Personal | Personal Accident

Accidental Disability Claim

We note the unfortunate event which has transpired.

Complete and submit your personalized claim form and we will get started with your claim. Asterisks (*) Indicate the required information that is compulsory to complete the submission.

Policy and insured information
Incident details

Home / Accidental Disability Claim

Policy and Insured Information

First name

Surname

Identification number

AIG policy number

Contact number

Alternative contact number

Email address

Residential address

Address line 1

Address line 2

Address line 3

Address line 4

Postal code

Do you have a broker? Yes No

Broker completing the claim form? Yes No

Brokerage name

* Brokerage branch

* Broker name

Broker contact number

* Broker email

* Broker’s claim number

* Broker’s policy number

Home / Accidental Disability Claim

Incident Details

* Provide us with the date and time of the incident

Describe how the accident occurred

Description of the loss event and injuries sustained

State the exact cause and nature of the disability and any important factors connected therewith