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Travel Insurance

* is mandatory

Title

Fullname of the person to be Insured

Permanent Address 1

Address 2

City

Telephone

E-mail

Destination

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Travel period

Leaving Sri Lanka on

Returing to Sri Lanka

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Travellers

Passport No

Date of birth - policy holder

Name :		Date of Birth :

Accompanying person 1

Accompanying person 2

Accompanying person 3

Accompanying person 4

Purpose of visit

Are you Presently in good health

Yes

( The applicants above the age of 65 years should submit the medical form filled by a medial practitioner. Please click here to download the medical form )

Plan Benefits (I) Please select destination

(II) Medical Scheme (US$)

Premium for Travel MAX

Select the Travel Type

Pay for Travel MAX

GENERAL NOTES :
Age & Validity
· Travel Max is offered for persons below the age of 80 and valid for residents of Sri Lanka.
· Persons older than 70 years a medical certificate has to be submitted.
· Travel Max children below 17yrs will be charged 50 % of normal rate when traveling with an immed- iate parent who has also purchased a travel insurance policy from HNBA.
· Non insurable persons - Sportsmen ( professional & semi professional).
· Travel policies are valid only for the journey originated from Sri Lanka.
Duration
· Travel Max - Ages below 70 yrs 180 days.
- Ages 70 plus to 80 yrs 60 days.
Important Exclusion
· Pre - Existing condition.
· Deductibles.
· Medical check-ups.
· Watersports, Wintersports ( can be covered at an additional premium).
Please click here to see the benefits of each policy.

Other Terms/Conditions/ Exclusions as per the policy wording.