1 |
Claimant Statement *
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A
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0
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1
|
Claimant_Statement
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|
2 |
Claimant NRIC / Passport / Residence card *
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A
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0
|
1
|
Claimant_NRIC
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|
|
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3 |
Attending Physician Statement (Accident & Hospitalisation Claim) (for claim amount exceeding RM500) *
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A
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0
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1
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Attending_Physician_Statement
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4 |
Medical Certificates or Light Duty Certificates *
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A
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0
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1
|
Medical_Certificate
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5 |
Original Bills and Receipts (applicable for reimbursement claims) *
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A
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0
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1
|
Original_Bills_and_Receipts
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|
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6 |
Other relevant Medical Reports
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A
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0
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0
|
Other_Relevant_Medical_Reports
|
|
|
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7 |
Police Report
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A
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0
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0
|
Police_Report
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|
|
|
8 |
Newspaper Cutting, if any (Kindly translate in English or Bahasa Melayu if article is not in these languages)
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A
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0
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0
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Newspaper_Cutting
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|
|
9 |
Photograph of Dismemberment / Injured Part (applicable for Permanent Dismemberment / Disablement claims)
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A
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0
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0
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Photograph_of_Dismemberment
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|
10 |
Imaging Reports i.e. MRI, X-ray, CT Scan (applicable for Broken Bones and Burns claims)
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A
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0
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0
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Imaging_Reports
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11 |
Claimant Statement *
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C
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0
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1
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Claimant_Statement
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|
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12 |
Claimant NRIC / Passport / Residence card *
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C
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0
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1
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Claimant_NRIC
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|
|
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13 |
Confidential Medical Certificate - depends on the type of disease or illness or Life Claim Questionnaire *
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CI
|
0
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1
|
Confidential_Medical_Certificate
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|
|
|
14 |
Relevant Diagnosis Imaging / Post-Surgical Report
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CI
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0
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0
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PolRelevant_Diagnosis_Imagingice_Report
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|
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15 |
Histopathology / Histology Report (for Cancer claim only)
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CI
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0
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0
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Histopathology_Report
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|
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16 |
Other relevant Medical Reports
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CI
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0
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0
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Other_Relevant_Medical_Reports
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|
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17 |
Letter of Consent
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CI
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0
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0
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Letter_of_Consent
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|
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18 |
Claimant Statement *
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D
|
0
|
1
|
Claimant_Statement
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|
|
