Travel Insurance Document

TRAVEL INSURANCE CLAIM FORM

AAR INSURANCE KENYA LIMITED

GEORGE WILLIAMSON HOUSE, 4TH NGONG, 2ND FLOOR, P.O. BOX 41766-00100, TEL: 020 – 2895000/2715319
FAX: 020 – 2715328, EMAIL: info@aar.co.ke

CLAIM REFERENCE NO:

POLICY NO:

(1) PERSONAL PROPERTY/MONEY AND DOCUMENTS

Please complete this form and return it with relevant documentation to the address above. Do not hesitate to call if you have any queries.

A. PERSONAL DETAILS

Full name (as per policy):

Date of birth: Occupation: Telephone:

B. INSURANCE DETAILS

Policy name:

Date trip booked: Travel date: From To

Name of Travel Agent:

Name of Tour Operator if any:

Hotel accomodation details resort Country:

C. PERSONAL PROPERTY, MONEY AND DOCUMENTS

Including Baggage Delay)

Date Of Loss/Damage: Place Of Loss/Damage:

Full Details/Circumstances:

Was The Loss /Damage Reported To The Police? Yes No

Date Of Loss /Damage Reported To The Airline? Yes No

If No, Please State Reason:

Date Of Loss /Damage Reported To The Tour Operator:

Is Your Property Also Covered Under Household Contents Insurance? Yes No

If Yes, Please Give Details Below:

Please continue on a separate sheet if there is insufficient space. Please mark all documents for your claim reference.

(II) CURTAILMENT/MISSED DEPARTURE TRAVEL DELAY/PERSONAL LIABILITY

A. CANCELLATION/LOSS OF DEPOSIT/CURTAILMENT

Reason for Cancellation or Curtailment:

(1) FOR CANCELLATION/LOSS OF DEPOSIT

Date Trip originally booked: Total Cost of holiday:

Date insurance purchased: Amount refunded:

Date trip cancelled: Amount claimed:

(2) FOR CURTAILMENT OF TRIP

Date Trip originally booked: Date of Incident causing Curtailment:

Date Insurance purchased: Actual Return Date:

Original Transport Method (Air/Ferry/Coach....):

Amounts claimed for Additional Expenses:

IF THE REASON FOR THE CLAIMS IS MEDICAL, A MEDICAL REPORT BY THE USUAL DOCTOR OF THE PERSON WHOSE CONDITION GIVES RISE TO THE CLAIM MUST BE SUBMITTED

B. MISSED DEPARTURE/TRAVEL DELAY

Reason for Delay or Missed Departure:

(1) FOR MISSED DEPARTURE

Point of Departure:

Date & Time of Planned Departure:

Transport Used (Air/Coach/Ferry, etc.):

Method Employed to Rejoin Trip:

Amount Claimed:

(2) FOR TRAVEL DELAY

Scheduled Date and Time of Departure:

Actual Date and Time of Departure:

Number of hours delay: Flight number: Airline Company:

C. PERSONAL LIABILITY

Address of holiday apartment/hotel:

Date and time of incident:

Full details of the incident:

(III) MEDICAL EXPENSES CLAIM SECTION

Please complete this form and return it with all relevant documentation to the above address. Please do not hesitate to call if you have any queries

MEDICAL AND EMERGENCY EXPENSES/HOSPITAL BENEFIT

Date of Injury/Onset of Illness: Place of Injury/Illness:

Details of Injury/Illness:

Circumstances of Accident (if applicable)

Have you suffered from the same/similar condition before? Yes No

If YES, please ask your usual doctor to complete the attached medical certificate.

PLEASE NOTE: Any charge made by a doctor for medical reports must be paid by the claimant.

If hospitalized, please state:

Admission Date: Discharge Date:

The following documents must be sent with your claim form for claim processing

1. Your Safari Card

2. Your original holiday/flight confirmation and/or receipt or deposit receipt

3. A Doctor’s Report, stamped and dated.

4. Hospital, Doctor, Chemist, Dentist receipts for amounts claimed

5. Receipts for additional travel and/or accommodation expenses (if applicable)

6. Any other relevant documentation to support your claim

7. Confirmation from the carrier stating reason for delay including actual travel time

DECLARATION

I declare that to the best of my knowledge all particulars contained in this form are true and correct.