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The Bajaj Allianz Travel form serves as an essential document for individuals seeking travel insurance coverage through Bajaj Allianz General Insurance Company Limited. This form incorporates various sections that require the proposer to provide personal information, including their name, address, contact details, and date of birth, along with their passport number. It is critical to specify travel dates, including departure and arrival, as well as select an appropriate travel plan from options such as Travel Elite - Silver, Gold, Platinum, and others. Moreover, it includes questions about the health history of the proposer, which aids in determining coverage eligibility. Specific inquiries focus on past illnesses, hospital admissions, and medications. This information helps the insurer assess the risk associated with providing coverage. In addition, there are sections to disclose details about family members traveling with the proposer, ensuring comprehensive coverage. The form also addresses payment details, including whether payment will be made via cash or cheque. A declaration statement at the end of the form confirms that the information provided is accurate, while also acknowledging the limitations of coverage related to pre-existing medical conditions. For student companions, additional information regarding the student's course, school overseas, and medical examination is required, emphasizing the thoroughness of the application process.

Bajaj Allianz Travel Example

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Bajaj Allianz General Insurance Com pany Lim ited

Regd. Office & Head Office : GE Plaza, Airport Road, Yerawada, Pune - 411 006.

P-9910

Interm ediary Code

TRAVEL ELITE PROPOSAL FORM

1.Nam e of the Proposer :

2.Address :

3.Phone No. :

4.E-m ail

5.Date of Birth

6.

Passport No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assignee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Departure Date :

 

 

 

 

 

 

 

 

 

 

 

 

 

Arrival Date :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Plan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Travel Elite -

 

 

 

Silver

 

 

Gold

 

 

 

Platinum

 

 

 

 

 

 

 

 

Elite Asia Flair

 

 

Elite Asia Suprem e

 

 

 

Travel Elite Fam ily

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Travel Age Elite -

 

 

 

Silver

 

 

Gold

 

 

 

Platinum

 

 

 

Student Elite -

 

 

 

Standard

 

 

Silver

 

 

 

Gold

 

 

DOWNLOADED FROM WWW.INSUREATCLICK.COM - IMD CODE : 10000006

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Corporate Elite

Corporate Lite

 

 

 

 

Corporte Plus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Choose Geographic Coverage :

Excluding USA / Canada

 

 

Including USA / Canada

 

 

Asia Including Asia (Excluding Japan)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fam ily M em bers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S.No.

 

 

Nam e

 

 

Date of Birth

Gender

 

 

Passport No.

Assignee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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a) Are you suffering or have you

b) Have you been

c) Are you currently or

 

d) Have you ever

Please m ention the

 

 

 

 

ever suffered from any illness/

adm itted to any hospital

in past have been on

 

claim ed under your

nam e, address and

 

S.No.

 

disease / ailm ent upto the date of

/ nursing hom e / clinic

any m edications ?

 

earlier travel policy?

telephone no. of your

 

 

m aking this proposal or suffer

for treatm ent or

Please m ention

 

If yes, please give

fam ily doctor and/ or

 

 

 

 

 

 

 

 

 

from physical defect or deform ity?

observation ?

 

 

 

details under the

specialist

 

 

 

 

Please give details

 

Please give details

 

 

 

section claim ed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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1

 

 

 

 

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If answer to any of the above a) to d) is Yes.

Please give details :

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I hereby declare & warrant that the above statem ent is true and com plete in all respects and that inform ation relevant to m y application of insurance has been disclosed to you. I understand that this policy does not cover any pre-existing m edical condition/ injury/ illness/ deform ity and com plications arising from them that are declared or undeclared. I will not be travelling against the advice of a physician will not be travelling for the purpose of obtaining m edical treatm ent. I consent to Bajaj Allianz seeking m edical inform ation from any doctor in respect of any m atter relating to m y physical or m ental health and I authorize and consent to him giving such inform ation to Bajaj Allianz and / or to the claim s adm inistrator or m edical advisors.

I agree to this proposal and the declaration shall be the basis of the contract between m e and Bajaj Allianz and I agree to accept the policy subject to the term s & conditions prescribed by Bajaj Allianz General Insurance Com pany Ltd.

Paym ent Details

Cash / Cheque

Am ount

Cheque No.

Cheque Dt.

