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*:
Citi Cash Back Visa Signature Card
Citi Rewards Visa Signature Card
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 Citi Card that is not under the above drop-down list of eligible Citi 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*: