CLAIMS FORMS
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As part of our policy to provide its clients and the market with quick, efficient and user friendly service, certain usefull Claim Forms and Claim guidelines from Asia Insurance (Cambodia) are available here.

When experiencing a claim, in order to get the full benefit of Asia Insurance (Cambodia)'s 24 hour Claim Service, we would recommend that you immediately call upon our Claim Officers, via our Claim Hotline number, who will then be able to provide assistance, and ensure a smooth and efficient settlement, especially in stressful and difficult situations.

If you however, were not able to do so at the time of the incident, you can advise us of a claim via email. Simply fill in the details required inside the provided fields in either related form, and submit it to us via email. Please note that once submitted, the completed form will be placed inside your email software's Outbox until you perform the Send & Receive function.

Our Claim Department will get in touch with you once your duly completed application is received by our office.
 
 
  MOTOR VEHICLE CLAIM REPORT FORM
   
Complete this form to report an incident involving all types of vehicles, private or commercial, covered by Asia Insurance (Cambodia).
     
  NOTICE OF CLAIM FORM
   
Complete this form to report any type of claim other than those mentioned above.
     
     


BUPA International Medical Claim Form (2004)


Goodhealth - Asia Care Medical Claim Form (2006)

   


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CLAIMS GUIDELINES
   
  Guideline for claim procedure on Burglary Insurance
 

In cases when property insured was burglarized or stolen, the following procedures are necessary to facilitate and accelerate the claim process :

Step 1 : To take necessary action

1. Do not disturb the crime scene, or move anything for verification by the Police and our Claims Department Officer;
2. Examine the condition and assess the extent of loss and/or damage;
3. Immediately notify Asia Insurance (Cambodia)s Claims Department at 012 816 669;
4. Notify the Police and obtain a copy of the Police report;

Step 2 : Supporting documents

Prepare the details of the claim in writing, including the following information :

1. Name of Insured and Policy number;
2. Value of items or subject matter insured;
3. List of loss and/or damaged property;
4. Date, time and place of the occurrence;
5. Details of event;
6. Name list of eyewitnesses (if any);
7. Copy of the Police report;
8. Asset report and/or stock card (if any);
9. Other insurance policy covering the same property (if any);
10. Family register & identity card;
11. Rental and security contracts duly signed with the security company (if any).

Step 3 : Claim Consideration

After the investigation is completed and all requested documents are duly submitted, we will assess the loss and inform the insured of the claim consideration result as soon as possible.

 
Guideline for claim procedure on Fire  
 

In such cases when the insured property suffers damages or loss due to a fire or other extended perils, the following steps are necessary to facilitate the claim procedure and consideration:

Step I : Taking the necessary action

1. Immediately notify Asia Insurance (Cambodia)s Claims Department at 012 816 669;
2. Assess the condition and extent of the damage or loss to the insured property;
3. Notify the incident to the Police and obtain a copy of the Police report;
4. Do not move the damaged property or other concerned evidence until permitted so by the Insurance Company;

Step 2 : Necessary documentation

As fire cases go, an official surveyor is usually appointed to investigate the circumstances of the event and losses incurred. So as to facilitate the Claims procedure, please prepare the following documents giving details of the damaged or lost property :

1. Name of the insured and policy number;
2. Details, quantity and value of items or subject matter insured;
3. Date, time and location of occurrence;
4. Cause of loss and details of event;
5. Name list of eyewitnesses (if any);
6. Copy of the Police report;
7. Documents showing the existence and value of the insured property at the time of the incident;
8. Copy of identity card and household residence registration of the Insured;
9. Document showing the repair assessment issued by a qualified contractor;
10. Copies of any other Insurance Policy covering the same property (if any);
11. Any other documents as required by the appointed surveyor.

Step 3 : Claim consideration

After the investigation is completed and all requested documents are duly submitted, we will assess the loss and inform the insured of the claim consideration result as soon as possible.

