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Claim Submission

Describe the circumstances of the incident

Please enter a valid policy number.

Number of your Travel insurance policy

Please enter a valid policy number.

Number of your Motor insurance policy

Please enter a valid policy number.

Number of your Home Insurance Policy

Please enter a valid policy number.

Number of your Personal Accident policy

Please enter a date of loss

When did the incident occur

Please enter a date of loss

When did the incident occur

Please enter a date of loss.

When did the incident occur

Please enter a date of loss.

When did the incident occur

Please choose a valid nature of loss.

Please choose a valid nature of loss.

Please choose a valid nature of loss.

Please choose a valid nature of loss.

Please choose a valid nature of your claim.

Please choose a valid nature of your claim.

Please choose a valid nature of your claim.

Please choose a valid nature of your claim.

Enter valid summary

Enter valid summary

Enter valid summary

Enter valid summary

Please enter a valid policy number.

Please enter a valid policy number.

Please enter a valid policy number.

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Please upload any document or image that can help us to understand the circumstances leading to loss.

Driving License

Please upload a copy of your driving license

STNK

Please upload a copy of your vehicle STNK

KTP

Please upload a copy of your KTP

Damage Photographs

Please upload all damage photographs (max 6)

KTP

Please upload a copy of your KTP

Boarding Pass/Flight Tickets

Please upload a copy of your flight tickets/boarding pass

Medical Bills/Reports to be reimbursed

Please upload a copy of verified bills to be reimbursed

KTP

Please upload a copy of your KTP

Medical Bills/Reports to be reimbursed

Please upload a copy of verified bills to be reimbursed

KTP

Please upload a copy of your KTP

Damage Photographs

Please upload all damage photographs (max 6)

Upload section for each document required (depending on the selected illness)

Please upload all damage photographs (max 6)

Upload section for each document required (depending on the selected illness)

Please upload all damage photographs (max 6)

Upload section for each document required (depending on the selected illness)

Please upload all damage photographs (max 6)

Maximum 2 MB. PDF, PNG or JPG files only.

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Contact Information

Enter Your Name

Enter Middle Name

Enter Last Name

Enter Valid Email

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Enter Valid Mobile Number

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Enter Valid Mobile Number

Select Region

Select City

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