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SPEEDY CLAIMS PROCESSING

COMPLETE PEACE OF
MIND WHEN YOU CLAIM

Travel Claim

IMPORTANT STATEMENT - You are to disclose in this claim form, fully and faithfully all the facts which you know or ought to know, otherwise the claims issued hereunder may be invalidated.

Policy
Verification

Personal
Information

Claim
Selection

Claim
Information

Document
Upload

Claim
Summary

Payment
Details

Claim
Submission

PLEASE ENTER THE FOLLOWING DETAILS FOR VERIFICATION PURPOSES:

POLICY NUMBER *

INSURED IC OR PASSPORT NUMBER *

I/We agree to disclose in this claim form to National Insurance Company Berhad, fully and faithfully all the facts which I/we know or ought to know, otherwise the claims issued hereunder may be invalidated.

POLICY NUMBER

POLICY HOLDER NAME

INSURED IC OR PASSPORT NO.

INSURED NAME *

CONTACT PERSON/PERSON-IN-CHARGE *

CONTACT NUMBER *

EMAIL ADDRESS *

PLEASE MAKE YOUR CLAIM SELECTION, BELOW:

MEDICAL CLAIM

BAGGAGE DELAY & DAMAGED & PERSONAL EFFECTS

TRAVEL DELAY, MISSED FLIGHT, CANCELLATION & CURTAILMENT

CAR RENTAL

OTHER RELEVANT CLAIM

YOU HAVE SELECTED ""

PLEASE SELECT APPLICABLE CLAIM TYPE, BELOW:

PERSONAL ACCIDENT

MEDICAL, DENTAL AND OTHER EXPENSES

BAGGAGE AND PERSONAL EFFECTS

DELAYED BAGGAGE

PERSONAL MONEY & TRAVEL DOCUMENTS

TRAVEL DELAY

MISSED FLIGHT CONNECTION

LOSS OF DEPOSIT OR CANCELLATION

CURTAILMENT

OVERBOOKED SCHEDULE PUBLIC CONVEYANCE

RENTAL VEHICLE EXCESS

PERSONAL LIABILITY

HIJACKING

HOMESURE

PLEASE REVIEW THE LIST OF DOCUMENTS THAT YOU ARE REQUIRED TO PREPARE FOR UPLOAD, FOR THIS CLAIM

PLEASE ENTER THE FOLLOWING DETAILS FOR YOUR CLAIM:

PLEASE DETAIL ALL RELEVENT INFORMATION RELATING TO YOUR PERSONAL ACCIDENT CLAIM

Characters: 0/2000

DATE OF INCIDENT (DD/MM/YYYY) *

TIME OF INCIDENT (24HR FORMAT) *

HAS INSURED BEEN ADMITTED TO HOSPITAL?

Yes

HAS INSURED BEEN GIVEN LEAVE OR HOSPITALISATION LEAVE OR LIGHT DUTIES?

Yes

HAS THE INSURED EVER SUFFERED FROM A REOCCURRENCE OF, OR OTHER MEDICAL CONDITION RELATING TO, THIS ILLNESS OR SIMILAR CONDITION?

Yes

PLEASE PROVIDE DETAILS OF ANY REOCCURRENCE OF OR OTHER MEDICAL CONDITION, THAT RELATES TO THIS ILLNESS OR SIMILAR CONDITION

Characters: 0/2000

PLEASE PROVIDE ANY OTHER RELEVANT INFORMATION, TO SUPPORT YOUR CLAIM

Characters: 0/2000

PLEASE ENTER THE FOLLOWING DETAILS FOR YOUR CLAIM:

DATE OF YOUR ARRIVAL (DD/MM/YYYY) *

TIME OF YOUR ARRIVAL (24HR FORMAT) *

DATE OF BAGGAGE RETURN (DD/MM/YYYY) *

TIME OF BAGGAGE RETURN (24HR FORMAT) *

ANY COMPENSATION WAS RECEIVED FROM AIRLINE/CARRIER?

Yes

DATE OF BAGGAGE LOSS (DD/MM/YYYY) *

TIME OF BAGGAGE LOSS (24HR FORMAT) *

LOCATION/COUNTRY?

DESCRIPTION OF THE DAMAGED BAGGAGE

Characters: 0/2000

YEAR OF BAGGAGE PURCHASE?

PLACE OF BAGGAGE PURCHASE?

ORIGINAL PRICE OF THE BAGGAGE?

CLAIM AMOUNT OF THE BAGGAGE?

ARE ANY OF YOUR PERSONAL AFFECTS REPORTED TO BE MISSING OR DAMAGED?

Yes

LIST OF YOUR PERSONAL AFFECTS, IF ANY

Characters: 0/2000

STATE AMOUNT, AND ITEMS REPORTED MISSING/STOLEN

Characters: 0/2000

ADD MORE

PLEASE PROVIDE ANY OTHER RELEVANT INFORMATION, TO SUPPORT YOUR CLAIM

Characters: 0/2000

PLEASE ENTER THE FOLLOWING DETAILS FOR YOUR CLAIM:

NAME OF AIRLINES/CARRIER *

ORIGINAL FLIGHT DETAILS

DATE OF FLIGHT (DD/MM/YYYY) *

TIME OF FLIGHT (24HR FORMAT) *

PLACE OF DEPARTURE *

FLIGHT NUMBER *

DELAYED/RESCHEDULED FLIGHT DETAILS

DATE OF FLIGHT (DD/MM/YYYY) *

TIME OF FLIGHT (24HR FORMAT) *

PLACE OF DEPARTURE *

FLIGHT NUMBER *

DATE OF TRIP BOOKING (DD/MM/YYYY) *

DATE OF TRIP CANCELLATION (DD/MM/YYYY) *

REASON FOR CANCELLATION/CURTAILMENT *

Characters: 0/2000

ADD MORE

PLEASE PROVIDE ANY OTHER RELEVANT INFORMATION, TO SUPPORT YOUR CLAIM

Characters: 0/2000

PLEASE ENTER THE FOLLOWING DETAILS FOR YOUR CLAIM:

DATE OF INCIDENT (DD/MM/YYYY) *

TIME OF INCIDENT (24HR FORMAT) *

DATE OF EXCESS PAYMENT (DD/MM/YYYY) *

PLEASE PROVIDE ANY OTHER RELEVANT INFORMATION, TO SUPPORT YOUR CLAIM

Characters: 0/2000

PLEASE ENTER THE FOLLOWING DETAILS FOR YOUR CLAIM:

PLEASE PROVIDE ANY OTHER RELEVANT INFORMATION, TO SUPPORT YOUR CLAIM

Characters: 0/2000

								PLEASE UPLOAD YOUR FILES, WHICH SHOULD BE IN EITHER JPG, PNG OR PDF FORMAT. EACH INDIVIDUAL FILE SIZE SHOULD NOT EXCEED 3MB.
								
ALL DOCUMENTS MARKED WITH * ARE MANDATORY

UPLOAD DOCUMENT (TRAVEL/FLIGHT ITINERARY) *

UPLOAD DOCUMENT (INSURED'S PASSPORT) *

UPLOAD DOCUMENT (MEDICAL BILLS) *

UPLOAD DOCUMENT (MEDICAL/DENTAL REPORTS) (IF AVAILABLE)

UPLOAD DOCUMENT (MEDICAL DISCHARGE) (IF AVAILABLE)

UPLOAD DOCUMENT (REPATRIATION BILLS/INVOICES)

UPLOAD DOCUMENT (PROPERTY IRREGULARITY REPORT) *

UPLOAD DOCUMENT (ACKNOWLEDGE RECEIPT OF BAGGAGE) (IF AVAILABLE)

UPLOAD DOCUMENT (REPLACEMENT RECEIPT IN REGARDS TO LOSS OF PASSPORT) *

UPLOAD DOCUMENT (RECEIPTS AND BILLS) (IF ANY)

UPLOAD DOCUMENT (PICTURES OF DAMAGED BAGGAGE) *

UPLOAD DOCUMENT (POLICE REPORT FOR STOLEN ITEMS) (IF AVAILABLE)

UPLOAD DOCUMENT (TRAVEL DELAY REPORT FROM AIRLINE) *

UPLOAD DOCUMENT (LETTER OF REFUND FROM TOUR AGENT/AIRLINE) *

UPLOAD DOCUMENT (RECEIPTS OF MEALS/ACCOMMODATION/REFRESHMENTS) *

UPLOAD DOCUMENT (TRAVEL AGENT LETTER, FLIGHT/TOUR/HOTEL BOOKING INVOICE) *

UPLOAD DOCUMENT (MEDICAL REPORT)

UPLOAD DOCUMENT (VEHICLE AGREEMENT/CERTIFCATE OF INSURANCE) *

UPLOAD DOCUMENT (POLICE REPORT FOR ACCIDENT/INCIDENT) (IF AVAILABLE)

UPLOAD DOCUMENT (REPAIR INVOICE/INCIDENT REPORT) (IF AVAILABLE)

UPLOAD DOCUMENT (RECEIPTS FOR EXCESS) *

UPLOAD DOCUMENT (PHOTOS OF INCIDENT/PROPERTY) *

UPLOAD DOCUMENT (OTHER) (IF AVAILABLE)

DO YOU HAVE ANY OTHER CLAIMS TO MAKE?

