ASIC | Travel Form

TRAVEL INSURANCE

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Information

Step 1 - 5

Full Name:*

Email Address:

Address:*

Trip Type:*

Individual Family

Covid 19:*

Not Covered Covered (10% Premium Increase)

Region:*

Duration:*

Country From:*

Country To:

City From:*

City To:*

Policy Start Date:*

Choose Package:

Step 2 - 5

Package For Travel Guard

Coverages For Travel

					Amount in USD $
Sr.#	Benefits	Standard	Silver	Gold	Platinum
1	Referrel to Medical Correspondence Abroad	Covered	Covered	Covered	Covered
2	Delivery of Urgent Messages	Covered	Covered	Covered	Covered
3	Covid 19	Covered	Covered	Covered
4	Long Distance Medical Advice	Covered	Covered	Covered	Covered
5	Dispatch of A special Physician on-site	Covered	Covered	Covered	Covered
6	Transportation to Join Policy Holder	Round trip Ticket + USD 100 as Dailyallowance Max 10 Days
7	Evacuation or Medical Reparation	Covered	Covered	Covered	Covered
8	Emergency Dental Care				600
9	Assistance with the return of Dependent Children	One-Way Ticket	One-Way Ticket	One-Way Ticket	One-Way Ticket
10	Repatriation of Mortal Remains Cover of Medical	10,000	25,000	50,000	100,000
11	Expense and Hospitalization Abroad OPD	10,000	50,000	50,000	50,000
12	Winter Sports Ski Coverage	Not Coverd	Not Coverd	10,000	10,000
13	Contribution to Sea and Mountain Search and Rescue	Not Coverd	Not Coverd	25,000	25,000
14	Compensation for loss or Disappearance of Baggage	800	800	800	800
15	Comepensation for flight cancellation	150	150	150	150

Beneficery Details:

Step 3 - 5

Full Name:*

Cell Number:*

Relation:*

CNIC#*

Address:*

Personal Details:

First Name:*

Last Name:*

Passport Number:*

CNIC Number:*

Cell Number:*

Date of Birth:*

Relation:*

P.O.BOX Number:*

Gender:*

Documents Upload:

Upload Traveler Passport:*

TRAVEL INSURANCE

Information

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Choose Package:

Step 2 - 5

Beneficery Details:

Step 3 - 5

Personal Details:

Documents Upload:

Policy Summary

Covid 19:

Trip Type:

Region:

From:

Duration:

Traveler Age:

Package :

Amount (Rs.) :