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Forms and Policies


 

In this section you can download claims and administration forms you may need when applying for insurance or in making an insurance claim. If you have any questions you may call us on +(84 28) 3921 9908 or email us at This email address is being protected from spambots. You need JavaScript enabled to view it..

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Policy Wording

 
Health Insurance Policy Wording
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Travel Insurance Policy Wording
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Application Forms

Healthcare Insurance Application
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Healthcare Insurance Application For Family
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Personal Accident Insurance Application
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Income Declaration
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Large Amount Questionnaire
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Beneficiary Designation
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Travel Insurance Application
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Frequent Travel Declaration Form - Individual
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Claim Forms

 
Notification of Claim Form
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Dental Claim Form
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Incident Report
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Attending Physician's Statement for Death Claim
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Claim Form Death
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Travel Insurance Claim Form
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First Oral Examination Report
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Medical Declarations & Reports

Chest Pain Questionnaire
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Diabetes Questionnaire (Applicant)
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Diabetes Questionnaire (Medical Attendant)
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Epilepsy Questionnaire
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Gout Questionnaire
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Hypertention Questionnaire
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Referral for Follow-Up Care
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Respiratory Questionnaire
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Treatment Plan for Radiation and Chemotherapy
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Oral Examination Report
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Treatment Plan for Physiotherapy/Chiropractice/Acupunture
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Physician Examination Report for Applicants Over Age 65 (Medical Attendant)
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Modification of Policies

Application for Policy Transfer
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Application for Reinstatement
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Application for Upgrade
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Application for Change of Benefit
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Personal Accident Upgrade Application Form
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