We also need a copy of ACC’s letter outlying their contribution to treatment. If your claim is urgent, simply call us on 0800 500 216.. Start your claim AIA SINGAPORE OUTPATIENT CLAIM FORM 3 Tampines Grande, #07-00, AIA Tampines, Singapore 528799, Fax: 6538 5603 / 6538 4340, Email : aiasmu@alliancemedinet.com Clinical / Specialist 1. Admission to Private Hospitals / Clinics / Hospitals outside Singapore (1) Duly completed and signed claim form (Part 1) › AIA may be required to disclose my personal information if disclosure is required by law, including laws of other jurisdictions, for example to government and regulatory authorities. › Medical information can be included in the emails sent to the email address detailed on this claim form or subsequent addresses I provide to AIA claims. The Policyholder or Insured Person must notify the Company immediately after the event which could give rise to a claim. Please submit the form & the requirements at the nearest Tata AIA Life branch office or the address given below; Tata AIA Life Insurance Company Limited, B- wing, 9th Floor, I-Think Techno … 3. It provides a monthly income if you become disabled due to an accident. a. Submission of Group and Affinity insurance products, email to groupclaim@income.com.sg b. Submission of Personal life/health insurance products, DPS or ElderShield, email to csquery@income.com.sg. (JAN 2012) AIA SINGAPORE GROUP HOSPITAL & SURGICAL INSURANCE CLAIM FORM Corporate Solutions 3 Tampines Grande, AIA Tampines #07-00, Singapore 528799 Fax: 6538 5603 Email: sg.eb.claims@aia.com (5) Claim Settlement Advice from Medisave -approved Integrated Shield Plan (if any) – example, AIA Healthshield, NTUC Incomeshield, AVIVA Myshield,Prudential Prushield or Great Eastern Supremehealth . Claims EZ website for AIA customers. To do that, AIA require you to furnish them with a written notice not later than 30 days from the date of incident. Payment Facilities. Failing to do so might result in rejection of your claim. Claims Forms Death Claim Form Dismemberment Claim Form Accelerated Claim Form Accidental Death Claim Form Disability Claim Form Other Forms Beneficiary Change Form Name Change Form Address Change Form Electronic Payment Form Don’t see the form you’re looking for? ... Group Accident. Please note that claimants are required to bear the fee for obtaining the report. This form provides us with your consent to attain your medical information from the hospital on your behalf. › Medical information can be included in the emails sent to the email address detailed on this claim form or subsequent addresses I provide to AIA claims. Please quote our reference number when corresponding with us. AIA Star Protector Plus is a personal accident insurance plan for kids that offers affordable worldwide accident and health cover for your child. You will be asked about your basic information as well as some details about the type of claim you are filing. AIA Company Limited RC SCAN 1st Floor, AIA Tower 1 181 Surawong Road, Bangkok 10500 (CSG Claim Form) Corporate Solutions - Group Dental Claim Form PART I: PLEASE FILL IN THE INFORMATION REQUIRED BY DENTIST TO AVOID RETURN OF CLAIM DUE TO INCOMPLETE INFORMATION, PLEASE ANSWER ALL QUESTIONS. (i) Call the Company at 1800 88 8811; or (ii) Complete the Personal Accident & Health Claims Form and email it to MYPAClaims@aig.com. CLAIM FORM OUTPATIENT PT AIA FINANCIAL is a leading life insurance firm registered and supervised by Financial Service Authority INSTRUCTIONS 1 This Claim Form is applicable for one patient only and must be completed and signed by the Insured/ Participant and/or Policy Holder or if the patient is a minor it must be completed and signed by the Insured/ Claimant Statement for Life (Corporate Solutions) Claimant's Statement Critical Illness and Female Product Claim (filled by the assured) Get your personal accident plan today! You will be asked about your basic information as well as some details about the type of claim … Death (all causes of death) Claim Forms (Download this form in other Language). If you wish to make a claim, you must send us the appropriate forms and proofs within 90 days after discharge from hospital or the date on which relevant medical services are performed and completed. Whether you’ve been in a car accident, had your home burgled or damaged, making a claim with us is simple. This information is of a general nature only and has been prepared without taking into account factors like your objectives, financial situation or needs. Choose the type of claim you would like to file and fill out the form under each section. › AIA may be required to disclose my personal information if disclosure is required by law, including laws of other jurisdictions, for example to government and regulatory authorities. Aviva offers three types of Personal Accident plan - Plus, Standard and Lite - choose the plan that matches your lifestyle. AIA Vitality is available with eligible Priority Protection and Priority Protection for Platform Investors products issued by AIA Australia Limited (ABN 