Travel Insurance Benefits	Basic Plan
Medical and Related Expenses Emergency Medical & Hospitalization Medical Transportation & Repatriation Emergency Outpatient (Excess $ 50) Emergency Dental (Excess $ 50) Early Return if Family Member Dies Escort of Beneficiary Below 15 Years Beneficiary's Stay, Max 10 Nights Emergency visit by family member Burial, Cremation, Return of Remains Hospital Cash Benefit, Max 10 days Passive War and Terrorism Cover Hijack, Hostage, Wrongful Detention Per Event, Max 10 Days	Cover Limit USD 40,000 Included in Medex Included in Medex USD 300 USD 1,000 Nil USD 80 per night 1 Economy Ticket USD 3,000 USD 15 per day Covered Cover Limit USD 100 per day
Personal Accident Accidental Death Permanent Total Disablement	Cover Limit USD 20,000 USD 20,000
Baggage Luggage Delay Information Services Luggage Delay (Max 24 Hrs) Loss of Luggage Travel Inconveniences Journey Cancellation (Excess $ 100) Journey Curtailment (Excess $ 100) Travel Delay Missed Departure Passport Theft / Loss	Cover Limit Services Only USD 50 Per 12 Hrs USD 400 Cover Limit USD 1,000 USD 1,000 Nil USD 300 Actual Cost
Travel Assistance Administrative Info Services Consular Referral Emergency Accommodation Travel Arrangements Sending Urgent Messages Personal Liability Personal Liability Legal Expenses Abroad Lawyer's Expenses Advance for Bail	Cover Limit Service Only Service Only Service Only Service Only Service Only Cover Limit USD 100,000 Cover Limit USD 500 USD 500
Premium Payment Modes	Order Processing
Pay "CIC General Insurance" via > Cheque Payment > Bank Deposit or Transfer > Bank Debit or Standing Order Co-op Bank, Upper Hill Branch Bank A/c No. 0112-0000-5443-00 > Mpesa Paybill Number: 600112 > NCBA Bank Premium Financing > I & M Bank Premium Financing > Salary Deduction Check-off Ref: Name, ID, Passport or Policy N/b: Cash Payment is NOT Allowed	Please Place Your Order and Send, Text or Email us Proof of Payment to: info@insurenow.co.ke, info@insurekenya.com, 0722111760, 0779211760, contact page, chat box, or call us for collection of > Bank Order Forms > Bank Deposit Slip > Mpesa Confirmation > Premium Financing Forms Free Policy Doc Delivery: 24 Hours
Declaration	Declaration
1. I/we declare that I/we have read the cover involved as described in the summary of the terms and conditions as outlined in the policy document.	2. I/we declare that I/ we accept such terms and conditions.
3. I/we declare that to the best of my knowledge and belief that are not aware of any circumstances which are likely to lead to the cancellation or curtailment of the proposed journey.	4. I/we agree that The Company shall have the right to access my/our medical records prior to the journey in order to proceed with an assessment of a claim and /or render medical assistance.

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[Age 70-80] CIC Travel Insurance Upto 365 Days, Sum Insured USD 40,000

Brand: CIC General Insurance Company Ltd
Product Code: CIC General Insurance, Mpesa Paybill 600112
Availability: In Stock

KSh 14,943.60

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Applicant Postal Address

Applicant Physical Address

Applicant Phone Number

Applicant Email Address

Applicant Activity / Occupation

Applicant Business / Employer

Applicant Weight (Kgs)

Applicant Height (Ft & In)

Applicant Full Name

Beneficiary ID / Passport Number

Beneficiary Phone Number

Beneficiary Date of Birth

Beneficiary Gender

Beneficiary Name

Q. Your Doctor or Hospital Postal Address?

Q. Your Doctor or Hospital Phone Number?

Q. Your Doctor or Hospital Email Address?

Q. Your Doctor or Hospital Full Name?

Q. Is there any other medical condition that any of the insured person is suffering from? Yes/No. If Yes, please give details

Q. Does any of the persons to be insured suffer from any chronic or recurring illness? Yes/No. If Yes, please give details

Q. Does any of the persons to be insured suffer from any physical defect or infirmity? Yes/No. If Yes, please give details

Q. Has any persons to be insured suffered any accident previously? Yes/No. If Yes, please give details and extend of injuries

Q. Number of Travel or Journey Days

Q. Cover Start Date

Q. Purpose of Travel

Q. Countries and Continent Visiting

Select a Payment Mode to CIC General Insurance Ltd

Cheque Payment

Mpesa Paybill Number 600112

Coop Bank, A/c 01120000544300, Upperhill

Insurance Premium Financing by I and M Bank

Insurance Premium Financing by NCBA Bank

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