Cholamandalam Travel Insurance & Chola Student Insurance online

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Renewal / Extension Form of Cholamandalam Travel and Student Insurance


Proposal form for Extension/Renewal of Cholamandalam Insurance Policy
Policy Number:
Policy Holder Name:
Policy Holder Date of Birth: (dd/mmm/yyyy)
Policy Name:
Email :
Phone:
Original Policy Start date : (dd/mmm/yyyy)
Original Policy End date : (dd/mmm/yyyy)
Duration of Initial Policy :
Total days of extension & Date till when the extension required:   
Reason for Extension / If policy already expired, reason for delay in extension:
Are you in good health now? (Y/N): Yes No
Has any Extension made to the policy (Y/N)(If “Yes”, Provide the total duration of the Policy as on expiry of the last extension): Yes No   days
Please confirm if any claim is made during the expiring policy (If yes, mention the Claim): Yes No 
I hereby solemnly declare that above information given by me is true of my knowledge and understanding.
 
    

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  • Sub-Limits are applicable only for senior citizens(above 70 years)


  • Buy from anywhere in the world with credit card (Indian and International cards accepted)


  • Policy will be issued and emailed to you on completing the purchase

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