Claim for Complimentary* Insurance

Death Claim- Natural/Illness/Accident

1. Claimant’s Statement (to be completed by Claimant)
2. Certified true copy of Death Certificate
3. Certified true copy of deceased’s NRIC
4. Certified true copy of nominee's NRIC/Birth Certificate
5. Certified true copy of Marriage/Birth Certificate (for proof of relationship)
6. Post- Mortem report (due to accident)
7. Certified true copy of police report (due to accident)
8. Photocopy of newspaper cuttings (if any)
9. Burial Certificate/Permit

Total & Permanent Disability Claim (TPD) - Term/Personal Accident

1. Claimant’s Statement (to be completed by Claimant)
2. Attending Physician’s Statement (to be completed by Doctor)
3. Certified true copy of Claimant's NRIC
4. Certified true copy of medical report (if any)
5. Certified true copy of Police Report (due to accident, if any)
6. Certified true copy of medical report from SOCSO, if claiming from SOCSO
7. Letter of termination from employer (if employed)

Partial Permanent Disability Claim (PPD) - Accidental only

1. Claimant’s Statement (to be completed by Claimant)
2. Attending Physician’s Statement (to be completed by Doctor)
3. Certified true copy of Claimant's NRIC
4. Certified true copy of related medical report (if any)
5. Certified true copy of police report (if any)
6. Photographs depicting the injuries sustained by the Injured Person (if any)

Claim for Complimentary* Insurance

Death Claim- Natural/Illness/Accident

1. Claimant's Statement - Death Claim
2. Attending Physician’s Statement - Death Claim (To be completed by Attending Physician at the claimant's expense)
3. Consent for the release of information form
4. Certified true copy of Death Certificate
5. Certified true copy of deceased’s NRIC
6. Certified true copy of nominee's NRIC/Birth Certificate
7. Certified true copy of Marriage/Birth Certificate (for proof of relationship)
8. Post- Mortem report (due to accident)
9. Certified true copy of police report (due to accident)
10.Photocopy of newspaper cuttings (if any)
11.Burial Certificate/Permit

Total & Permanent Disability Claim (TPD) - Term/Personal Accident

1. Claimant’s Statement - Total & Permanent Disability Claim (To be completed by Person Covered/Claimant
2. Attending Physician’s Statement - Total & Permanent Disability Claim (To be completed by the Attending Physician/Surgeon at the Claimant's own expenses)
3. Certified true copy of Claimant's NRIC
4. Certified true copy of medical report (if any)
5. Certified true copy of Police Report (due to accident, if any)
6. Certified true copy of medical report from SOCSO, if claiming from SOCSO
7. Letter of termination from employer (if employed)

Partial Permanent Disability Claim (PPD)- (Complimentary* Insurance - Accidental only)

1. Claimant’s Statement - Total & Permanent Disability Claim (To be completed by Person Covered/Claimant)
2. Attending Physician’s Statement - Total & Permanent Disability Claim (To be completed by the Attending Physician/Surgeon at the Claimant's own expenses)
3. Certified true copy of Claimant's NRIC
4. Certified true copy of related medical report (if any)
5. Certified true copy of police report (if any)
6. Photographs depicting the injuries sustained by the Injured Person (if any)

Claim for Mutual Gold Complimentary* Takaful Group PA, PRS – Shariah-Based Series Complimentary* Personal Accident and Public e-Islamic Cash Deposit Fund Complimentary* Personal Accident

Personal Accident Death Claim / Total & Permanent Disability Claim (TPD) – Accidental only 

1. Disability Claim Form For Group Family Takaful Plan (to be completed by Claimant)
2. Medical Certificate For Disability (to be completed by Doctor)
3. Copy of Claimant's NRIC
4. Copy of medical report (if any)
5. Copy of Police Report (due to accident, if any)
6. Copy of medical report from SOCSO, if claiming from SOCSO
7. Letter of termination from employer (if employed)

Partial Permanent Disability Claim (PPD) - Accidental only

1. Disability Claim Form For Group Family Takaful Plan (to be completed by Claimant)
2. Medical Certificate For Disability (to be completed by Doctor)
3. Copy of Claimant's NRIC
4. Copy of related medical report (if any)
5. Copy of police report (due to accident, if any)
6. Photographs depicting the injuries sustained by the Injured Person (if any)

