Welcome to Fill in Claims Information

Please fill information in the below form for further investigation and service.

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Information of Notified Person

Name

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Last name

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Telephone

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Information of Insured Person

Name

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Last name

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Policy Number

ID Number

Date of loss

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Place of loss

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How was the loss caused

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List of damaged/Symptoms of illness

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File Upload

*Allianz Ayudhya General Insurance reserve the right to request the original document.
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File Upload

“I here by give my consent to collect, use and disclose my personal data for the purpose of advertising, conducting marketing analysis, proposing and offering about products, services and other privilege programs provided by the Company, companies in Allianz Group, or the Company’s contracting parties, and for other purposes as specified in the” Privacy Notice

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