Flight Coupon Policy

Flight Details
Flight No *
Airlines Company *
Flight To *
Date Of Travel *
Flight From *
Date Of Birth
Other Details
Wheel Chair Y/N
Assignee Details
Sl No.Name *Assignee Relashionship *Share % *Action
Basic Cover
Sum Insured *
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OICL Office State *
City/Town *
Branch/Office *
Please select a role to continue
Whether any agent is involved for this proposal?
* If 'NO' is selected, the policy will be issued under code of Development Officer without an Agent.