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Documents required in support for claiming medical expense for customers

documents required in support for claiming medical expense

important documents required in support for claiming indemnity

(please affix signature to certify true copy of all documents)

1. documents containing the information of the insured     |download|

2. personal accident claim form     |downloan|

3. copy of citizen id card of the insured and/or persons with clamming right or beneficiary

4. copy of citizen id card of the authorized persons (in case of actions taken by authorized person)

5. copy of house registration of the insured and/or persons with clamming right or beneficiary

6. copy of related daily police report/alcohol test result (if any, or if such practice is required by laws)

7. copy of passbook (to receive indemnity), in case of the receipt of indemnity is made through promptpay

8. please specify the bank’s name …….…….mobile phone no. ……………………..citizen id no.………………………..

*relevant documents as the case may be 

reimbursement for loss of organs, sight, or permanent disabilities:

1. original receipt of the medical expenses

2. doctor’s certificate or relevant medical documents

3. doctor’s certificate according to the company’s form (in case of permanent disability)     |download|

4. certificate (in case of loss of organs, and permanent disability)

5. medical documents (if any, before the person is deceased)

reimbursement for death

1. copy of death certificate

2. copy of autopsy report (back-front)

3. death registration

4. copy of house registration of the deceased (with the stamp “dead”)

5. medical documents (if any, before the person is deceased)

reimbursement for loss of income  

1. copy of medical expense receipt and other medical documents which confirms the inpatient status of the insured 

in the case where the insurance policy states beneficiary or lawful heir

1. copy of citizen id card or birth certificate (in case of minor child)

2. copy of citizen id card of beneficiaries of all lawful heirs 

3. married certificate of the insured and beneficiary and that of parents of the insured (if any) 

4. police daily report with the name of all lawful heirs of the insured (in case of beneficiaries are lawful heir.)

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Admin 6/6/2018 5:15:03 PM