Please provide us with the following details to activate your Travel Coverage, at least 5 working days before your trip. You will receive an SMS confirmation within 3 working days (from the submission date), which contains a unique reference number for each trip you submit.
*All fields required.
Date of Birth*:
You have charged your Full Fare to your*:
Citibank Classic Visa Card
Citibank Classic MasterCard
Citibank Clear Visa Card
Citibank Clear Platinum Visa Card
Citi Cash Back Platinum MasterCard
Citi Cash Back Visa Signature Card
Citi Cash Back World MasterCard
Citibank Gold Visa Card
Citibank Platinum Visa Card
Citibank Platinum MasterCard
Citibank Rewards Visa Signature Card
Citibank Rewards World MasterCard
Date of Full Fare charged*: (For this Complimentary Travel Insurance to be valid, travel dates must be within 6 months from the date of transaction when your Full Fare air ticket was charged to your Citi Card*)
You are travelling*:
Together with my Spouse and /or Children
You will be required to fill in the Spouse's Details if you are travelling with your Spouse.
Kindly note: In the event that you have charged your Full fare of your air ticket to a Citibank Card that is not under the above drop-down list of eligible Citibank Card*, you will not be under coverage of this Complimentary Travel Insurance. Please refer to the specific cardmember benefits, Terms & Conditions.
Spouse's Full Name:
Spouse's Date of Birth:
No. of Children travelling together with you*: