Easy Steps to Get F1-OPT Insurance

f1-opt insurance

Student Personal Information

Name

This field is required

Email Id

Please enter a valid email-Id

Phone Number

Phone

Please enter a valid phone number

Gender

This field is required

Date of Birth

Your University

Travel Information

Currently in India?

Travel Date

This field is required

Coverage Start Date

Coverage End Date

Coverage Period

Other Information

Student's Pan Number

This field is required

Sponsor Name

This field is required

Emergency Contact Number

Phone

This field is required

Alternate Email Id

This field is required

Mother’s Name

This field is required

Student's Passport Number

This field is required

Nominee's Name

This field is required

Nominee Relation

This field is required

Nominee DOB

This field is required

Address In India

This field is required

Health Declaration

I have left India as on , and I request you to issue me a policy effective as soon as possible, since post my travel from India there have been no contingencies/medical events & emergencies reported by me till date. Also I do not anticipate any medical situation in the policy period from to which can lead in claim and hereby declare that I am in a sound physical and mental health at the time of the purchase of this policy.

The reason, I could not purchase the insurance before traveling as I was busy with my travel preparations and exams.

Name:

Date: 28-11-2024

Nominee Details

Name:

DOB:

Relation:

Need help? Chat with us