claim-eform | ព្រូដិនសលកម្ពុជា

Make a claim

Make a

Claim

All fields marked with * are mandatory

Claim Information

Select Your Product Type

Select Your Claim Type

Claimant Details

Name*

ID Number*

Contact Address*

Phone Number (Eg: 023964222) *

Role*

Other role

Details Regarding Claim Event

Happened To

Policy Number*

Life Assured Name*

Cause of Claim*

Date of Claim Event*:

Payment Details

Bank Name*

Bank Account Name*

Bank Account Number*

Does Life Assured also have life insurance policies with other companies?

Life Insurance Company Name

Policy Number

Sum Assured Amount

Required Documents

Request Verification

to request for OTP on your registered contact number.

OTP Number*

I guarantee that the information provided is true and accurate, and take all legal responsibility regarding the accuracy of this information. I authorize Prudential (Cambodia) Life Assurance PLC to store and share my data and sensitive information (name, bank account information, etc.) within Prudential (Cambodia) Life Assurance PLC and third-party banks to make claim payments.

Your claim has been submitted successfully.

Email or contact us at pcla.claims@prudential.com.kh or 095 964 222

(working hour) for any claim-related inquiries.

Our claim team will contact you within 3 working days for additional/incomplete documents.

Your claim number is