If you would like to add more claims to this session, please select ‘YES’ below, and you will be directed to add more claims. If you have completed your claims, please select ‘NO’ below and you will be directed to enter your Beneficiary Bank details.

YES

NO

PLEASE FILL IN BENEFICIARY BANK DETAILS:

BENEFICIARY BANK NAME *

OTHER BENEFICIARY BANK NAME *

BENEFICIARY NAME *

BENEFICIARY BANK ACCOUNT NUMBER *

BENEFICIARY ADDRESS *

BENEFICIARY BANK SWIFT CODE *

Declaration

Please note that you are submitting this claim to National Insurance Company Berhad. Please see our full Terms of Conditions and Privacy Policy.

By submitting this claim to us, you are deemed to have agreed to us collecting, using, disclosing and processing your personal data for the purpose of assessing your claim. This may include disclosing and sharing your personal data with our service providers and/or with other insurers in the general insurance industry, including BDCB, for the proper processing, handling and/or dealing with your claim, which includes investigating the said claim and complying with applicable laws (collectively, 'the Purpose'). We may also need to disclose or share your personal data with service providers who are sited outside Brunei for the Purpose.

I declare that the information given is true and correct to the best of my knowledge and belief. I understand that any false or fraudulent statements or any attempt to suppress or conceal any material facts shall render the policy void and National Insurance Company may refuse to pay the claim.

If you would like to add more claims to this session, please select ‘CONFIRM’

If you have completed your claims, please select ‘CONFIRM’

The employee was given leave (MC or hospitalisation leave) or light duty.

Injured during travel.

Location of the accident (please name the Kg area)
Example: Gadong area (in front of the Lexus / NBT)

Claim for medical expenses if you get sick or injured whilst traveling internationally.

Claim for baggage and personal effects loss or damage.

Claim for travel delay, or missed, cancelled or curtailed flights.

Claim for car rental excess cover or deductible, for accident or damage to your rental car.

Claim for all other travel related incidents.

Claim submission is in-progress.

PLEASE ENSURE THAT FOLLOWING DOCUMENTS IN EITHER JPG, PNG OR PDF FORMAT ARE PREPARED & READY TO BE SUBMITTED AS PART OF YOUR ONLINE CLAIM SUBMISSION. EACH INDIVIDUAL FILE SIZE SHOULD NOT EXCEED 3MB.

MEDICAL EXPENSES

Copy of Itemized Medical Bills and/or Pharmacy Bills
Copy of Medical and/or Dental Report detailing diagnosis and/or written confirmation for unfit to travel
Copy of Travel and/or Flight itinerary
And any relevant documents relating to your respective claim submission

Note: Every Letter, Claim, Writ, Summons and Legal Proceeding, should be notified or forwarded to National Insurance Company Berhad immediately upon receipt

PLEASE ENSURE THAT FOLLOWING DOCUMENTS IN EITHER JPG, PNG OR PDF FORMAT ARE PREPARED & READY TO BE SUBMITTED AS PART OF YOUR ONLINE CLAIM SUBMISSION. EACH INDIVIDUAL FILE SIZE SHOULD NOT EXCEED 3MB.

BAGGAGE DELAY AND DAMAGED TO BAGGAGE (PERSONAL EFFECTS)

Copy of Property Irregularity Report from Carrier (damage and delay baggage)
Pictures of Damaged Baggage (if any)
Copy of Police Report (in the event of stolen personal documents and/or money)
Copy of Travel and/or Flight itinerary
And any relevant documents relating to your respective claim submission

Note: Every Letter, Claim, Writ, Summons and Legal Proceeding, should be notified or forwarded to National Insurance Company Berhad immediately upon receipt

PLEASE ENSURE THAT FOLLOWING DOCUMENTS IN EITHER JPG, PNG OR PDF FORMAT ARE PREPARED & READY TO BE SUBMITTED AS PART OF YOUR ONLINE CLAIM SUBMISSION. EACH INDIVIDUAL FILE SIZE SHOULD NOT EXCEED 3MB.

TRAVEL DELAY (CANCELLATION, MISSED FLIGHT ETC)

Written confirmation from Airline in regards to Travel Delay
Receipts for meals, accommodation or refreshment expenses incurred in the event for Missed Flight Connection
Travel Agent letter / tour booking invoice in the event of trip cancellation / curtailment
Letter from Tour Agent / Airline in regards to refund amount
Copy of Travel and/or Flight itinerary
And any relevant documents relating to your respective claim submission

Note: Every Letter, Claim, Writ, Summons and Legal Proceeding, should be notified or forwarded to National Insurance Company Berhad immediately upon receipt

PLEASE ENSURE THAT FOLLOWING DOCUMENTS IN EITHER JPG, PNG OR PDF FORMAT ARE PREPARED & READY TO BE SUBMITTED AS PART OF YOUR ONLINE CLAIM SUBMISSION. EACH INDIVIDUAL FILE SIZE SHOULD NOT EXCEED 3MB.

