MAPFRE Middlesea Travel Insurance Claim form Logo
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  • Travel Insurance Claim Form

  • IMPORTANT NOTES

    Insurers, their Agents and Insurance Associations share information with each other to prevent fraudulent claims and for underwriting purposes. In the event of a claim, some or all the information you supply on this form and the proposal form together with other information relating to the claim may be provided to other Insurers, their Agents and Insurance Associations.

    ALL RELEVANT QUESTIONS MUST BE FULLY ANSWERED

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  • There is something wrong with the dates selected. Please check
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  • Cancellation and abandonment

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    • Check what documents you may need 
    • Hotel Accommodation vouchers/receipts Flights invoices and receipts Tour/holiday programme Medical report/s, Death certificates and/or other supporting documentation Refund confirmation for unused flights etc In the event of cancellation you are kindly asked to notify the travel agent/ticket issuing office immediately and apply for the refund of taxes and other dues.
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  • Personal accident

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  • Medical emergency and associated expenses

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    • Check what documents you may need 
    •   Medical Report/s and medical invoices and/or receipts Hospital reports and hospital invoices and/or receipts (In-patients hospital treatment or surgery is to be notified and authorized by MAPFRE Middlesea plc) Refund Confirmation for unused flights etc Receipts for additional accommodation and traveling
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  • Hospital benefit

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  • There is something wrong with the dates selected. Please check
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  • There is something wrong with the dates selected. Please check
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  • Medical information

  • DECLARATION I authorise MAPFRE Middlesea p.l.c. to share information with others (including insurers and Insurance Associations) in order to prevent fraudulent claims. I declare that all the answers given and the statements made are true and correct. Furthermore I declare that I have not withheld any information relevant to the claim. I give explicit and unequivocal consent to MAPFRE Middlesea p.l.c. to seek any information from any doctor, surgeon, hospital, clinic, laboratory or persons that have records or knowledge of my health in order for the validity of the claims to be established. I hereby authorise any doctor, surgeon, hospital, clinic, laboratory or persons that have records to provide full medical information concerning myself and my dependants. I give consent to MAPFRE Middlesea p.l.c. to process my personal data supplied by myself or any person, body or entity in order to process, handle and settle the claim
  • Please use the space below to provide your signature directly
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  • Delayed/missed departure

  • Original      

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  • Reschedule
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    • Check what documents you may need 
    •  Delayed Departure Boarding Pass for Actual Departure Reason for delay sustained duly supported by documentation (Airline declaration/Newspaper cutting etc) Missed Departure Airline's declaration to confirm refunds for the unused flights Receipts for extra charges incurred New flight ticket Supporting evidence & prove why departure was missed
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  • Lost, damaged or delayed luggage

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    • Check what documents you may need 
    • Damaged Suitcase Original Damage Report by Airline, Original Baggage Tags/Original Baggage Check Receipts If a report is not filed at the airport, insured is to lodge a report in writing with the Airline within seven days from date of flight   Non-Delivery of Suitcase Original Property Irregular Report Airline Baggage Check Receipt   Stolen Items: Police report or Airline report or Hotel report within 24hrs of loss Receipts/Valuations/manuals/accessories of stolen items (if available) Quote/s replacement of same or similar item/s Claimants may be requested to make a sworn statement (affidavit)   Delayed Luggage  Original Property Irregularity ReportReceipts of suitcase when collected/returned or similar documentation Original baggage - check Receipt Original receipts for emergency expenses incurred   In case item cannot be repaired: Damage item and accessories
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  • Lost, theft or damaged personal belongings, money and passport

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  • List details and amounts claimed in respect of additional accommodation and travel expenses incurred if you lose your passportwhilst you are abroad (Attach invoices/receipts).
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    • Check what documents you may need 
    •   Police Report filed within 24hrs of loss Bank Statement/s confirming amount of local cash withdrawn and foreign currency exchanged
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  • Vehicle policy excess

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  • Legal liability to others

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  • Signatures

  • I/We hereby declare that the above information and statements are, to the best of my/our knowledge and belief, correct and complete.
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  • DATA PROTECTIONMAPFRE Middlesea p.l.c. is legally bound to follow the provisions of the Data Protection Act, 2001. MAPFRE Middlesea p.l.c. is registered with the Office of the Commissioner for Data Protection to process data in accordance with this Act. The Data Protection Policy of MAPFRE Middlesea p.l.c. is compliant with this Act, a copy of which is available on request. MAPFRE Middlesea p.l.c. (C-5553) is authorised by the Malta Financial Services Authority to carry on both Long Term and General Businessunder the Insurance Business Act, 1998.

  • Please provide bank details to faciliate any claim payments

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