Bank/ Nam e

Branch

Signature :

Date :

Additional inform ation to be com pleted by the student (Only for student com panion plan)

λ

Nam e of the Student

:

 

 

λ

Date of Birth

:

 

 

λ

Nam e of the School overseas

:

 

 

λ

Detailed address of the school/ Telephone no:

 

DOWNLOADED FROM WWW.INSUREATCLICK.COM - IMD CODE : 10000006

λ

Course opted for

:

λ

Duration of the course

:

λ

Num ber of Sem esters

:

λ

Tuition fees per Sem ester

:

λTuitions financed by (Self, parents, borrowing from bank or FI's), please give details

λHave you undergone m edical exam ination/ fitness test?

λWould like to state any thing that is not asked which you m ay want the insurer to know?

Nam e :

Signature :

 

Date :

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Form Characteristics

Fact Name Description
Provider Information Bajaj Allianz General Insurance Company Limited is headquartered at GE Plaza, Airport Road, Yerawada, Pune - 411 006.
Travel Plans Offered Various plans are available, including Travel Elite - Silver, Gold, Platinum, and different plans tailored for families and students.
Health Disclosure Requirements The proposer must disclose any existing medical conditions and relevant medical history on the form before purchasing insurance.
Governing Laws The insurance policy is governed by the laws of the state in which it is issued, which may include state-specific regulations and insurance laws.

Guidelines on Utilizing Bajaj Allianz Travel

Filling out the Bajaj Allianz Travel form is a straightforward process that requires accurate information to ensure your coverage needs are met. Follow the steps below to complete the form correctly.

  1. Enter your Name in the designated field.
  2. Provide your Address in full detail.
  3. Input your Phone Number.
  4. Fill in your Email address.
  5. Enter your Date of Birth.
  6. Provide your Passport Number.
  7. Note the Departure Date and Arrival Date of your trip.
  8. Choose your Plan from the available options listed.
  9. Select your Geographic Coverage based on your travel area.
  10. List any Family Members traveling with you by filling in their details including Name, Date of Birth, Gender, and Passport Number.
  11. Answer the health-related questions (a to d) pertaining to your medical history. If any answers are "Yes," provide additional details.
  12. Read and acknowledge the declaration statement regarding accuracy, consent, and understanding of terms.
  13. Input Payment Details, including Cash/Cheque amount, Cheque number, Cheque date, and Bank/Branch information.
  14. Add additional information if required, especially if you are filling it out for a student companion plan.
  15. Finally, sign and date the form.

What You Should Know About This Form

1. What is the Bajaj Allianz Travel form used for?

The Bajaj Allianz Travel form is designed as a proposal document for individuals seeking travel insurance coverage. It collects essential personal information about the proposer, trip details, and health-related questions that impact the insurance policy.

2. What information do I need to provide in the form?

The form requires the following information: your name, address, phone number, email, date of birth, passport number, travel dates, plan selection, and details about family members also traveling. Additionally, it solicits information regarding any past or current medical conditions.

3. Can I include family members in the travel insurance?

Yes, you can include family members in the travel insurance coverage. The form provides sections for entering the names, dates of birth, genders, and passport numbers of each accompanying family member.

4. What are the plan options available in the Bajaj Allianz Travel form?

The form offers several travel insurance plans, including Travel Elite Silver, Gold, Platinum, Elite Asia Flair, Family Travel, and Student Elite. Each option provides different coverage levels, allowing travelers to choose according to their needs.

5. What if I have pre-existing conditions?

The form requires you to declare any pre-existing medical conditions. Coverage may not extend to conditions that were declared or undeclared before the proposed trip. It is essential to disclose accurate information to ensure compliance with policy terms.

6. How do I confirm the accuracy of my information?

You confirm the accuracy of your information by signing the declaration section of the form. This declaration is a crucial component, as it asserts that all provided details are true and complete.

7. Are there any additional details needed for students?

If the proposer is a student, additional information is required, such as the name and address of the school overseas, course details, and tuition information. This information helps tailor the insurance coverage to the student's specific situation.

8. How can I make the payment for my travel insurance?

Payment can be made in cash or by cheque. The form provides fields to specify the payment amount, cheque number, cheque date, and bank branch information. Clear completion of this section will facilitate a smooth transaction.

9. What should I do if I have more questions about the form?

If you have additional questions, it is recommended to contact Bajaj Allianz customer service or consult a knowledgeable representative. They can provide detailed information and further assistance regarding any concerns with the travel form or insurance options.

