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					                                              Oman Insurance Company
                                            P.O. Box No. 5209, Dubai, UAE

                                                 Travel Insurance - Claim Form
Insured Name
Mrs/Ms/Mr

Policy No.                                                              Expiry Date:

No. of Members:                Adult       ____________                       Children             ____________

Communication details of the Insured person

Tel No.                                                                       Address __________________________

Fax:                                                                          Email       __________________________

Mobile

Journey details
Destination     _____________________________                                 Flight No            ____________

Date                   d   d     m     m     y     y    y     y               Time         ______________

Airport of Departure           _________________________

Nature of Claim:
Cancellation Charges                                   Delayed Baggage
Emergency Medical Expenses                             Personal Money
Cutting Short Trip                                     Personal Liability
Personal Accident                                      Missed Departure
Loss of Passport                                       Legal Expenses
Loss of Baggage

                              ________________________________________________________________________
                                   ____________________________________________________________________
Description of the Claim: _________________________--_________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Amount Claimed                 __________________________
Delay/Loss notified to        ___________________________
Particulars of the compensation received : __________________________________________________________


Declaration: I hereby declare that the information provided hereu is true & correct and understand that any wrong information
provided is likely to render my claim paid / payable void & recoverable from me.

Date      d   d     m      m     y     y     y     y                    Signed __________________________

Please attached the following documents (Original may be requried for verification)

Documents required in respect of all the claims
• Copy of the charge slip (Authorisation code or Transaction number if the Credit Card is utilised for online transaction)
• Copy of the Statement of account showing the transaction related to purchase of ticket.
• Copy of the air ticket and /or ticket issued by a licensed common carrier.
• Copy of the Passport and Visa page.
• Any other document as may be necessary.

Documents required in respect of Cancellation Claims
• Notification of cancellation of journey must be given in writing to the tour operator or to accommodation and
transport providers
• Death or Medical certificate of Cardholder’s close relative causing cancellation of trip.
• Evidence of other reason (like SRCC or quarantine etc.,) which causes cancellation of trip.
• Any other document as may be necessary.

Documents required in respect of Cutting Short Trip Claims
• Notification to be given to Assistance Company prior to departing to return home)
• Death or Medical certificate of Cardholder’s close relative leading to cut short your trip
• Evidence of other reason (like SRCC or quarantine etc.,) which leads to cutting short of trip.




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                                               Oman Insurance Company
                                             P.O. Box No. 5209, Dubai, UAE

                                                 Travel Insurance - Claim Form

• Police report because your home or place of work has been burgled
• Any other document as may be necessary.

Documents required in respect of Emergency Medical Claims
• Assistance Company must be notified within 48 hours or in the event claim is over $500/- of admission for inpatient
 treatment (outside of the country in the AGCC) or in the event that any emergency repatriation is required
 or in the event of the death of any Insured Person
• Detailed Medical report issued by the Doctor who had treated the Insured.
• Invoice for Medicines purchased / facilities availed.
• Air ticket/other evidence of travel undertaken by the designated person or the dependent children
• Cash receipt given by the hospital.
• Proof of repatriation expenses if applicable
• Any other document as may be necessary.

Documents required in respect of Personal Accident Claims
• Copy of Death / Disability Certificate from Competent Authority
• Medical Report with details of treatment given (if any)
• Police Report
• Any other document as may be necessary.

Documents required in respect of Loss of Passport Claims
• Notification must be given to the nearest Embassy and a written Report obtained from them of the loss
• Police Report
• Any other document as may be necessary.

Documents required in respect of Loss of Baggage Claims
• Written confirmation from carrier that baggage is “non-traceable” or “lost”.
• Report from Police, Airlines, Shipping lines or their handling agents in respect of loss of baggage.
• Original invoices supporting the loss of baggage claims.
• Any other document as may be necessary.

Documents required in respect of Delayed Baggage Claims
• Written confirmation of Airlines or Shipping lines or their handling agents stating the reasons and period of delay
 in respect of travel delay or delayed baggage.
• Original receipts indicating cost of essential items
• Any other document as may be necessary.

Documents required in respect of Loss of Personal Money Claims
• Police Report
• Written report from appropriate issuing authority of debit cards / credit cards
• Any other document as may be necessary.

Documents required in respect of Personal Liability claims
• Notice of claim lodged on the Insured by third party.
• Copies of Correspondence exchanged between Insured and third party.
• Any other documents as may be required.\

Documents required in respect of Missed Departure claims
• Original invoices supporting additional accommodation (room only) and travel expenses incurred
• Police report
• Any other documents as may be required.

Documents required in respect of Legal Expenses claims
• Notice of claim lodged on the Insured by third party.
• Copies of Correspondence exchanged between Insured and third party.
• Original invoices of the legal expenses incurred
• Any other documents as may be required.




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