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Your Details:
Type of claim
Motor Insurance
Credit Loan Scheme
Marine Insurance
Group life Insurance
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Policy Holder Name
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Employee Name
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Certificate Number
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Car Plate Number
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Contact Name
Contact Email Address
Contact Mobile Number
Incident Information:
Type of incident
Type of incident
Accident
Fire
Theft
Others
Type of incident
Type of incident
Death
Permanent Disability
Loss of Employment
Others
Type of incident
Type of incident
Damage of goods
Theft
Others
Nature of Incident
Type of incident
Illness
Natural
Accidental
Disappearance
Other Claim Type
Date of incident
Current Location of Vehicle
Loan Balance as at date of incident
Current Location of damaged goods
Description of incident