79 004 837 861, AFSL 230043). *C090112010206* AIA SINGAPORE ACCIDENT & HOSPITALISATION CLAIM FORM Doctor's Statement To be completed by your attending doctor, and applicable if your claim is more than $1,500 1. Fill out the form. Accident Claim Form. If ACC declines your claim, please enclose a copy of the letter from ACC with your claim form. It provides protection against accidental injuries and burns, as well as coverage for 16 common diseases, giving them the confidence to explore life to the fullest. Ensure that the overall size of your email attachment(s) does not exceed 30MB. Submit the completed claim form and relevant documents to us as soon as possible. No If “No”, complete Section (F) Details of Illness & Section (G) Authorisation & Declaration. Email to plineclaims@income.com.sg the completed claim form with a scanned copy or picture of all required supporting documents.. This form is for filing of claims for :- - Treatment at Government Polyclinics Submit your claim online to receive your claims payment faster and hassle-free through FAST or PayNow payment options. Choose the type of claim you would like to file and fill out the form under each section. • To apply, complete and sign “Telegraphic Transfer Request Form for Claim Payment”. Protect yourself and your loved ones with Aviva Personal Accident insurance. There are three types of claims that you can file depending on your policy’s benefit: Accident, Illness, or Death. Please be advised that insureds are required to keep all original documents for 2 years from the date of submission as we reserve the right to request for verification of such documents. Call us at 877-801-3727 Then, based on the type of the event, complete the corresponding claim form below: Death; Total and Permanent Disability; Accident… Download and print this form from Making A Claim web page via www.aia.com.sg > Help & Support > Making A Claim > Death Claim > Let AIA Singapore know how you would like to receive payment. Enjoy greater peace of mind with AIA HealthShield pre-authorisation at any private specialist clinic or hospital when you get your medical bill pre-approved before admission or surgery. CLAIM FORM INPATIENT PT AIA FINANCIAL is a leading life insurance firm registered and supervised by Financial Service Authority INSTRUCTIONS 1 This Claim Form is applicable for one patient only and must be completed and signed by the Insured/ Participant and/or Policy Holder or if the patient is a minor it must be completed and signevd by the Insured/ If you are unable to submit your claim online, you can choose one of the following channels to submit your claim during this period.. Email your claim to us. If ACC is paying a part of the claim, AIA may be able to top this up. Thank you for your online Personal Accident Claim notification. The AIA Form Library is where you can find all the different documents for claims and requests for assistance. The policy owner(s) will be notified about this claim. There are three types of claims that you can file depending on your policy’s benefit – Accident, Illness, or Death. Protect what you truly love with AIG's MyGuardian PA, personalized protection designed for you and your loved ones. NAME OF PATIENT: AGE: SEX: Visit Philam Life's forms library to find all our downloadable insurance forms including living claims, death claims, customer requests and auto-pay. You should request your attending doctor to complete the “Medical Report” section of the claim form. The claim needs to reach us within 30 days of the incident. 4. For medical claims, keep the original medical bills/receipts for six months as we may request for them on case-by-case basis prior to settlement of the claim. Our Personal Accident cover comes with 24/7 global coverage that insures you against accident-incurred injuries, acts of terrorism and more. You can report your claim online, and someone from our team will get in touch within two working days, or at a time that suits you.. Part I: Claimant's Statement-FATCACRS self certification forms Individual -FATCACRS self certification forms Non Individual Part II: Physician's Statement; Death Certificate issued by a local government body like Municipal Corporation / Appropriate Authority If you wish to make a claim, you must notify us in writing within 30 days from the date of the accident causing the injury, and send us the appropriate forms and relevant proof within 90 days from the date of the accident. Have peace of mind when you protect your people from unforeseen incidents. Introducing MyGuardian PA, a personal accident plan that provides comprehensive coverage to protect you from medical expenses, loans, bills and more. For more information, you may wish to refer to the Monetary Authority of Singapore’s Dispute Resolution Guide. 4. Yes If “Yes”, complete Section (E) Details of Accident & Section (G) Authorisation & Declaration. Please note that the declaration at the end of this online form must be read and accepted by each policy owner and the claimant (or their parent/guardian if under 16) before it's submitted.