Forms and policies

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 inquiry@pacificcross.com.vn.

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Policy Wording
Health Insurance Policy Wording
Travel Insurance Policy Wording
Member Guide for Health Insurance Plan
Member Guide for Health Insurance Plan
Application Form
Healthcare Insurance Application
Healthcare Insurance Application For Family
Income Declaration
Beneficiary Designation
Frequent Travel Declaration Form - Individual
Personal Accident Insurance Application
Large Amount Questionnaire
Travel Insurance Application
Claim Form
Claim Form
Incident Report
Claim Form Death
First Oral Examination Report
Dental Claim Form
Attending Physician's Statement for Death Claim
Travel Insurance Claim Form
Progress Note
Medical Declarations & Reports
General Questionnaire
Chest Pain Questionnaire
Diabetes Questionnaire (Medical Attendant)
Gout Questionnaire
Referral for Follow-Up Care
Treatment Plan for Radiation and Chemotherapy
Treatment Plan for Physiotherapy/Chiropractice/Acupunture
Diabetes Questionnaire (Applicant)
Epilepsy Questionnaire
Hypertention Questionnaire
Respiratory Questionnaire
Oral Examination Report
Physician Examination Report for Applicants Over Age 65 (Medical Attendant)
Update of Medical Declaration
Modification of Policies
Application for Policy Transfer
Application for Change of Benefit
Personal Accident Upgrade Application Form
Application for Reinstatement
Application for Information Changing
Application for Changing of Product