Claims Notification Form
Employer Name
*
Employer ROC/NRIC
*
Order Code
*
Select Order Code
Employer Email
*
Employer Contact Number
*
Cause of Loss
*
Select Cause of Loss
Incident Date
*
Remarks
Insurance Product(s)
*
Select Insurance Product
Insurance Guarantee & Foreign Worker Hospitalisation scheme
Foreign Worker Hospitalisation scheme only
Worker Name
*
Worker Passport No
*
Batch Id
*
Worker Name
Worker Passport No
Worker Permit No
Worker Expiry Date
Notify Claim