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Note: As each claim is unique, further information may be requested by us. If any part of your claim is of a dishonest or fraudulent nature, your claim will be denied and referred to the appropriate authorities.

Personal Information

I'd like to claim for






A. Medical & Dental Expenses Claim

Please scan or take a picture, and attach the following documents under 'Supporting Documents' section. 1. Flight / Cruise itinerary and boarding pass. 2. A copy of passport 3. A copy of NRIC, PR, or Work Pass 4. Lastly, please mail the ORIGINAL documents of doctor memo or medical report or Inpatient Discharge Summary (IDS) outlining 1st onset date and diagnosis of the medical condition, to us at 12 Marina View, #14-01 Asia Square Tower 2 Singapore 018961.

B. Luggage & Personal Effects

Please scan or take a picture, and attach the following documents under 'Supporting Documents' section. 1. Flight / Cruise itinerary and boarding pass. 2. A copy of passport 3. A copy of the receipt of purchase/ warranty card/ credit card statement for the loss or damaged items. 4. A copy of the police or carrier or relevant authority report/ letter. 5. A copy of the repair quotation (for the damaged items). 6. A copy of the bank statement/ withdrawal slip/ currency exchange slip showing amount withdrawn for the trip (for theft of money). 7. Photo of the damaged items. 8. A copy of NRIC, PR, or Work Pass

C. Travel, Baggage Delay / Flight Misconnection

Please scan or take a picture, and attach the following documents under 'Supporting Documents' section. 1. Flight / Cruise itinerary and boarding pass. 2. A copy of passport 3. A copy of the airline letter or report stating the reason and duration of the delay (for flight delay). 4. A copy of the Property Irregularity Report (for baggage delay and/or damaged baggage) 5. A copy of luggage acknowledgement receipt stating the date and time upon claimant received your luggage (for baggage delay). 6. A copy of NRIC, PR, or Work Pass

D. Cancellation Claim / Ticket Protection

Please scan or take a picture, and attach the following documents under 'Supporting Documents' section. 1. Flight / Cruise itinerary and boarding pass. 2. A copy of passport. 3. A copy of doctor memo or medical report/ Inpatient Discharge Summary (IDS) outlining the 1st onset date and diagnosis of the medical condition (if cancelled due to medical condition) 4. A copy of the death certificate (if cancelled due to the death of your family). 5. A copy of the birth certificate or marriage certificate (proof of relationship). 6. A copy of the cancellation slip or letter from the airline/ hotel stating any refunds or no refunds given. 7. A copy of NRIC, PR, or Work Pass 8. A copy of towing cmpany's service form/ repair shop's jobsheet (for Ticket Protector). 9. Employer's letter stating sudden need for business trip (for Ticket Protector).

E. Rental Vehicle Excess

Please scan or take a picture, and attach the following documents under 'Supporting documents' section. 1. A copy of the driver’s license. 2. A copy of the car booking rental agreement. 3. A copy of the incident or police report. 4. A copy of the final repair invoice from the repairer. 5. A copy of credit card/ bank statement which showing the amount charged and corresponding Singapore Dollar conversion. 6. A copy of NRIC, PR, or Work Pass

Supporting Documents (File Size < 10 MB)

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Breakdown of amount claimed

Payment Details

Claim Form Submission Certificate

I/We certify that this claim form has been completed in full and all required information and documentation as specified in this claim form have been uploaded. I/We certify that the information given in this form is truthful, accurate and complete. No information that is likely to affect this claim has been withheld. I/We understand that this claim may be refused if information is untrue, inaccurate or concealed. I/We understand that if this claim is fraudulent, it will be reported to the relevant authorities. I/We consent to the collection, use and disclosure of personal information in order to handle my/our claim. I/We acknowledge that if I/we do not agree to the collection of this personal information then Allianz Global Assistance will be unable to process my/our claim. I/We acknowledge that I/we will provide all necessary assistance as required by Allianz Global Assistance to process this claim.