eClaim Personal Accident(PA)/Travel Accident(TA)

Online personal / travel claims / motor in life, body and medical section request

Assured information

* For your benefit, please input information follow by car book registration
Name * : Surname * :
Mobile * : Telephone :
Policy No. * :  
Email * :
Date * :
Details :
Description :

Documentation

ID Card * JPG,GIF,PNG,PDF,TIFF
Image(s) Accident * JPG,GIF,PNG,PDF,TIFF
Attached Receipt * JPG,GIF,PNG,PDF,TIFF
Memo JPG,GIF,PNG,PDF,TIFF
Note * File attachment is needed
  
Please enter the letters in the image above *: