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For Comparative Insurance Quote: Om Plaza, 430/7, 1st Floor, Sant Nagar, East of Kailash, New Delhi-65
Phone: 011-41324957, 41623784, Mob:+91-8447757651 & 53 Email: ria1@surekhae.com
Overseas Travel Health Insurance Policies from India
 
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(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
1. Personal Details
Proposer's name (as per passport)  
Passport No  
Date of Birth  
Nominee Name & Address  
Corresspondence Address House No.
  Street
  Locality
  City
  State
  Pin
Phone number  
Fax number  
E-mail ID  
Married  
Mother's full maiden name Yes
No

2. Primary purpose of visit Business1 Leisure VFR* Others
*visiting friends / relatives
3. Place (s) of visit ...........................................................
4. Geographical Scope  - worldwide( excl US/Canada ) worldwide
5. Plan Requested
Salt & Pepper Cover (For traveler aged 71 years and above)
a) Single Trip  Royal 25 Royal 50
(Please refer to brochure for details and eligibility)

Q. 6 - 8 to be filled for Single Trip options only
6. Departure Date ( first day of insurance )
D D M M Y Y Y Y
7.Return Date 
D D M M Y Y Y Y
8.Insurance required for (no. of days)
9.Insured no. of days
10. For persons above the age of 70, please enclose the results of the detailed medical test and the medical statement in enclosed format.
11. Please tick the appropriate option and fill the amount details
Cash Premium
Amount Rs.
Cheque No.
Cheque Date
Bank Name Name
Branch (if cheque)
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