Property Claim Form

A. Policy Information

Policyholder's Full Name

Policy/Certificate No.

B. Claimant Details

Full Name

Tick if Claimant is policy holder

NRIC/FIN No.

Mobile No.

Is your Company GST Registered?

Yes No

Correspondence Address

C. Loss Details

Date of Loss

Time of Loss

Location of Loss

Description of Loss/Accident & Nature of Loss/Damage

When was it discovered?

Who discovered it?

Name of person responsible for the loss or damage

Address of person responsible for the loss or damage

For loss of property, please state the place, date and time when it was last seen by you

Date last seen

Time last seen

Place last seen

Is there any other insurance on the property? If yes, give details.

Yes No

Please provide details:

Do you own the property? If no, give name and address of the owner.

Yes No

Name of the Owner

Address of the Owner

Is any part of the premises lent, let or sub-let or are receiving paying guests? If so, give details.

Yes No

Please provide details:

Is the property subject to a hire purchase or loan agreement? If yes, give name and address of finance or lending company.

Yes No

Name of finance or lending company

Address of finance or lending company

D. Particulars of Claim

Articles actually lost or stolen are to be described first.
Articles which have been damaged must also be described and shown after lost or stolen article descriptions.

Describe the Property Lost, Destroyed or Damaged

Where was it Bought

When was it Bought

Price Paid/Estimated Cost of Repair (SGD)

Value at the Time of Loss (SGD)

Amount Claimed (SGD)

Article #1

+ Add another entry

Total Amount (SGD)

E. Bank Account Details

Please provide your bank details for us to accelerate your claims payment process by direct transfer to your bank account.

Name (as per bank account)

Bank Name

Bank Code

Account No.

Branch Code

F. Declaration, Authorization & Customer's Data Privacy Consent

[Declaration] I/We confirm that I am/We are the claimant and/or the Policyholder and I/We declare that all the particulars given above are to the best of my/our knowledge true and correct.

[Authorization] I / We hereby consent to and authorize the medical practitioner involved in the claimant’s care to discuss and disclose treatment details and discharge arrangements with and to AXA Insurance Pte Ltd. I/We agree that a copy of this consent shall have the validity of the original.

[Customer’s Data Privacy Consent] In connection with my/our and/or the claimant’s claims, I/We give consent for AXA Insurance Pte Ltd (“AXA”) and their respective representatives or agents to collect, use, store, transfer and/or disclose the information (including that provided by sources other than myself) concerning me/us and/or the claimant, to or with all such persons (including any member of the AXA Group or any third party service provider, and whether within or outside of Singapore and the Policyholder when claiming under a Group Policy) for the purpose of enabling AXA and their respective representatives or agents to provide me/us and/or the claimant (where applicable) with services required of an insurance provider, including the evaluating, processing, administering and/or managing my/our and/or the claimant’s claims or the Policyholder Group Policy(ies) with AXA (as the case may be), and for the purposes set out in AXA’s Data Use Statement which can be found at http://www.axa.com.sg (“Purposes”).

I, the claimant agree to abide by the terms & conditions.

G. Documents Required for Claim Assessment

Below is a list of minimum documentation required to process your claim. In certain circumstances, additional information may be required in order for further confirmation.

Documents Required (Please tick against the documents you have submitted)

Invoices/receipts showing date, price and place of purchase of the articles/property set out above

Colour photos showing the damaged property &/or CCTV footage showing circumstances of incident

Technical report from repairer on the cause and extent of the damaged property

At least 2 quotations for repair/replacement of the lost or damaged property

Police Report - For Theft and Burglary

H. Final Steps

Upload Supporting Documents

Please note: Total file size should not exceed 3MB.
Please only upload files that end in types: .png, .gif, .jpeg, .jpg, .pdf, .doc
File name must only contain alphanumeric characters, hyphen, dash and no spaces.
Please attach the relevant supporting documents with your claims submission to expedite claim processing.

Other

Please type what you see in the image:

Please review and ensure all details are accurate before you proceed.

File A Claim

A. Policy Information

B. Claimant Details

C. Loss Details

D. Particulars of Claim

Total Amount (SGD)

E. Bank Account Details

F. Declaration, Authorization & Customer's Data Privacy Consent

G. Documents Required for Claim Assessment

H. Final Steps

Confirmation content comes here