Proposal form for Extension/Renewal of Bajaj Allianz policy

1. Initial Policy No

2.Name of Insured

3. Insured Date of Birth

(dd/mmm/yyyy)

4. Policy Name

5. Email

6. Phone

7. Initial Policy Start date

(dd/mmm/yyyy)

8. Original Policy End date

(dd/mmm/yyyy)

9. Duration of Initial Policy

10. Number of Days Extension Required

11. Have you Filed Any Claims on the Original Policy?

Yes No

I hereby declare that I am in Good Health and that no event has occurred
which can give rise to any claim in my earlier policy period mentioned above I request that my policy be extended further.

I reconfirm that I am in good health and that I had given a proposal form at the time of taking the policy and that this declaration shall be the basis for the issuance of policy for the additional days requested above and it will be subject to the standard terms and conditions and special clauses as applied to my policy specifically.

Thanking You,

Bajaj Allianz renewal request

Insurance customers who are already covered with Bajaj Allianz travel or student insurance and willing to extend can place a renewal request using the above form. Once the renewal request is placed our customer support executives will process the same with the underwriters to get approval for further process. The renewal request for Bajaj Allianz travel or student insurance should be placed before the expiry of the policy to avoid any in your policy coverage.

The NRIOL website allows the insurance customers to conveniently request for the renewal of existing Bajaj Allianz travel or student insurance. Customers are expected to complete the online renewal application to request for the extension of existing Bajaj Allianz travel or student insurance policy. After placing the renewal request customers should wait till the request is accepted for renewal from the underwriting team.

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