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How to file a claim

Insured Details

Insured Name*
Enter complete name                                                                                                                                          
A.K.A (Nickname)
          Gender  
                                                       
Date of Birth 
   Policy/Plan Number 
Type of Claim*
Date of Death/Diagnosis/Confinement/Disability* 
  
Place of Death, if applicable
  Cause of Death/Diagnosis
Name of minor beneficiary/ies, if any

Contact Details

Contact Person*
Relationship to the Insured*         E-mail Address*
Address*



Phone No.*           

Fax No.                  

Mobile No.*            

Name of Informant*


Relationship to the Insured* 

                        E-mail Address*

                                       





 

 

Address*  



Phone No.*             



* Required Field