Traveler Outside India Insurance Request Form

If the traveler is already outside India and interested to get insurance cover from Indian insurance companies, please complete this application to request for approval from the insurance company to purchase travel insurance/student insurance. Once the approval is received our customer service executive will get back to you.

Please provide correct information in the application and based on the details furnished by you we will try to get approval from the underwriters.

Overseas mediclaim insurance for travelers already outside India

1. Traveler Name
2. Traveler Date of Birth
  OR age      years
3. When did you travel from India
4. Date of returning to India
5. Duration of Stay
6. Destination country
7. Need insurance from
8. I Certify that
9. Contact e-mail id
10. Contact phone number
11. Applicant Nationality
12. Are you currently insured?
     
13. If yes, Current insurance
14. Is the traveler a student?
    
15. Name of the university
16. How much longer are you a student?
17. Security Code
Security Image  (Not case sensitive)
Please fill this form and one of our customer service team will get back you soon.
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  • Address
  • InstantCover Insurance Web Aggregator Private limited
    710, 6th B Cross, 16th Main Road, Koramangala 3rd Block,
    Bangalore - 560 034.
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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022