Malaysia-EA

Step

Claimant information

Please submit 1 claim per claimant even if you are insured under the same policy.

Claimant Details

I am the policyholder

Policy Number:

Claimant’s Name as per Policy:

Claimant’s Date of Birth:

Claimant’s ID Type:

Claimant’s ID:

Contact phone:

Contact Email:

Confirm Email:

Trip Details

Trip destination:

Scheduled departure date:

Scheduled return date:

Location of Incident:

Date of Incident:

Payee Info

Bank Name:

Account name:

Bank account number:

* Payment will be processed upon successful claim outcome. Depending on claim volumes, we strive to provide a claim outcome within 7-21 working days.

** Redemption details will be sent in your settlement offer

Step

Accident Details

I fell sick or was injured

What happened?

I fell sick

I was injured

What was the doctor’s diagnosis?

I have suffered from a similar condition before

Name and Address of doctor consulted

Date(s) of consultation(s)

Please provide your incident description

Please select the expenses you are claiming for

Overseas medical expenses

Local medical expenses

Emergency dental expenses

I needed someone to care for me while hospitalized

I needed someone to bring the children back to Malaysia

Medicine Emergency

Please provide details of medical bill expenses

Were you hospitalised overseas?

Check-in time:

Check-out time:

Add another item

Please provide details of local medical bill expenses

Add another item

Please provide details of dental expenses

Add another item

Please provide details of compassionate visit expenses

Add another item

Please provide details of return of minor children expenses

Add another item

Please provide details of medical emergency

Add another item

I was treated for COVID-19 overseas

Please provide your incident description

Were you issued with a Quarantine Order?

Check-in time

Check-out time

Were you issued with a Quarantine Order due to COVID-19?

Check-in time

Check-out time

Details of medical bills expenses due to COVID-19

Add another item

My flight was delayed

Which airport was your flight delayed at?

What was the reason for delay?

Strike or other industrial action

Riot or civil commotion

Poor weather conditions or natural disasters

Airspace restriction or airport closure

Other

Please provide your scheduled flight number

Scheduled departure date and time

Actual flight no.

✖

Actual departure date and time

Please provide your incident description

My baggage was delayed

Which airport were you supposed to collect your luggage?

Which flight number did you travel on?

Your arrival date and time

Baggage collection date and time

Please provide your incident description

I missed my connecting flight

Please provide details of your flight to the connecting point:

Actual arrival date and time at the connecting airport:

Please provide details of your flight to the destination:

Actual departure date and time from the connecting airport:

Please provide your incident description

My flight was overbooked

Which airport were you scheduled to depart from when it was overbooked?

Please provide your scheduled flight number

Scheduled departure date and time

Actual flight no.

Actual departure date and time

There was a flight diversion

Please select the airport you arrived at

What was the reason for diversion?

Adverse weather

Emergency medical treatment of a fellow passenger

Other

Please provide your scheduled flight number

Scheduled departure date and time

Actual flight no.

✖

Actual departure date and time

Please provide your incident description

I lost something

What did you lose?

I lost my money

I lost my personal document

I lost my baggage and/or personal belongings

Were they stolen?

Details of your Personal money

Add another item

Details of replacing your personal document

Add another item

Details of your Personal documents

Add another item

Details of your personal belongings lost

Add another item

Please specify other costs:

Add another item

Please provide your incident description

Sport equipment

Please provide your incident description

Details of equipment expenses

Add another item

Hijack

Enter your total claim amount

Number of hours affected

Please provide your incident description

Common Carrier Delay

Enter your total claim amount

Number of hours affected

Please provide your incident description

My trip was cut short

Please provide your incident description

Please select the expenses you are claiming for

Unused or additional airfare expenses

Unused or additional accommodation expenses

Please provide details of airfare expenses

Add another item

Please provide details of accommodation expenses

Add another item

My trip was disrupted

Is this what happened?

Me and/or my travel companion got really sick, or was seriously injured

We were hijacked; or, there was a riot or civil commotion in the city I/we were in or was planning to go to

Our flight was cancelled due to closure of the airport/runway/airspace, or adverse weather conditions

A Travel Alert was issued in our planned destination

Other, please specify

Please provide your incident description

Please select the expenses you are claiming for

Additional travel expenses

Additional accommodation expenses

Please provide details of airfare expenses

Add another item

Please provide details of accommodation expenses

Add another item

I Had To Cancel My Trip

What happened?

I got really sick or injured; or claiming on behalf of the Insured traveller who passed away.

