Make a Claim [MaidEase]

Select type of claims you want to make:

MaidEase Claim

Important Notes

  1. The acceptance of this form is NOT an admission of liability on the part of the Company.
  2. Claims should be submitted within twenty one (21) days after completion of the journey.
  3. All final bills, certificates, supporting documents should be provided to substantiate your claim.
  4. All medical reports must be submitted at the claimant’s expense before a claim can be admitted.
  5. Please answer in full all applicable questions as incomplete answers may delay claims settlement.

General Claim Details

Please state any reference number assigned to you earlier

General Section

Insured/Claimant’s Particulars

65
65
65

Maid Information

Details of Loss

Please press and hold the <Ctrl> Button if you are selecting multiple files. Allowed file types are pdf, jpeg, jpg, png, zip, docx, doc, xlsx, xls.

Important Notes

  1. The acceptance of this form is NOT an admission of liability on the part of the Company.
  2. Claims should be submitted within twenty one (21) days after completion of the journey.
  3. All final bills, certificates, supporting documents should be provided to substantiate your claim.
  4. All medical reports must be submitted at the claimant’s expense before a claim can be admitted.
  5. Please answer in full all applicable questions as incomplete answers may delay claims settlement.

Sign & Complete

I / We hereby declare that the above statements are true to the best of our / my knowledge and belief and I / We undertake to advise Sompo Insurance Singapore Pte. Ltd. (“Sompo”) promptly of all developments in connection with the claim. I / We further authorise Sompo to treat the submission of this form as my / our making a claim under my / our policy.

I / We hereby authorize any hospital physician, other person who has attended or examined me, to furnish to Sompo, or its authorized representative, any and all information with respect to any illness or injury, medical history, consultation, prescriptions or treatment, and copies of all hospital or medical records. A photocopy of this authorization shall be considered as effective and valid as the original.

I / We acknowledge and agree (in case of corporate policy, I represent that I have obtained the consent of the individuals in relation to this policy) that Sompo may collect, use or disclose and/or process my / our personal data (in case of corporate policy, personal data of individuals in relation to this policy) in accordance with the Personal Data Protection Act 2012 for the purposes and uses described in Sompo’s Privacy Policy (including for Sompo to provide the services related to this insurance policy, screening activities in accordance with legal/regulatory obligations/risk management procedures and for investigating fraud, misconduct or any unlawful action or omission relating to this claim or my / our policy). This may include disclosure to Sompo’s business partners, intermediaries, third party service providers, other insurers or reinsurers, or industry associations. For more details please see Sompo’s Privacy Policy that can be found at www.sompo.com.sg

I / We consent to receive marketing and promotional information from Sompo (e.g. via email, mail, SMS, etc). I / We understand that I / We can withdraw or manage my / our consent to receive marketing and promotional information at www.sompo.com.sg

I / We am/are aware of and agree to abide by the policy terms, conditions and exclusions and confirm that the information given in this application/form is true, accurate and complete.

If your claim is approved and you are registered with PayNow, the settlement will be made directly to your bank account. Otherwise, we will mail a cheque to the address provided by you in the previous page.


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