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File A Claim

File A Claim
File A Claim

Travel Claim Form

A. Policy Information

Policyholder's Full Name

Policy/Certificate No.

B. Claimant Details

Full Name

NRIC/FIN No.

Email

Mobile No.

Correspondence Address

C. Travel & Loss Details

Travel Period (From)

Travel Period (To)

Travel Agency (if applicable)

Date of Loss/Accident

Location of Loss/Accident

Time of Loss/Accident

Type of Accident


Description: Circumstances of the Loss/ Accident or Nature of Illness

Total amount claimed

Have you made a claim against any other party in respect of this event? If yes, please provide:

Name of other party/insurance company:

Description of claim

D. 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

E. 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”).

F. 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.

Type of Loss/Accident

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

Basic for all types

(plus) as applicable below:

+ Accidental Death, Total Permanent Disablement
+ Medical expenses, Hospitalisation Allowance, Hospital Visit benefit, Compassionate Visit, Child Care Benefit
+ Loss/ Damage to Baggage & Personal Effect
+ Purchase of Essential Items
+ Baggage Delay
+ Personal Money & Travel Documents
+ Trip Cancellation/Travel Curtailment
+ Trip Postponement/Replacement of Traveller
+ Travel Delay/Travel Diversion
+ Travel Overbooked or Misconnected
+ Fraudulent Use of Lost Credit Card
+ Personal Liability
+ Financial Collapse of Travel Agency
+ Rental Car Excess Cover
+ Emergency Personal Mobile Phone Charges
+ Loss of Sports Equipment, Golf Equipment, Hole-in-one Celebration
+ Pet Care
+ Quarantined Allowance for Influenza A
+ Hijacking Inconvenience
+ Kidnap & Hostage
+ Home Care Benefit
+ Study Interruption

G. Final Steps

Upload Supporting Documents

Please note: Total file size should not exceed 3MB.
Please only upload files that end in types: .xls, .xlsx, .doc, .docx, .jgp,.gif, .png, .jpeg, .pdf, .txt
Please attach the relevant supporting documents with your claims submission to expedite claim processing.

Please type what you see in the image:

Captcha image

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

Thank you for your online Travel Claim notification.

Our claims officer is reviewing your submission and will update your claim status in 14 days' time.
Please quote our reference number when corresponding with us.

Please note that you may experience some delay during our peak season from July –
August and from December – January.
During this period you will receive our update on your claim within 21 days.

  
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AXA Contact Info
Tel: 1800 880 4888 (Within Singapore) / +65 6880 4888 (International)
Fax: +65 6880 4740
8 Shenton Way, #24-01 AXA Tower, Singapore 068811

AXA Customer Centre is located at:
#01-21/22. (For Parking please click here)

Operating Hours: 9:00am – 5:30pm (Monday – Friday)