Travel Policy

Customer Information

Business Channel

Source of Business

Customer

Insured Group

Sub Agent/RM

Relationship Officer/CRO

Insured Information

Traveller Name / Insured Name

Mobile Number

E-mail Address

Travel Information (Please Enter Passenger Age As On Travel Date)

Travel With Family?

YesNo

Travel Zone

Travel From

Travel Destination

Arrival Date/Start Date

Return Date / End Date

Travel Duration Days

No. of Passengers Aged 0 & 17 (on Travel Date)

Infants less than 3 months excluded from the policy coverage

No. of Passengers Aged 18 & 65 (on Travel Date)

No. of Passengers Aged 0 & 65 (on Travel Date)

No. of Passengers Aged 66 & 75 (on Travel Date)

Age loading applicable

No. of Passengers Aged 76 & 80 (on Travel Date)

Age loading applicable

No. of Passengers Aged 81 & 85 (on Travel Date)

Age loading applicable

CampaignCode

Insured Information

Address

P.O.Box Number

Nationality

Country of Residence

Qatar Id

Referral Code

Contact Name

Contact Person's Mobile

Passenger Information

Expected Passenger count: Adults Aged 0 To 65 = [ 0 ], Adults Aged 18 To 65 = [ 0 ], Adults Aged 66 To 75 = [ 0 ] , Adults Aged 76 To 80 = [ 0 ], Children Aged 3m To 17 = [ 0 ]

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Additional Documents

Privacy Notice

Travel Policy

Basic Information

PlanDetails

AdditionalDetails

Summary

Additional Documents

Premium Summary

Commission Summary

Information Summary

Benefits/Documents