Name of Claimer (Required)

Assistance/Membership Number (Required)

Telephone Number (Required)

Corresponding E-mail(Required)

Claimed Benefits (Please select one or more from below)

Details (Required)

Upload Documents (Required): Please follow the instructions in your insurance policy to provide relevant documents and pictures/scanned image of required information for claims. If you've got too many or too big files, please adjust the file size accordingly, or submit in batches.

Statement (Required)