Awards

Online Travel Delay Claim Form

Instructions - Please complete the attached form and press the Submit Claim button.

We will acknoweldge receipt within 30 minutes by sending you an email that will confirm your claim reference number and tell you what documents to send in to us to support your claim.

Part 1. Claim Contact
Title: Please select an item.
First Name: A value is required.
Last Name: A value is required.
Date of Birth: (dd/mm/yyyy) A value is required.Invalid format.
Address Details
First Line (including house name / number): A value is required.
City: A value is required.
State: A value is required.
Postcode A value is required.
Country Please select an item.
Phone: A value is required.Invalid format.Minimum number of characters not met.
Email: A value is required.Invalid format.

Part 2. Claimants
Total Number of Claimants A value is required.Invalid format.The entered value is less than the minimum required.
Please list details of all people claiming including the main contact, detailed above, if applicable:
Claimant 1
Title: Please select an item.
First Name: A value is required.
Last Name: A value is required.
Date of Birth: (dd/mm/yyyy) A value is required.Invalid format.
Relationship to Lead Insured: Please select an item.
Claimant 2 (if applicable)
Title:
First Name:
Last Name:
Date of Birth: (dd/mm/yyyy)
Relationship to Lead Insured:
Claimant 3 (if applicable)
Title:
First Name:
Last Name:
Date of Birth: (dd/mm/yyyy)
Relationship to Lead Insured:
Claimant 4 (if applicable)
Title:
First Name:
Last Name:
Date of Birth: (dd/mm/yyyy)
Relationship to Lead Insured:
Claimant 5 (if applicable)
Title:
First Name:
Last Name:
Date of Birth: (dd/mm/yyyy)
Relationship to Lead Insured:

Part 3. Policy Information
Agent who Issued the Policy A value is required.
Scheme Name A value is required.
Certificate Number A value is required.
Date of Policy Issue (dd/mm/yyyy) A value is required.Invalid format.
Policy Start Date (dd/mm/yyyy) A value is required.Invalid format.
Policy End Date (dd/mm/yyyy) A value is required.Invalid format.

Part 4. Trip Details
Date Trip Booked (dd/mm/yyyy) A value is required.Invalid format.
Booked Departure Date (dd/mm/yyyy) A value is required.
Booked Return Date (dd/mm/yyyy) A value is required.Invalid format.
Trip Destination Please select an item.

Part 5. Delay Information
Scheduled Departure Date (dd/mm/yyyy) A value is required.Invalid format.
Scheduled Departure Time A value is required.Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.(hh)

A value is required.Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.(mm)
Actual Departure Date (dd/mm/yyyy) A value is required.Invalid format.
Actual Departure Time A value is required.Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.(hh)

A value is required.Invalid format.The entered value is less than the minimum required.The entered value is greater than the maximum allowed.(mm)
Transport Type Please select an item.
Cause of Delay Please select an item.
Carrier Reference (e.g. flight no) A value is required.
If Cause of Delay was Other, please elaborate:
Was the transport delayed or cancelled? Please select an item.
Tick if you checked-in to original travel arrangement
Tick if the schedule departure was for an international crossing
Tick if the delay occured on the first outward or last return leg of the trip

Part 6. Additional Information
Please provide any other information you think may be helpful:

Part 7. Declaration

On clicking the 'Submit Claim' button below you will be sending an insurance claim to us. In doing so, you also declare that:

  1. You are the Claim Contact detailed in Part 1 above.
  2. You have authority from the other insureds to claim on their behalf (if applicable).
  3. The information in this form is accurate and correct to the best of your knowledge and belief.
  4. You shall provide the insurer with any further information which may reasonably be required.
  5. You understand that the making of a fraudulent or exaggerated claim is a criminal offence and may leave you liable to prosecution.

IMPORTANT: Please tick the following box to confirm agreement to the declaration:
Please make a selection.

We will also destroy any documents that you submit to us after 6 months of receipt. Please tick here if you require your documents returned to you:

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Awards
Approved Partner of:
Partners: AXA Voyager Insurance Services UK General Opera Underwriting Avid Insurance Services
Telephone: 0844 887 0305 / + 44 (0) 20 8667 1600 Email: enquiries@rpclaims.com Address: Airport House, Purley Way, Croydon, CR0 0XZ
Rightpath Claims is a trading style of Rightpath Insurance Solutions Ltd. © 2012 Rightpath Insurance Solutions Ltd.
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