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SUBMIT CLAIM

Please upload the required documents and fill the form below:
( Already submitted a claim? Check your reference number here )

Upload Document

Mandatory Documents to be uploaded:

  • Scanned copy/photo image of receipt for COVID-19 testing
  • Scanned copy/photo image of identity card (front)
  • Scanned copy/photo image of identity card (back)
  • Upload one of the following:
    • Scanned copy/photo image of the signed Claim Form downloaded from this website, OR
    • Scanned copy/photo image of Doctor's referral letter/Medical Advisory Note to indicate you are required to do COVID-19 test, OR
    • Scanned copy/photo image of Order For Supervision And Observation At Home Form (As per Annex 14a of Guidelines COVID-19 Management in Malaysia).
COVID-19 Declaration





*

Close contact defined as :

  • Health care associated exposure without appropriate Personal Protective Equipment (including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same close environment of a COVID¬19 patient).
  • Working together in close proximity or sharing the same classroom environment with a COVID-19 patient
  • Traveling together with COVID-19 patient in any kind of conveyance
  • Living in the same household as a COVID-19 patient
  • Confirmed case of COVID-19 defined as a person with laboratory confirmation of infection with the COVID-19
Personal Details
Payment Details

Notes:

  • You will be notified by email once the payment has been made.
  • Please ensure that the bank account information provided in this Form is accurate. Administrator shall not be liable if payments are erroneously credited due to inaccurate account number provided.
  • No joint name account is allowed.

Declaration & Authorisation

I understand and agree that any personal information collected or held by the Administrator (whether contained in this form or otherwise obtained) may be held, used and disclosed by the Administrator to individuals / organisation related to and associated with the Administrator or any selected third party (within or outside of Malaysia, including reinsurance/retakaful and claims investigation companies and industry associations / federations) for the purpose of processing this application and to communicate with me for such purposes. I understand that I have a right to obtain access to and to request correction of any personal information held by the Administrator concerning me. Such request can be made to my own insurance company or takaful operator.

I understand and agree that

  • I am allowed to claim this benefit once only, irrespective of the number of policies/certificates that I have with multiple insurers/takaful operators and is subject to availability of the fund;
  • The Administrator's acceptance of this claim form is not an admission of the Administrator’s liability of my/our claim.
  • I have read & understand the Terms & Conditions of COVID-19 Test Fund.

I hereby request that payment(s) due and payable to me by the Administrator be paid to bank account stated above by way of Inter-bank Giro/RENTAS/TT and confirm that :-

  • I consent to the Administrator releasing the above data to its banker(s) in order to facilitate payment(s) to me by way of Inter-bank Giro/RENTAS/TT.
  • All information provided herein are correct and accurate.
  • My request herein shall be irrecoverable without the consent of the Administrator. The Administrator may at any time in its absolute discretion effect payment(s) to me by other mode(s).
  • I shall keep the Administrator and its banker(s) indemnified against any loss and/or damage howsoever arising from any matters in relation to Inter-bank Giro/RENTAS/TT requested by me herein including but not limited to error/misdescription in information furnished, delayed payment(s) and any other circumstances beyond the Administrator and its banker(s)'s control.

Note on Administrator: The disbursement of the Covid-19 Test Fund is jointly administered by Life Insurance Association of Malaysia (LIAM), Persatuan Insuran Am Malaysia (PIAM) & Malaysian Takaful Association (MTA), together with all members of these associations.


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If you have any questions, please
call us at 1-300-22-1188 or 15-500