PNR No.
Or
Certificate no.
Travel Insurance certificate no
Customer name
Checkbox
Select only those customers for whom claim has to be registered
Mobile No.
Nationality
Train number
Train name
Travel Date
PNR Number
Origin Station
Destination station
Nature of Loss
Travel/Loss/Accident Date *
  • Accidental Death of the Insured

    Date of Death *
    Time of Death *
    Documents Required

    Report of the Railway Authority confirming the accident of the train

    Report of the Railway Authority carrying the details of the passengers declared dead

    Duly Completed Personal Accident Claim Form signed by Nominee / Legal Heir along with the NEFT mandate details

    Death Certificate

    Post-Mortem Report

    Attested copy of FIR

    Photo identity proof of nominee

    Legal heir/Succession certificate (In case nominee is not declared)

  • Permanent Total Disablement

    Date of admission (If available in case of Hospitalization expenses)
    Date of discharge (If available in case of Hospitalization expenses)
    Documents Required

    Report of the Railway Authority confirming the accident of the train

    Report of attending doctor confirming the extent of disability

    Medical bills corresponding to doctor’s prescription.

    Duly Completed Personal Accident Claim Form signed by insured / Nominee

    Attested copy of disability certificate from Civil Surgeon of that Hospital in which the treatment has undergone stating percentage of disability.

    Attested copy of FIR/MLC

    All X-Ray / Investigation reports and films supporting to disablement.

    Claim form with NEFT details of the beneficiary

    Photograph before & after disability

  • Permanent Partial Disablement

    Date of admission (If available in case of Hospitalization expenses)
    Date of discharge (If available in case of Hospitalization expenses)
    Documents Required

    Report of the Railway Authority confirming the accident of the train

    Report of attending doctor confirming the extent of disability

    Medical bills corresponding to doctor’s prescription.

    Duly Completed Personal Accident Claim Form signed by insured / Nominee

    Attested copy of disability certificate from Civil Surgeon of that Hospital in which the treatment has undergone stating percentage of disability.

    Attested copy of FIR/MLC

    All X-Ray / Investigation reports and films supporting to disablement.

    Claim form with NEFT details of the beneficiary

    Photograph before & after disability

  • Hospitalization Expenses for Injury

    Date of admission (If available in case of Hospitalization expenses)
    Date of discharge (If available in case of Hospitalization expenses)
    Documents Required

    Report of the Railway Authority confirming the accident of the train

    Discharge Summary/Consultation paper/Treatment papers

    Claim form with NEFT details of the beneficiary

  • Transportation of mortal remains

    Date and time of Death
    Date of Transportation
    Claim Amount
    Documents Required

    Report of the Railway Authority confirming the accident of the train

    Report of the Railway Authority carrying the details of the passengers declared dead

    Photo identity proof of nominee.

    Legal heir/Succession certificate

    Attested copy of FIR

Travelers Home Address and Nominee Details
Traveler
Name
Address
Line 1
Address
Line 2
Address
Line 3
Pincode
Area
Travel
Certificate No.
Nominee
Name
Nominee
Relationship
  • Coverage against Household Theft / robbery during the travel period

    Date of Theft / robbery *
    Claim Amount
    Documents Required

    Duly Completed Claim Form signed by Insured along with the NEFT mandate details

    Attested FIR copy (Itemized list of lost items to be mentioned)

    Original Bills of Lost Items

    Residence proof & Current Address proof where the theft took place

    Photo ID proof of Insured

NEFT Details
Account holder name *
IFSC code *
MICR Code *
Bank Name *
Bank Account no. *
Cancelled Cheque *

Cancelled cheque


I agree to receive the settlement amount for the above claim / claims in the above bank account details provided


Note: If any of the policyholder/s wish to receive settlement amount in another bank account, please log fresh claim/s and provide new NEFT details
I hereby agree to be contacted on my mobile no. even if it is registered on NDNC registry.