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19 |
Claimant NRIC / Passport / Residence card *
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D
|
0
|
1
|
Claimant_NRIC
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|
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20 |
Death Certificate *
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D
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0
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1
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Death_Certificate
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21 |
Marriage Certificate (if claimant is spouse) or Birth Certificate of Claimant (if claimant is child) or Birth Certificate of Deceased (if claimant is parents) as Proof of Relationship
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D
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0
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0
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Marriage_Certificate
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|
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22 |
Letter of Consent
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D
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0
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0
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Letter_of_Consent
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|
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23 |
Report of death abroad from National Registration Department (NRD) - if insured dies abroad
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D
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0
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0
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Report_of_death_abroad
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|
|
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24 |
Letter of Administration / Grant of Probate / Distribution Order (applicable for policy without nomination)
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D
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0
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0
|
Letter_of_Admission
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|
|
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25 |
Deceased NRIC / Passport / Residence card
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D
|
0
|
0
|
Deceased_NRIC
|
|
|
|
|
If death due to Illness of natural cause, please submit item 9 below (if applicable)
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D
|
1
|
0
|
|
|
|
|
26 |
Physician Statement Form (for policy duration within 2 years from the issue Date or Reinstatement Date, whichever is the later, except for Senior Gold policies)
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|
D
|
0
|
0
|
Physician_Statement_Form
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|
|
|
|
if death due to Accident, please submit item 10 - 13 below (if applicable)
|
D
|
1
|
0
|
|
|
|
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27 |
Post Mortem / Coroner Report (for policy duration less than 5 years from the Issue Date or Reinstatement Date, whichever is the later) *
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D
|
0
|
1
|
Post_Mortem
|
|
|
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28 |
Toxicology Report
|
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D
|
0
|
0
|
Toxicology_Report
|
|
|
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29 |
Police Report
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|
D
|
0
|
0
|
Police_Report
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|
|
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30 |
Newspaper Cutting, if any (Kindly translate in English or Bahasa Melayu if article is not in these languages)
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D
|
0
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0
|
Newspaper_Cutting
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|
|
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31 |
Claimant Statement *
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|
H
|
0
|
1
|
Claimant_Statement
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|
|
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32 |
Claimant NRIC / Passport / Residence card *
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|
H
|
0
|
1
|
Claimant_NRIC
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|
|
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33 |
Attending Physician Statement (Accident & Hospitalisation Claim) *
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|
HFOC
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0
|
1
|
Attending_Physician_Statement
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|
|
|
34 |
Histopathology Report (applicable for Female Illnes claims i.e. Fibroid, Ovarian Cyst etc) *
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HFOC
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0
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1
|
Histopathology_Report
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|
|
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35 |
Original Bills and Receipts *
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|
HFOC
|
0
|
1
|
Original_Bills_and_Receipts
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|
|
36 |
Admission and Discharge Notes / Summary or Hospital Bills / Invoices
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|
HFOC
|
0
|
0
|
Admission_and_Discharge_Notes
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|
|
|
37 |
MRI, X-ray, CT Scan or other Radiology / Medical Reports
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|
HFOC
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0
|
0
|
Imaging_Reports
|
|
|
|
38 |
Attending Physician Statement (Accident & Hospitalisation Claim) *
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|
HHIB
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0
|
1
|
Attending_Physician_Statement
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|
|
|
39 |
