Due to company will update form version from times to times,
kindly download latest version direct from Gesica or Epartner.
If want to download from below link, kindly login E-Partner first.
– Accident Rider Claims Requirement Checklist
(Check List)
– Accident Claim Form – Claimant’s Statement
(Fill in by CLIENT)
– Accident Claim Form – Attending Physician Statement
(Fill in by DOCTOR)
CTC = Certified True Copy
– Accident Claim Form – Attending Physician Statement
1. Accident Claim Form – Claimant’s Statement
2. Original copy of Letter of Authorisation /Consent (3 copies)
3. CTC of Life Assured’s NRIC
4. CTC of Claimant’s NRIC (if different from Life Assured)
5. CTC of Driving License, if due to road traffic accident）
6. CTC of Police Report(s)
7. Original or CTC of Medical Certificate(s)
8. Original Itemised Bill(s)/Tax Invoice(s)
9. Original Receipt(s)）
– CTC of CT Scan Report(s)
– CTC of MRI Report(s)
– CTC of X-ray Report(s)
If Life Assured is a non-Malaysian or event occurred outside Malaysia (except Singapore)
(i) CTC of Life Assured’s Full Passport Book