NICL National Insurance Company Limited
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Name of Applicant (as on passport)  
Citizenship  
Passport Number (please use additional sheet if more than one travelers are applying)  
Organization  
Date/Place of Entry in Pakistan  
Flight Number  
Time of Arrival  
Date/Place of Exit from Pakistan  
Flight Number  
Time of Departure  
Stay Duration in days    
Number of travelers to be insured    
Coverage Plan chosen (please tick) Classic Superior  
Purpose of visit (please tick) Govt. Delegates Official Trade Delegates
Business Travelers Tourists 		 
CONTACT INFORMATION
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Email    
Mobile    
Phone       
Fax    
Nominee Name:
(please use the additional Boxes if there is more than one representative)
a.
b.
c.
 
Nominee Address & Phone & Email  
     
I declare that this information is true to the best or my knowledge
 
 
Claim intimation and Contacts

In case of claim please visir http://nicl.com.pk/travel_claim_form.aspx and submit claim form throug the website or you may call 021-111-642-642 (9AM - 5PM PST) Staurday & Sunday off or email us at travel@nicl.com.pk