ទម្រង់ទាមទារសំណង
ទាញយក
Health Form

Insured’s part - Claim Form for Injury / Illness

ទាញយក
Health Form

Attending physician's part - Physician Report

ទាញយក
Death Claim Form

Death Claim Request Form - Beneficiary fill in

ទាញយក
Death Claim Form

Declaration of Physician in case of Insured's Death

ទាញយក
TPD Form

Compensation Claim Form for Total Permanent Disability

ទាញយក
TPD Form

Report of Physician Certifying Disability

ទាញយក
In Case of Death Form

The Consent letter of Beneficiary or Heir(s) to disclose personal data