Claim for Mutual Gold Complimentary* Group Personal Accident, PRS – Conventional Series Complimentary* Personal Accident and Public e-Cash Deposit Fund Complimentary* Personal Accident

Death Claim – Accidental only 

1. Notice of Claim Under Personal Accident Policy
2. Electronic Credit Payment (ECP) Authorisation Form together with a copy of the Beneficiary(ies) bank statement/ first page of bank passbook with account details
3. Death Certificate
4. A copy of the Deceased Person's Identity Card
5. A copy of the Deceased Person's driving license
6. A copy of the Beneficiary's Identity Card
7. Post mortem report
8. Letter of Administration or Grant of Probate
9. Documents to substantiate the relationship between the Deceased and the Beneficiary
10. Police report

Total and Permanent Disability Claim – Accidental only 

1. Notice of Claim Under Personal Accident Policy
2. Electronic Credit Payment (ECP) Authorisation Form together with a copy of the Beneficiary(ies) bank statement/ first page of bank passbook with account details

3. A copy of the Insured Person's Identity Card
4. A copy of the Injured Person's driving license (if the Injured person was the driver/rider of the of the vehicle during the accident)
5. Police report, if any

6. Medical report

7. Photographs depicting the injuries sustained by the Injured Person

Claim for Complimentary* Insurance

Death Claim - Natural/Illness/Accident

1. Death Claim Form (to be completed by Claimant)

2. Certified true copy of Death Certificate
3. Certified true copy of Deceased’s NRIC
4. Certified true copy of Claimant's NRIC
5. Certified true copy of Proof of Claimant’s relationship to Deceased
6. Death Claim Doctor’s Statement (to be completed by the last attending physician at own expenses)

7. Certified true copy of Grant of Probate/Letter of Administration, for Life Assured without Nomination of Beneficiary Form

8. Certified true copy of details Post Mortem Report

9. Certified true copy of Police Report (due to accident)
10. Certified true copy of Toxicology report (due to accident)
11. Copy of Newspaper cutting, if any (due to accident)

Note: If the Deceased is non-Malaysian or if the death event occurred outside Malaysia

12. Certified true copy of Deceased's Full Passport Book/Citizenship Certificate

13. Certified true copy of Confirmation letter from National Registration Department (for death outside of Malaysia)

14. Certified true copy Foreign Death Certificate

Total & Permanent Disability Claim (TPD) – Natural/Illness/Accident

1. Claim Form (to be completed by Claimant)
2. Confidential Medical Certificate (to be completed by the treating Doctor at own expenses)

3. Certified true copy of Life Assured's NRIC

4. Certified true copy of PERKESO offer Letter and PERKESO 'Keputusan Jemaah Doktor'

5. Certified true copy of Medical Report for application of PERKESO Keilatan

6. Certified true copy of Medically Boarded Out Letter from Employer with Medical Report

7. Certified true copy of all relevant investigation Test Reports

8. Certified true copy of Police Report(s) if disability due to an accident, if applicable

9. Copy of Newspaper Cutting(s) if disability due to an accident, if applicable

Partial Permanent Disability Claim (PPD) - Accidental only

1. Claim Form (to be completed by Claimant)
2. Attending Physician’s Statement (to be completed by the treating Doctor at own expenses)
3. Certified true copy of Police Report
4. Certified true copy of X-ray Report(s)
5. Certified true copy of CT scan Report(s)
6. Certified true copy of MRI Report(s)

Terminal Illness

1. Claim Form (to be completed by Claimant)
2. Confidential Medical Certificate (to be completed by the treating Doctor at own expenses)
3. Certified true copy of all relevant investigation Test Reports

Repatriation Benefit

1. Death Claim Form (to be completed by Claimant)       

2. Death Claim Doctor’s Statement        

3. Death Certificate     

4. Original receipts of cost incurred in repatriation of mortal remains and its itemised bills

5. Proof of travel

6. Certified true copy of Deceased’s NRIC

7. Certified true copy of Claimant's NRIC

8. Certified true copy of Proof of Claimant’s relationship to Deceased

9. Certified true copy of Grant of Probate/Letter of Administration, for Life Assured without nomination