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Overseas Travel Health Insurance
 
Policy information of health insurance products for overseas travel health insurance policies including comparison rates, policy language, coverage etc. Go to Main Page
(1) Overseas Travel Health Insurance   (2) Salient Points Of Overseas Travel Insurance
(3) Best & Economical Policy for Overseas Travel   (4) Selection of Overseas Travel Insurance
(5) Specimen proposal form of ICICI Lombard   (6) Policy wording individual overseas travel insurance (Tata AIG)*
(7) Policy Wording /Proposal Form/ Brochure   (8) Policy wording overseas travel insurance (ICICI Lombard)
(9) Product details of Various Companies for Overseas Travel Insurance/Policy
 
General/Health Insurance Companies Products
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   5- Specimen proposal form of ICICI Lombard Students Overseas Mediclaim policy
ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED
Regd. Office: ICICI Bank Towers, Bandra Kurla Complex, Mumbai - 400 051,Tel: (+91 22) 2653 1414 Fax: (+91 22) 2653 1657 GLOBETROTTER PROPOSAL FORM OVERSEAS INDIVIDUAL TRAVEL INSURANCE POLICY
1. Personal Details
Issuing Branch
Phone No.
Agent Reference
Policy No.
Payment Rs.
Payment Type
Payment Ref No.
Rural / Urban
Proposal Form No.
Customer Id No.
PLEASE ANSWER ALL QUESTIONS. Insurance is a contract of Utmost Good Faith requiring the Insured not only to disclose all material facts but also not to suppress any material facts in response to the questions in the proposal form. If you think any fact is material, please disclose it. PLEASE COMPLETE THE FORM IN CAPITAL LETTERS USING AN INK PEN.
NOTE : The liability of the Company does not commence until this proposal has been accepted by the Company and premium has been paid.

INSURED OF THE AGE OF 71 AND ABOVE
Salt & Pepper Cover
The medical expenses incurred for immediate medical assistance arising out of illness or accident, including any extra additional costs of medically necessary and prescribed transportation to the Republic of India ;

  1. Complete and permanent loss of checked in baggage ;
  2. Reasonable expenses necessarily incurred for emergency purchase of essential items in case of a delay of checked in baggage for more than 12 hours ;
  3. Loss of passport ;
  4. Accidental bodily injury ;
  5. Personal liability resulting from death, injury or damage to a third party;
  6. Hijack Distress Allowance ; and
  7. Financial Emergency Allowance

Significant Exclusions
Medical expenses arising out of pre-existing conditions, pregnancy, cancer addiction to alcohol, drugs, mental disorder, anxiety, depression, venereal disease, orthopedic degenerative disease treatment, HIV, ionizing radiation, sporting activities, war and war like consequences.

Expenses arising out of loss of valuables, money, securities and tickets; loss of passport in public places; employer's contractual liability, personal liability of the insured person(s) where applicable.

Note : The foregoing is only an indication of the cover offered. For details, please refer to the Policy.

DETAILS: Put a (a) mark wherever applicable
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