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Policy Information

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Claim Details

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Upload Your Supporting Documents

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Payee & Contact Details

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Declaration

The below information is not mandatory but will assist in expediting your claim outcome and payout.

Other Insurance / Information

I have made previous claims in respect of Travel Insurance

Insurer's name:

Nature of claim:

Date of claim:

Amount:

I have other insurance covering this incident

Insurer's name:

Type of insurance:

Policy number:

I was able to receive compensation or refund from other sources

Payer

Name of payer:

Total amount received in CAD:

Add another bill

Additional Supporting

I used a credit card to pay for my flights

Cardholder name:

First 6 digits of your card number:

Last 4 digits of your card number:

I have personal medical/accident insurance

Company name:

Primary member:

Insurer's name:

Plan name:

I have corporate medical insurance

Company name:

Primary member:

Insurer's name:

Plan name:

Please note that you are submitting this claim to Xodus Travel Services Inc. Please see our full Terms and Conditions, Privacy Policy and Cookie Policy.

By submitting this claim to us, you are deemed to have agreed to us collecting, using, disclosing and processing your personal data for the purpose of assessing your claim. This may include disclosing and sharing your personal data with our service providers and/or with other insurers for the proper processing, handling and/or dealing with your claim, which includes investigating the claim.

I declare that the information given is true and correct to the best of my knowledge and belief. I understand that any false or fraudulent statements or any attempt to suppress or conceal any material facts shall render the policy void and the Insurer may refuse to pay the claim.

I acknowledge that Xodus has the right to request for any supporting documents for verification of my claim and I will retain all original supporting documents such as medical bills and receipts for a period of at least six months from the date of this submission. I further acknowledge that Xodus has the right to re-assess any claim and recover any sum paid, should there be any discrepancies.

In addition to the declaration and authorisation provided above, I/we agree and consent to the Company, its related corporations (collectively, the "Companies"), as well as their respective representatives and agents collecting, using, disclosing and sharing amongst themselves my/our personal data, and disclosing such personal data to the Companies' authorised service providers and relevant third parties for purposes reasonably required by the Companies to evaluate, admit, process and/or administer my/our claims.

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Review Your Submission

Submitted for Review

Claim Reference No.

TR000064

What’s next?

We will review your claim and provide you a response by email within 2 business days:

charose2@gmail.com

If you have any questions related to your claim, please directly reply-to the acknowledgement email sent to you for the fastest support.

Policy Information

Before we begin:

Are you currently travelling and either actively, or planning on seeking medical attention?

Have you already contacted us regarding this event?

What happened?

Description of the claim

Details of your medical claim

Item

Upload Your Supporting Documents

Upload Itemized Receipt

Upload Proof of Payment for Self-Paid Expenses

Description of the claim

Details of your medical claim

Item

Upload Your Supporting Documents

Upload Itemized Receipt

Upload Proof of Payment for Self-Paid Expenses

What happened?

What was the reason for the trip cancellation?

Description of claim

Details of your non-refundable, non-recoverable portion of prepaid airfare and/or travel arrangements

Details of your additional charges

What happened?

What was the reason for the trip interruption?

Description of claim

Claim details

Details of prepaid expenses

Details of airfare expenses

Details of your other additional unplanned expenses

Claim details

Description of claim

Details of your necessary toiletries and clothing items

Item

Description of claim

Claim details

Details of prepaid expenses

Details of airfare expenses

Details of your other additional unplanned expenses

Claim details

Details of your airline lost/damaged by airline

Details of replacing your personal document

Details of your personal belongings lost

Details of your necessary toiletries and clothing items

Details of your necessary toiletries and clothing items

Description of claim

Description of claim

Flight/travel itinerary

Medical reports including complete diagnosis by attending physician

Flight/travel itinerary

Medical reports including complete diagnosis by attending physician

Scheduled flight/travel itinerary

Reason for cancellation

Expense receipts

Refund Information

Scheduled flight/travel itinerary

Reason for cancellation

Expense receipts

Refund Information

Scheduled flight/travel itinerary

Actual flight/travel itinerary

Flight delay report

Expense receipts

Scheduled flight/travel itinerary

Reason for cancellation

Expense receipts

Refund Information

Scheduled flight/travel itinerary

Property Irregularity Report

Lost items reported

Airline compensation

Luggage delivery receipt or letter

Purchase and expense receipts

Photo of damage

Repair receipt

Police Report

Scheduled flight/travel itinerary

Other documents to support your claim

How would you like to receive your payment?

How can we contact you?

Other Insurance / Information