Common mistakes

Completing the Bajaj Allianz Travel form can be a straightforward task, but there are common mistakes that could lead to complications. One significant error occurs when individuals neglect to provide their full and accurate address. All sections of the address should be filled in completely to ensure proper communication and verification. Skipping this step might delay processing or even jeopardize coverage.

Another frequent oversight involves the phone number. Many people forget to include their current phone number or input an incorrect one. This information is crucial for prompt communication regarding any questions or updates related to the insurance policy. Ensuring that the phone number is active and reachable can save you time and hassle.

Failure to list the correct date of birth is also a common mistake. This detail is vital for confirming eligibility and sorting premium rates. Missing or incorrect dates can cause confusion and delay the approval of coverage. It's essential to check this entry carefully.

Some applicants overlook the passport number. It’s pivotal for identifying the insured traveler. Missing this crucial detail might result in rejection of the application since proper verification cannot be completed without it. Always double-check that this section is accurately filled out.

In the health-related questions, some people fail to provide adequate details if they answer "Yes" to any of the inquiries. Omitting important information can lead to issues when the time comes to file a claim. When providing medical history, it’s best to include all relevant details for transparency and accuracy.

Moreover, many applicants forget to read the terms and conditions associated with the policy. Understanding these terms allows for informed decisions regarding coverage. Rushing through this section could lead to misunderstandings about what the policy does and does not cover.

Sometimes, individuals fail to sign the form or provide a date. This seemingly minor administrative error can lead to significant delays in processing the application. Without a signature, the form may not be considered valid, resulting in potential loopholes in coverage.

In cases involving family members, applicants often neglect to list all individuals accurately under the family members' section. Each family member needs to be accounted for, along with their necessary details, to ensure everyone is covered properly. Missing out on family members can mean expensive surprises later on.

Lastly, one major pitfall is not keeping a copy of the completed form. Failing to retain this documentation can lead to frustration, especially if there are any disputes or inquiries from the insurance company. Keeping a record ensures that you are prepared for any follow-up needed regarding your application.

Documents used along the form

When applying for travel insurance through Bajaj Allianz, you may need to submit additional documents to support your application. These can enhance your chances of approval and clarify your needs. Below are some common forms and documents you might encounter alongside the Bajaj Allianz Travel form.

  • Proof of Travel Arrangements: This includes flight itineraries, hotel bookings, or confirmation letters. These documents validate your travel plans and provide dates of departure and return.
  • Passport Copy: A clear photocopy of your passport is typically required. This ensures that your identity and travel eligibility are verified.
  • Medical History or Health Insurance Documents: Providing any existing medical records or documentation from your current health insurance can help in the assessment of your application, especially if you have pre-existing conditions.
  • Payment Confirmation: A record of payment for the insurance policy, such as a receipt or bank statement, is necessary to confirm that you have completed the transaction for the coverage.

Having these documents ready can facilitate the application process. This proactive approach helps ensure that your travel coverage is processed smoothly and efficiently.

Similar forms

  • Insurance Policy Application: Similar to the Bajaj Allianz Travel form, an insurance policy application gathers personal information, previous insurance history, and medical details to assess risk and eligibility for coverage.
  • Medical History Questionnaire: This document requires individuals to disclose any past or present health issues. Like the travel form, it seeks to determine the applicant’s health status for underwriting purposes.
  • Travel Itinerary Form: An itinerary form requires details about travel plans, including dates and locations. The Bajaj Allianz Travel form also requests departure and arrival information, along with coverage specifics.
  • Claim Form: A claim form serves to initiate a request for benefits from the insurance policy. Similarly, the Bajaj Allianz Travel form includes a section on prior claims, highlighting the applicant’s history related to claims.
  • Beneficiary Designation Form: This document identifies who will receive benefits in case of a claim. The travel form mentions an assignee, similar to designating a beneficiary for travel insurance purposes.
  • Emergency Contact Form: This form collects information about individuals to contact in case of an emergency, much like how the travel form seeks details about the proposer and family members.
  • Passport Application: A passport application requires personal identification and travel details, akin to the travel form that asks for the applicant’s passport number and travel dates.
  • Student Visa Application: This document collects information about a student, including personal and educational details. Likewise, the travel form has a section specifically for student companions.
  • Rental Car Agreement: A rental agreement contains personal information and declarations about ability to drive. It mirrors the self-declaration aspect present in the Bajaj Allianz Travel form about travel and health conditions.
  • Health Insurance Application: This application requires details about the applicant's health and lifestyle, similar to the health questions included in the Bajaj Allianz Travel form.

