Skip to content
Bleu Glacio Trip
Facebook-f
Jki-instagram-line
Youtube
Jki-whatsapp
Twitter
Linkedin
Menu
Home
About Us
Flights
Buses
Properties
Gallery
Contact Us
Blogs
Menu
Holidays
Domestic
Our Incredible India
Bengal
International
Popular Countries
Europe & Other Countries
Fixed Departure
Trains
Hotels
Cabs
Cruise
Visa
Passport
Travel Insurance
Forex & Currency
Menu
Home
About Us
Flights
Buses
Properties
Gallery
Contact Us
Blogs
Travel Insurance
Travel Insurance Application Form
Full Name
Contact No.
Date of Birth
Gender
Select---
Male
Female
Transgender
Address
Destination(s) : Country (if International) State/Province (if Domestic)
Departure Date:
Return Date
Purpose of Travel
Select---
Leisure
Business
Education
Others
Travel Itinerary
Insurance Coverage Type
Select---
Single
Multi-Trip/Annual
Coverage Options:
Medical Expenses
Trip Cancellation
Trip Interruption
Baggage Loss/Delay
Accidental Death and Dismemberment
Other (Please Specify)
Coverage Amount (Specify Currency and Amount)
Number of Additional Travelers
(For each additional traveler, provide the following details)
1. Full Name 2. Gender 3. Date of Birth 4. Relationship to Primary Applican
Pre-existing Medical Conditions
If Yes, please specify
Medications
Select---
Yes
No
If Yes, please specify
Emergency Contact Person:
Full Name
Relationship
Contact Number
Email Address:
Declaration
I declare that the information provided is true and correct to the best of my knowledge.
I consent to the processing of my personal data for the purpose of this insurance application in accordance with the terms and conditions and privacy policy.
I allowing Bleu Glacio Trip or its staff to contact me and also send their promotional offers.
Send
You cannot copy content of this page
Add Your Heading Text Here
Property Booking
Property Name
No. of Rooms
Name
Contact No.
Check-in Date
Check-out Date
No. of Adult/s
No. of Children
Send
Travel with the Best Travel Operator
Call Us for details :
+91 987 458 1868