 
  Guideline for claim procedure on Industrial All Risks Insurance
 

In such cases when the insured property suffers a loss or damage, to facilitate and accelerate the claim procedure, please proceed as follows:

Step 1 : Taking the necessary action

1. Notify Asia Insurance (Cambodia)s Claim Department immediately at 012 816 669;
2. Determine the material & Financial extent of the damage or Loss;
3. In cases when property is lost, the Police Department has to be notified, and a copy of their report is to be obtained;
4. The damaged property must be left as is as much as possible, for further investigation by our company officer, or the appointed surveyor.

Step 2 : Supporting documents

To prepare the details of loss and/or damage in writing, revealing information as below :

1. Name of insured and policy number;
2. List and value of damaged or lost property;
3. Date, time and place of accident or incident;
4. Names of eye witnesses (if any);
5. List of insured Assets and according accounting documents;
6. Any other insurance policy covering the same property.

In case the property was missing through theft, this additional document is required :

1. Copy of Police report.

Step 3 : Claim Consideration

After the inspection is completed and all documents are duly submitted, we will assess the extent of damage or loss and inform the insured of the claim consideration result as soon as possible.

 
Guideline for claim procedure on Marine Cargo  
 

In such cases when the insured cargo is received in damaged condition, the insured or his agent are kindly requested to proceed as follows :

Step 1 : Taking the necessary action

1. To issue a notice of claim in writing to the carrier within 3 days of the delivery date;
2. Do not give the Clean Receipt to the carrier when your cargo is in doubtful condition;
3. When delivery is made by container, ensure that the container and its seals are examined immediately by their responsible officer.
4. If the container is received in damaged condition, or with its seals broken, or with seals other than as stated in the shipping documents, make an according remark (know as an exceptional clause) on the delivery receipt accordingly, and retain all defective or irregular seals for subsequent identification.

Step 2 : Supporting documents

1. Original Insurance policy or certificate;
2. Invoice & Packing list;
3. Original or true copy of Bill of Lading or Airway bill;
4. Wharf survey note and/or any other documentary evidence issued by the carrier showing the damage of insured cargo;
5. Certificates of weight and quantity at the Point of Origin and Destination;
6. Correspondences exchanged with the carrier regarding their liability;
7. Claim letter to insurance company.

Step 3 : Claim Consideration

After the inspection is completed and all documents are duly submitted, we will assess the extent of damage or loss and inform the claim consideration result to the insured as soon as it is possible.

 
  Guideline for claim procedure on Money Insurance
 

In such cases when a robbery occurs, and money is lost as a result, to facilitate and accelerate the claim procedure, please proceed as follows :

Step 1 : Taking the necessary action

1. Notify Asia Insurance (Cambodia)s Claims Department immediately at 012 816 669;
2. Do not disturb the crime scene, or move anything, for verification by the Police and our Claims Department Officer;
3. Verify the exact amount of lost money;
4. Notify the Police and obtain a copy of the Police report.

Step 2 : Supporting documents

Prepare the details of the claim in writing including the following information :
1. Name of Insured and policy number;
2. Amount of Money Robbed;
3. Accounting documents attesting to the existence of the money prior to the loss occurrence;
4. Date, time and location of robbery;
5. Details of event;
6. Name list of eye witnesses(if any).

If the Money was robbed during transit, please prepare additional information as follows :
1. Itinerary of normal route of transportation and details of transportation;
2. Details of the custodian responsible for the money whilst it was robbed or missing;
3. Copy of family register and identify card;
4. Copy of the involved staff member(s) full personnel file;
5. Copies of any other insurance policy concerned, if any;
6. Security contract made with the security company (if any).

Step 3 : Claim Consideration

After the investigation is completed and all requested documents are duly submitted, we will assess the loss and inform the insured of the claim consideration result as soon as possible.

 
Guideline for claim procedure on Public Liability  
 

In cases when a severe liability in incurred by your organization or company whilst operating your activity within your compound, the following procedure should be followed to facilitate and accelerate the claim process :

Step 1 : Taking the necessary action

1. Immediately notify Asia Insurance (Cambodia)s Claims Department at 012 816 669.
2. Verify the extent of the damage or injury.
3. If medical care is required, proceed accordingly, while informing the details to the appointed Claims Officer.
4. In cases of property damage, leave the damage property as is for our inspection.

