Renewal/Extension Form of Oriental Travel Insurance


Renewal/Extension Form of Oriental Travel and Student Insurance

Proposal form for Extension/Renewal of Oriental Insurance Policy
Insurance Certificate 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 :
Number of Days Extension Required:
Have you Filed Any Claims on the Original Policy?	Yes No
I hereby declare that there has been NO CLAIM whatsoever till date, against the above Oriental Insurance Policy and further state and confirm that there has been NO CHANGE till now in my Personal physical & medical condition since the date of issue of the first policy. You are now requested to kindly treat this letter as an Application / Proposal to renew this Insurance Policy as requested above. I declare that the information provided in this application is correct. Please do the needful at the earliest and oblige. Thanking You,

Insurance is the subject matter of the solicitation.

Renewal/Extension Form of Oriental Travel and Student Insurance