Notification Submission

Zurich Takaful Malaysia

The claim is processed by IHP (Integrated Health Plans (Malaysia) Sdn Bhd) Please submit all queries and claim document related to Medical claim to IHP email address : zurich.claims@ihp.com.my. You may also submit the claim document to : Integrated Health Plans (Malaysia) Sdn Bhd B03-A-13A, Level 13A, Menara Pacific 3 Jalan Bangsar, KL Eco City, 592OO Kuala Lumpur

SIGNAL by AXXESS Claim Notification

Full Name (as per NRIC/ID) *

Mobile Number *

Email Address *

Type Of Claim *

Benefits/Cause of Event *

In relation to this claim I am *

Certificate Name *

Certificate Number *

Member Name *

Member ID Type *

Member ID Number *

Loss Date/Claim Date *

Request Type *

Claim Number *

Remarks

Please Upload your claim documents here

Important Notes:
1. CTC - Certified True Copy.
2. To facilitate the processing, please submit to us all required documents.
3. The copy of documents must be certified by Zurich Takaful Officer, Judge, Magistrate or Solicitors.
4. The list of required documents for Group Family Takaful Claims serves as a guideline for claims submission. The
Company reserves the right to request for further information or documents or to view the original of copied
document submitted whenever necessary. Registration is considered as unsuccessful.
5. For any invalid and incomplete submission, registration is considered as unsuccessful. There will be no claim
acknowledgement send to you.
6. If you wish to talk to us regarding your claim and have any queries on the above, you may call us at 1-300-888-622 or
write in to us..

Total file upload maximum size is 20MB only.
Available to upload file with extension { .jpeg, .jpg, .pdf } only.

No.	Document Description	Claim Type	Sub Header Ind	Required Ind	Document Name
1	Claimant’s Statement Form *	D	0	1	Claimant’s Statement Form
2	Physician’s Statement Form *	D	0	1	Physician’s Statement Form
3	CTC of Claimant’s NRIC/Passport/Residence card *	D	0	1	CTC of Claimant’s NRIC/Passport/Residence card
4	Others, CTC of Death Certificate, Post Mortem report, Toxicology report, Police report(if any) *	D	0	1	Others, CTC of Death Certificate, Post Mortem report, Toxicology report, Police report(if any)
5	Claimant’s Statement Form *	T	0	1	Claimant’s Statement Form
6	Total and Permanent Disability Claim Form (Part B - Attending Physician’s Statement) *	T	0	1	Total and Permanent Disability Claim Form (Part B - Attending Physician’s Statement)
7	CTC of Claimant’s NRIC/Passport/Residence card *	T	0	1	CTC of Claimant’s NRIC/Passport/Residence card
8	Others, CTC of Termination letter, Socso Offer letter, Police report(if any) *	T	0	1	Others, CTC of Termination letter, Socso Offer letter, Police report(if any)
9	Neurological Examination Report (NER) *	T	0	1	Neurological Examination Report (NER)

I hereby declare that the above information is true and complete to the best of my knowledge and belief. I am fully understand that Zurich Takaful Malaysia Berhad (“you”) upon believing the information provided by me to be accurate and correct, will rely and act on the information given.

I hereby give my unconditional and unequivocal consent to you and all your related companies to process my/ Person Covered’s personal data revealed hereto.You are at liberty to process the data and share the information revealed thereto with any of your service providers and your other related companies provided that the revelation of my / Person Covered’s personal data strictly for the purposes in relation to the insurance claim made hereto. The consent given hereto is in line with the requirement set forth in the Personal Data Protection Act 2010. Kindly visit Personal Data Protection Notice Details to know more about our privacy/ PDPA policy.

I hereby allow Zurich Malaysia and/or its intermediaries to contact me on matters relating to this submission. For this Purpose, Zurich Takaful Malaysia Berhad and all other Zurich Insurance Group Subsidiaries operating in Malaysia, will also be referred to as ‘Zurich Malaysia’.

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