An immediate family member in Singapore, got really sick, was seriously injured, or passed away

I was served with a witness summons or jury service.

There was a serious damage to my home or place of business in Singapore due to burglary, fire, flood, typhoon, earthquake or landslip.

Our scheduled transportation was cancelled due to strike, industrial action, riot or civil commotion.

A Natural Disaster occurred at our planned destination.

Airspace or airport closure at our planned destination.

I was quarantined (not due to COVID-19).

Me and/or my travel companion was tested positive for COVID-19.

Me and/or my travel companion was identified and ordered to undergo quarantine or isolation due to COVID-19

An immediate family member was hospitalized or passed away due to COVID-19.

Me and/or my travel companion was deniend boarding of public transport by local authority.

Other, please specify

Please provide your incident description

Please select the expenses you are claiming for

Unused or additional airfare expenses

Unused or additional accommodation expenses

Additional travel expenses

Details of airfare expenses

Add another item

Details of accommodation expenses

Add another item

Details of Additional travel expenses

Add another item

I had to postpone my trip

Please provide your incident description

Please select the expenses you are claiming for

Unused or additional airfare expenses

Unused or additional accommodation expenses

Unused or additional other transportation expenses

Other unused or additional prepaid expenses

Please provide details of airfare expenses

Add another item

Please provide details of accommodation expenses

Add another item

Please provide details of transportation expenses

Add another item

Please provide details of other prepaid expenses

Add another item

None of the above

Enter your total claim amount

Please provide your incident description

Step

Payee info

Step

Supporting details

Providing these information would help us get you a faster outcome and payout.

Which credit card did you use to pay for your flights?

I didn't pay with a credit card

Card name:

Cardholder name:

Please provide Charlotte Rose Williams’s personal medical/accident insurance information

I don't have personal insurance

Insurer:

Plan name:

Please provide Charlotte Rose Williams’s corporate medical insurance information

I don't have employee insurance benefits

Company name:

Insurer:

Plan name:

Personal Data

In addition to the declaration and authorisation provided above, I/we agree and consent to the Company, its related corporations (collectively, the "Companies", as well as their respective representatives and agents collecting, using, disclosing and sharing amongst themselves my/our personal data, and disclosing such personal data to the Companies' authorised service providers and relevant third parties for purposes reasonably required by the Companies to evaluate, admit, process and/or administer my/our claims.

I have read and accept this

Step

Review Your Submission

Policy details

Claimant Details

Accident Details

Claim type:

Medical Expenses whilst Overseas

Total claim amount:

RMXXX

Description of accident:

I was injured in a motorbike accident when I was in collision with a child who came off the pavement on a skateboard directly in front of me.

When did it happen?

18/02/2022

Bill 1

Name of service provider:

Service provider

Date incurred:

6 June - 17 June 2023

Currency:

Amount:

XXX

Supporting docs

Personal Data

I have read and accept this

Submitted for Review

Claim Reference No.

XXXXXXXX

copied

What’s next?

We’ll be sending you email updates on your claim status:

If you have any questions related to your claim, please write to [email protected] in order for us to process your queries the soonest

Claimant information

Claimant Details

Trip Details

Payee Info

Accident Details

Claim type

Accident Details

I fell sick or was injured

I was treated for COVID-19 overseas

My flight was delayed

My baggage was delayed

I missed my connecting flight

My flight was overbooked

There was a flight diversion

I lost something

Sport equipment

Hijack

Common Carrier Delay

My trip was cut short

My trip was disrupted

I Had To Cancel My Trip

I had to postpone my trip

None of the above

Upload Your Supporting Documents

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Medical bills in Singapore

Medical bills Overseas

Medical report

Discharge summary

Other expense receipts

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Positive COVID-19 test

Medical invoices & receipts

Discharge summary

Hospital bill

Quarantine order

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Actual flight/travel itinerary

Flight delay report

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Property Irregularity Report

Luggage delivery receipt or letter

Proof of Purchase

Please provide documents

Flight/travel itinerary of your actual first flight

Certificate of Insurance

Flight/travel itinerary of your actual connecting flight

Note from your carrier

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Actual flight/travel itinerary

Note from your carrier

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Actual flight/travel itinerary

Note from your carrier

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Police Report

Purchase and expense receipts

Proof of possession of the amount loss

Property Irregularity Report

Lost items reported

Airline compensation

Please provide documents

Scheduled flight/travel itinerary

Certificate of Insurance

Other documents to support your claim

Please provide documents