Howden Solutions

Claims Notification Form

Employer Name*

Employer ROC/NRIC*

Order Code*

Employer Email*

Employer Contact Number*

Cause of Loss*

Incident Date*

Remarks

Insurance Product(s)*

Worker Name*

Worker Passport No*

Worker Name	Worker Passport No	Worker Permit No	Worker Expiry Date

Note :
*Compulsory Field
This claim form can be used for all products available i.e FWHS, FWIG, Maid & the Complimentary Personal Accident.
This claim form is not required for FWHS claim that is on cashless basis, unless a reimbursement claim is required.