Expat Income Protection Insurance (Claim Form)

  • To be completed by the Life Insured or Claimant in BLOCK letters.
  • Please answer all questions, use "not applicable" (N/A) as appropriate instead of leaving it blank. Counter-sign where amendments/alterations are made in the form.
  • The filing of this claim form is not to be construed as an admission of liabilities by Company.

Life Insured / Policy Holder Details

Claim Details

Detail description of the claim

Please refer to the requirement list of documents to support your claim

Accidental Death

Involuntary Loss of Employment

Serious Illness

Accident or Sickness

Authorization: I hereby authorize any physician, hospital, insurer/medical information bureau or other organization or person having any records, data or information as may be requested by Orient Insurance or their representative. I understand that in executing this authorization, I waiver the right for such information to be privileged. A Photocopy or scanned copy of this authorization shall be considered as effective and valid as original

Upload Documents (Passport copy, Emirates ID etc. Maximum Size allowed = 2 MB, Formats allowed = pdf, jpg, jpeg, png, gif, tif.)