Overseas Mediclaim Policy

Risk Details
Journey Details
Plan Type *
Plan Category *
Sum Insured Plan *
Journey Start Date *
Journey End Date *
Period of Insurance(in Days)
Trip Type *
Purpose Of visit *
Country of Visit *
Visiting Schengen Countries? *help
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Individual details
Name *
Relationship *
Date of birth *
Age (Mths)
Pre existing ailments
Occupation *
Gender *
Passport No. *
Whether engaged in winter sports/mountaineering etc
Assignee Details
Assignee Name*
Assignee Relationship*
Medical Details
Name of Physician in India
Medical Details
Address of Physician
Date of Medical Report
Whether Handicapped that he is not able to move
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OICL Office State *
City/Town *
Branch/Office *
Customer Information Sheet Click Here
  1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I am authorized to propose on behalf of these other persons.
  2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurance company and that the policy will come into force only after full payment of the premium chargeable.
  3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance by the company.
  4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at anytime has attended on person to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the person to be insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
  5. I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.
  6. I have carefully read the Prospectus and having understood the same, I propose for a policy in the standard form issued by the Company.
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.
Please select a role to continue
Continue Direct
* If 'Yes' is selected, the policy will be issued under code of BDE without an Agent and Broker.
If LoV is NULL, kindly check BDE maping in INLIAS
Age should be between six months and 25 years
Age should be between 18 and 80 years
Age should be between 180 days and 80 years
Please select relationshipship before selection Date Of Birth.
Journey end date should be after the date/time of date the Policy is purchased and within 90 days
Journey End Date must be after Journey Start date
Policy cannot be purchased if total period of insurance is less than 3 days and more than 180 days
Policy cannot be purchased if Journey Start Date is beyond 90 days
Duration of Journey will be 30 days or 45 days for multi trip type
Please contact OICL office
Please contact OICL office