Admission and Discharge Notes / Summary or Hospital Bills / Invoices *
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|
HHIB
|
0
|
1
|
Admission_and_Discharge_Notes
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|
|
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40 |
MRI, X-ray, CT Scan or other Radiology / Medical Reports
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|
HHIB
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0
|
0
|
Imaging_Reports
|
|
|
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41 |
Blood Test / Pap Smear / Mammogram / Abdomen / Pelvis Ultrasound Report *
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HMCA
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0
|
1
|
Blood_Test
|
|
|
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42 |
Original Bills and Receipts *
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|
HMCA
|
0
|
1
|
Original_Bills_and_Receipts
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|
|
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43 |
Child Birth Certificate *
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|
HNBA
|
0
|
1
|
Child_Birth_Certificate
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|
|
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44 |
Admission and Discharge Notes / Summary or Hospital Bills / Invoices *
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|
HWC
|
0
|
1
|
Admission_and_Discharge_Notes
|
|
|
|
45 |
Attending Physician Statement (Accident & Hospitalisation Claim) *
|
|
HWC
|
0
|
1
|
Attending_Physician_Statement
|
|
|
|
46 |
Claimant Statement *
|
|
T
|
0
|
1
|
Claimant_Statement
|
|
|
|
47 |
Claimant NRIC / Passport / Residence card *
|
|
T
|
0
|
1
|
Claimant_NRIC
|
|
|
|
48 |
Total and Permanent Disability Claim Form (Part B - Attending Physician Statement) *
|
|
T
|
0
|
1
|
TPD_Claim_Form
|
|
|
|
49 |
Neurological Examination Report (NER) *
|
|
T
|
0
|
1
|
Neurological_Examination_Report
|
|
|
|
50 |
Other Medical Report (if relevant)
|
|
T
|
0
|
0
|
Other_Medical_Report
|
|
|
|
51 |
EPF Withdrawal Letter (if applicable)
|
|
T
|
0
|
0
|
EPF_Withdrawal_Letter
|
|
|
|
52 |
SOCSO Offer Letter / SOCSO "Keputusan Jemaah Doktor Mengenai Keilatan" (if applicable)
|
|
T
|
0
|
0
|
SOCSO_Offer_Letter
|
|
|
|
53 |
Letter of Consent
|
|
T
|
0
|
0
|
Letter_of_Consent
|
|
|
|
54 |
Employment Termination Letter (if applicable)
|
|
T
|
0
|
0
|
Employement_Termination_Letter
|
|
|
|
|
if disability due to Accident, please submit 10 - 11 below (if applicable)
|
T
|
1
|
0
|
|
|
|
|
55 |
Police Report
|
|
T
|
0
|
0
|
Police_Report
|
|
|
|
56 |
Newspaper Cutting, if any (Kindly translate in English or Bahasa Melayu if article is not in these languages)
|
|
T
|
0
|
0
|
Newspaper_Cutting
|
|
|
|
57 |
Claimant Statement *
|
|
W
|
0
|
1
|
Claimant_Statement
|
|
|
|
58 |
Claimant NRIC / Passport / Residence card *
|
|
W
|
0
|
1
|
Claimant_NRIC
|
|
|
|
59 |
Confidential Medical Certificate - depends on the type of disease or illness or Life Claim Questionnaire *
|
|
WCI
|
0
|
1
|
Confidential_Medical_Certificate
|
|
|
|
60 |
Relevant Diagnosis Imaging / Post-Surgical Report
|
|
WCI
|
0
|
0
|
PolRelevant_Diagnosis_Imagingice_Report
|
|
|
|
61 |
Histopathology / Histology Report (for Cancer claim only)
|
|
WCI
|
0
|
0
|
Histopathology_Report
|
|
|
|
62 |
Other relevant Medical Reports
|
|
WCI
|
0
|
0
|
Other_Relevant_Medical_Reports
|
|
|
|
63 |
Letter of Consent
|
|
WCI
|
0
|
0
|
Letter_of_Consent
|
|
|
|
64 |
Death Certificate *
|
|
WD
|
0
|
1
|
Death_Certificate
|
|
|
|
65 |
Marriage Certificate (if claimant is spouse) or Birth Certificate of Claimant (if claimant is child) or Birth Certificate of Deceased (if claimant is parents) as Proof of Relationship
|
|
WD
|
0
|
0
|
Marriage_Certificate
|
|
|
|
66 |
Letter of Consent
|
|
WD
|
0
|
0
|
Letter_of_Consent
|
|
|
|
67 |
Report of death abroad from National Registration Department (NRD) - if insured dies abroad
|
|
WD
|
0
|
0
|
Report_of_death_abroad
|
|
|
|
68 |
Letter of Administration / Grant of Probate / Distribution Order (applicable for policy without nomination)
|
|
WD
|
0
|
0
|
Letter_of_Admission
|
|
|
|
69 |
Deceased NRIC / Passport / Residence card
|
|
WD
|
0
|
0
|
Deceased_NRIC
|
|
|
|
|
If death due to Illness of natural cause, please submit item 9 below (if applicable)
|
WD
|
1
|
0
|
|
|
|
|
70 |
Physician Statement Form (for policy duration within 2 years from the issue Date or Reinstatement Date, whichever is the later, except for Senior Gold policies)
|
|
WD
|
0
|
0
|
Physician_Statement_Form
|
|
|
|
|
if death due to Accident, please submit item 10 - 13 below (if applicable)
|
WD
|
1
|
0
|
|
|
|
|
71 |
Post Mortem / Coroner Report (for policy duration less than 5 years from the Issue Date or Reinstatement Date, whichever is the later) *
|
|
WD
|
0
|
1
|
Post_Mortem
|
|
|
|
72 |
Toxicology Report
|
|
WD
|
0
|
0
|
Toxicology_Report
|
|
|
|
73 |
Police Report
|
|
WD
|
0
|
0
|
Police_Report
|
|
|
|
74 |
Newspaper Cutting, if any (Kindly translate in English or Bahasa Melayu if article is not in these languages)
|
|
WD
|
0
|
0
|
Newspaper_Cutting
|
|
|
|
75 |
Total and Permanent Disability Claim Form (Part B - Attending Physician Statement) *
|
|
WTPD
|
0
|
1
|
TPD_Claim_Form
|
|
|
|
76 |
Neurological Examination Report (NER) *
|
|
WTPD
|
0
|
1
|
Neurological_Examination_Report
|
|
|
|
77 |
Other Medical Report (if relevant)
|
|
WTPD
|
0
|
0
|
Other_Medical_Report
|
|
|
|
78 |
EPF Withdrawal Letter (if applicable)
|
|
WTPD
|
0
|
0
|
EPF_Withdrawal_Letter
|
|
|
|
79 |
SOCSO Offer Letter / SOCSO "Keputusan Jemaah Doktor Mengenai Keilatan" (if applicable)
|
|
WTPD
|
0
|
0
|
SOCSO_Offer_Letter
|
|
|
|
80 |
Letter of Consent
|
|
WTPD
|
0
|
0
|
Letter_of_Consent
|
|
|
|
81 |
Employment Termination Letter (if applicable)
|
|
WTPD
|
0
|
0
|
Employement_Termination_Letter
|
|
|
|
|
if disability due to Accident, please submit 10 - 11 below (if applicable)
|
WTPD
|
1
|
0
|
|
|
|
|
82 |
Police Report
|
|
WTPD
|
0
|
0
|
Police_Report
|
|
|
|
83 |
Newspaper Cutting, if any (Kindly translate in English or Bahasa Melayu if article is not in these languages)
|
|
WTPD
|
0
|
0
|
Newspaper_Cutting
|
|
|
|
84 |
Additional Document
|
|
02
|
0
|
0
|
Additional_Document
|
|
|
|