Step 2 : Supporting documents

In cases of property damage, prepare a report of damage containing the following details :
1. Date, time and place of occurrence;
2. Details of event;
3. List of damaged property;
4. Quotation of repair or replacement (if any);
5. Copies of any other insurance policy covering the same property (if any);
6. Evidence proving the right of ownership of the damaged property;

In cases of injury, prepare a report containing the following details :
1. Date, time and place of occurrence;
2. Details of event;
3. Details of injury;
4. Receipt of Medical treatment;
5. Family register, identity card and/or other concerned document of the injured;

Remark : In no case shall the insured take responsibility for any mistake to the third party without the consent of the Insurance Company.

Step 3 : Claim consideration

After the inspection is completed and all requested documents are duly submitted, we will assess the loss and inform the insured of the claim consideration result as soon as possible.

 
  Guideline for claim procedure on Personal Accident
 

In case of accident causing injury to your self or a member of your personnel, the following procedure should be followed to facilitate and accelerate the claim process :


Step 1 : Taking the necessary action

1. Immediately notify Asia Insurance (Cambodia)s Claims Department at 012 816 669;
2. Verify the extent of the injury;
3. If medical care is required, proceed immediately, while informing the details to the appointed claims officer

Step 2 : Supporting documents

In cases of injury, prepare a report containing the following details :

1. Date, time and place of occurrence;
2. Details of event;
3. Details of injury;
4. Receipt of Medical treatment;
5. Doctor certificate;
6. Doctor prescription;

In cases of death, prepare the additional documents from the above as follows:

1. Certificate of death issued by the district officer, or relevant authority;
2. Family register, Identity card.

Step 3 : Claim consideration

After the inspection is completed and all requested documents are duly submitted, we will assess the loss and inform the insured of the claim consideration result as soon as possible.

     
  PERSONAL ACCIDENT CLAIM REPORT FORM
   
Require assistance regarding an accident involving yourself or one of your employees, complete this form.
     
 
Guideline for claim procedure on Workmen Compensation  
 

In such cases when a work related accident occurs, and an employee is injured whilst carrying out is duty, or within the time limit of the coverage, the following procedure should be followed to facilitate and accelerate the claim process :

Step 1 : Taking the necessary action

1. Immediately notify Asia Insurance (Cambodia)s Claims Department at 012 816 669.
2. Verify the extent of the injury.
3. If medical care is required, proceed accordingly, while informing the details to the appointed Claims Officer.
4. In cases of property damage as well, leave the damage property as is for our inspection.

Step 2 : Supporting documents

Prepare a report containing the following details:

1. Date, time and place of occurrence;
2. Details of event;
3. Details of injury;
4. Receipt of Medical treatment;
5. Company ID Card;
6. Employee Time Card, showing time in for work on day of event;
7. Employment details of injured employee;
a. Position Held;
b. Scope of work;
c. Job Description;
d. Basic Salary;
e. Employment History;
f. Any other details.
8. Family register, identity card and/or other concerned document of the injured

Step 3 : Claim consideration

After the inspection is completed and all requested documents are duly submitted, we will assess the loss and inform the insured of the claim consideration result as soon as possible.

     
  WORKMEN'S COMPENSATION CLAIM REPORT FORM
   
Complete this form to report a work related accident involving a member of your workforce with insurance coverage by Asia Insurance (Cambodia).
     
 
IMPORTANT NOTICE
 
 

In accordance with Article 17, the insurance policy will not be in force until the premium for such policy has been received and accepted by the company. In accordance to Article 21 of the same Law, If it is found that the risk is intentionally created by the insured, whether the claim already settled or not, in the case that the insurance company has found the fraudulent or risk creation which have proofs and evidences, the insurance company shall have the rights to refer to the court to void the liability or claiming back the settled amount.