Participant Accident Statement of Claim for Travel, Activity ... 2026

1. Click ‘Get Form’ to open the Participant Accident Statement of Claim in the editor.
2. Begin with Part I – Policyholder’s Statement. Fill in all required fields including Policy Number, Policyholder Name, and contact details. Ensure this section is signed by the Official Representative.
3. Proceed to Part II – Claimant’s Statement. Indicate whether the claimant is the Insured/Participant or Policyholder. Complete all relevant fields such as Claimant Name, DOB, and Social Security Number.
4. In the Information About the Claim section, check all applicable benefits claimed and provide detailed descriptions for each claim type, including dates and reasons for cancellations or delays.
5. Attach any Required Attachments as specified in Section D. This may include itineraries or proof of payment depending on your claim type.
6. Review all sections for completeness before signing the Important Notice at the end of the form. Retain copies of submitted documents for your records.

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