Dos and Don'ts

When filling out the Bajaj Allianz Travel form, it is important to follow certain guidelines to ensure clarity and accuracy. Here are some dos and don’ts to consider:

  • Do: Provide complete and accurate personal details, including your full name, address, and contact information.
  • Do: Ensure your passport number is entered correctly. Double-check this information to avoid any delays.
  • Do: Specify the correct travel dates. Ensure that the departure and arrival dates reflect your actual itinerary.
  • Do: Clearly answer all medical questions honestly. If applicable, provide details about any past illnesses or conditions.
  • Do: Review the completed form before submission. Ensure all sections are filled out correctly without any blanks.
  • Do: Sign and date your application, as this indicates your agreement with the information provided.
  • Do: Keep a copy of the completed form for your records.
  • Don’t: Do not rush through the form. Take your time to fill it out thoughtfully.
  • Don’t: Avoid leaving any required fields empty, as this may lead to processing delays.
  • Don’t: Do not provide vague answers to medical questions. Be specific regarding any health issues.
  • Don’t: Do not ignore the terms and conditions associated with the policy. Ensure you understand them fully.
  • Don’t: Avoid using abbreviations or shorthand that may confuse the reviewers.
  • Don’t: Do not assume that information from a previous application is still valid. Always provide up-to-date details.
  • Don’t: Do not postpone mailing or submitting your application; timely submission is crucial for coverage.

Misconceptions

  • Misconception: The Bajaj Allianz Travel form is too complicated to fill out. Many people believe that the travel form is overly complex. In reality, it is designed to be straightforward, with clear sections for personal information, travel details, and health disclosures.
  • Misconception: Submission of the form guarantees insurance coverage. A common misunderstanding is that sending in the form automatically secures insurance. Coverage only begins upon approval of the application and payment, and after the terms are reviewed.
  • Misconception: Pre-existing medical conditions are always covered. Some individuals think that pre-existing conditions are automatically included in the policy. However, such conditions may not be covered unless explicitly stated in the policy documents.
  • Misconception: Additional information is optional. Many assume they can skip parts of the form without consequence. Providing complete and accurate information is crucial for valid coverage and to avoid claims disputes later.
  • Misconception: The travel policy applies globally without exceptions. There's a belief that coverage is the same worldwide, but some plans may exclude certain regions. Always check the specific geographical coverage included in the selected plan.
  • Misconception: Health information is not necessary for travel insurance. Individuals often think that sharing health details is not essential. However, insurers require this information to assess risks and tailor coverage accordingly.
  • Misconception: Once insurance is purchased, there is no need for communication. People may believe that post-purchase, no further communication is needed. Staying in touch with the insurer is important for updates or changes in health that may affect coverage.

Key takeaways

When filling out and utilizing the Bajaj Allianz Travel form, it’s essential to keep the following key takeaways in mind:

  • Accurate Personal Information: Ensure that all details, such as your name, address, and contact information, are correct to avoid any potential issues with policy processing.
  • Understand Policy Options: Familiarize yourself with the available plans like Travel Elite, Asia Flair, and Student Elite. Choose the one that best suits your needs.
  • Geographic Coverage Selection: Be clear about your travel locations. Make note if you are excluding or including regions such as the USA and Canada.
  • Health Disclosure: Complete the health questions truthfully. If you have a medical history, provide relevant details. This can affect your coverage.
  • Family Member Details: If your plan covers family, list each member with their respective dates of birth and passport numbers accurately.
  • Review Pre-existing Conditions: Remember that pre-existing medical conditions are not covered. This applies to any condition you have at the time of application.
  • Consent for Medical Information: You will agree to let Bajaj Allianz consult with your healthcare provider regarding your health status, if necessary.
  • Keep Copies: Always retain a copy of the completed form and any documents submitted for your records.
  • Payment Details: Specify payment methods clearly, whether by cash or cheque, and ensure all relevant amounts and dates are noted.
  • Sign and Date: Last but not least, don’t forget to sign and date the form. This step is crucial as it confirms your agreement to the terms and conditions outlined in the policy.