CAR RENTAL EXCESS

Copy of Vehicle Agreement and Certificate of Insurance
Copy of Police Report where accident occurred
Copy of repair invoice and incident report
Copy of receipt for excess and/or third-party damages
Copy of Travel and/or Flight itinerary
And any relevant documents relating to your respective claim submission

Note: Every Letter, Claim, Writ, Summons and Legal Proceeding, should be notified or forwarded to National Insurance Company Berhad immediately upon receipt

PLEASE ENSURE THAT FOLLOWING DOCUMENTS IN EITHER JPG, PNG OR PDF FORMAT ARE PREPARED & READY TO BE SUBMITTED AS PART OF YOUR ONLINE CLAIM SUBMISSION. EACH INDIVIDUAL FILE SIZE SHOULD NOT EXCEED 3MB.

OTHERS (PERSONAL LIABILITY AND ETC)

Copy of Police Report where incident occurred
Copy of Itemized Medical Bills and/or Pharmacy Bills
Copy of Medical and/or Dental Report detailing diagnosis and/or written confirmation
Photos of incident and/or Property
Copy of Travel and/or Flight itinerary
And any relevant documents relating to your respective claim submission

Note: Every Letter, Claim, Writ, Summons and Legal Proceeding, should be notified or forwarded to National Insurance Company Berhad immediately upon receipt

Tailored personal & business insurance products.

Our products

COMPLETE PEACE OF
MIND WHEN YOU CLAIM

Travel Claim

MEDICAL CLAIM

BAGGAGE DELAY & DAMAGED & PERSONAL EFFECTS

TRAVEL DELAY, MISSED FLIGHT, CANCELLATION & CURTAILMENT

CAR RENTAL

OTHER RELEVANT CLAIM

PERSONAL ACCIDENT

MEDICAL, DENTAL AND OTHER EXPENSES

BAGGAGE AND PERSONAL EFFECTS

DELAYED BAGGAGE

PERSONAL MONEY & TRAVEL DOCUMENTS

TRAVEL DELAY

MISSED FLIGHT CONNECTION

LOSS OF DEPOSIT OR CANCELLATION

CURTAILMENT

OVERBOOKED SCHEDULE PUBLIC CONVEYANCE

RENTAL VEHICLE EXCESS

PERSONAL LIABILITY

HIJACKING

HOMESURE

YES

NO

Declaration

Claim Solutions

Motor Claim

Travel Claim

Workmen Compensation Protector Claim

Claim Solutions

Property Claim

Golfer Protector Claim

Other Claim

Tailored personal & business insurance products.

Contact Info

COMPLETE PEACE OFMIND WHEN YOU CLAIM

Travel Claim

MEDICAL CLAIM

BAGGAGE DELAY & DAMAGED & PERSONAL EFFECTS

TRAVEL DELAY, MISSED FLIGHT, CANCELLATION & CURTAILMENT

CAR RENTAL

OTHER RELEVANT CLAIM

PERSONAL ACCIDENT

MEDICAL, DENTAL AND OTHER EXPENSES

BAGGAGE AND PERSONAL EFFECTS

DELAYED BAGGAGE

PERSONAL MONEY & TRAVEL DOCUMENTS

TRAVEL DELAY

MISSED FLIGHT CONNECTION

LOSS OF DEPOSIT OR CANCELLATION

CURTAILMENT

OVERBOOKED SCHEDULE PUBLIC CONVEYANCE

RENTAL VEHICLE EXCESS

PERSONAL LIABILITY

HIJACKING

HOMESURE

YES

NO

Declaration

Claim submission is in-progress.

MEDICAL EXPENSES

BAGGAGE DELAY AND DAMAGED TO BAGGAGE (PERSONAL EFFECTS)

TRAVEL DELAY (CANCELLATION, MISSED FLIGHT ETC)

CAR RENTAL EXCESS

OTHERS (PERSONAL LIABILITY AND ETC)

Claim Solutions

Motor Claim

Travel Claim

Workmen Compensation Protector Claim

Claim Solutions

Property Claim

Golfer Protector Claim

Other Claim

Tailored personal & business insurance products.

Contact Info

COMPLETE PEACE OF
MIND WHEN YOU CLAIM