Make a Claim

Early Stage

• A Claim Request, using the company’s form

• An Authorization Letter (both Khmer and English), using the company’s form

• A copy of the PO’s or/and beneficiary (ies)’s ID card

• A copy of PO or/and the beneficiary (ies)’s bank account

• A copy of all Medical Records related treatment from specialist doctor to support the insured event. (The records must be in Khmer or English.)

Late Stage

• A Claim Request, using the company’s form

• An Authorization Letter (both Khmer and English), using the company’s form

• A copy of the PO’s or/and beneficiary (ies)’s ID card

• A copy of PO or/and the beneficiary (ies)’s bank account

• A copy of all Medical Records related treatment from specialist doctor to support the insured event. (The records must be in Khmer or English.)

• A copy of the standing order cancellation letter (if any)

Due to accident

• A Claim Request, using the company’s form

• An Authorization Letter (both Khmer and English), using the company’s form

• A physician’s statement of TPD, using the company’s form

• A copy of the PO’s bank account

• A copy of the PO’s ID card

• A copy of the police report of the insured event

• A copy of ALL Medical Records

Due to disease

• A Claim Request, using the company’s form

• An Authorization Letter (both Khmer and English), using the company’s form

• A physician’s statement of TPD, using the company’s form

• A copy of the PO’s bank account

• A copy of the PO’s ID card

• A copy of ALL Medical Records

Due to accident

• A Claim Request, using the company’s form

• A copy of the Family Book or Residence Book of LA

• A copy of the Death Certificate

• A copy of the beneficiary (ies)’s bank account

• A copy of the beneficiary (ies)’s ID card

• A copy of the standing order cancellation letter (if any)

• A copy of the police report of the insured event

• A copy of the corpse examination report (if any)

Due to disease

• A Claim Request, using the company’s form

• A copy of the standing order cancellation letter (if any)

• A copy of the Family Book or Residence Book of LA

• A copy of the Death Certificate

• A copy of the beneficiary (ies)’s bank account

• A copy of the beneficiary (ies)’s ID card

• Authorization Letter (Both Khmer and English), using the company’s form

• A copy of ALL Medical Records

Claimant who is legal guardian of minor beneficiary (ies), required these following documents:

• Copy of legal guardian’s ID card

• Copy of appointing legal guardian letter (in case legal guardian is not parent), certified by commune chief

• Copy of beneficiary (ies)’s birth certificate

For all Claim Types:

* The Company is responsible to assess the claim request within fifteen (15) working days starting from the date that the Company receives complete claim submission request and its all the necessary forms and documentary evidence.