.","I agree not to receive any rebate other than that mentioned in the published prospectus as per Insurance Act provisions.","I declare that if I or my close relatives become Politically Exposed Persons (PEP) in future, I will inform the company.","I confirm that premiums have been/will be paid from bonafide sources and not from proceeds of crime.","I understand the company may verify my KYC and PAN details and I am responsible for any mismatch consequences.","I agree that payments will be made only through electronic mode as per IRDAI regulations."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"services@indusindinsurance.com","label":"Health Insurance Claims Email","level":1,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","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":"claim","channel":"email","value":"indusind@europ-assistance.in","label":"Travel Insurance Claims Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance App\nWebsite:\nOnline Claim Intimation\nOffline Visit:\nLocate your nearest branch\nh","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91 22 48903009","label":"Car Insurance Claim Intimation","level":null,"hours":null,"applies_to":"motor","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":"claim","channel":"phone","value":"022 65934189","label":"Motor Claims Helpline","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"ation.\nNeed Guidance on Car Coverage?\nTalk to Our Professional Advisors\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nSteps to Take After a Car ​Accident\nThe following steps can expedite the road accident insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934188","label":"Health Claims Helpline","level":null,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"your nearest location.\nExpert health advice you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934184","label":"Travel Claims Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"e you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation\nYour claim gets rejected when you don't gi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+912248903009","label":"Inland Travel Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"rds your registered bank account.\nHow to Contact Us For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 552","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"91-22-67347843","label":"International Travel Helpline (abroad)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 209 5522","label":"International Travel Helpline (in India)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance","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/569-indusind-inland-travel-care-policy-main-claim-form"}