Make a Claim [Travel]


Select your policy type:

CIMB VISA INFINITE

Select type of claims you want to make:

PA/Medical Expenses

Flight Delay or Misconnection/Baggage Delay

Loss or Damage to Baggage

Trip cancellation

Other Benefits

CIMB VISA SIGNATURE

Select type of claims you want to make:

Accidental Death/Permanent Disablement

Flight/Baggage Delay

Baggage Loss

Trip cancellation

Other Benefits

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 thirty (30) 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.
  6. You may use one form for multiple claimants if within the same family and payment is to the same person.

General Claim Details

Please state any reference number assigned to you earlier

Insured/Claimant’s Particulars

  1. Medical and TCM bills must indicate a breakdown of the expenses incurred (consultation and medication prescribed). Do not submit receipts as these will not show enough information for the claim to be assessed.
  2. The medical condition being treated must be clearly stated on the statement or doctor’s memo.
  3. Specialist Consultation and Treatment must be referred by a General Practitioner

Insured/Claimant’s Particulars

65
65
65

Circumstances of Claim

Claim History / Other Insurances

Documents Required

  1. Medical Bills and Certificate.
  2. Medical Report.
  3. Boarding Pass/Air Ticket.
  4. Police or other reports as applicable.

PA/Medical Expenses

Upload Documents

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Documents Required

  1. Property Irregularity Report
  2. Other documents showing when baggage was returned

Flight & Baggage Inconvenience


Original flight Details

Delayed Flight Details

Upload Documents

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BAGGAGE DELAY


Baggage Delay Details

Upload Documents

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Documents Required

  1. Purchase Receipts.
  2. Property Irregularity Report
  3. Police or Other Reports.

Loss or Damage to Baggage / Personal Effect

Loss or Damage to Baggage / Personal Effect

Item Description Date of Purchase*(DD/MM/YYYY) Original Purchase Price(S$)         

Upload Documents

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.

Loss of Travel Document And Money

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.

Trip Curtailment including Disruption

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.

Documents Required

  1. Medical report to state that you are unable to travel or continue your journey.
  2. Letter or booking invoice from your travel agent to certify amount paid and amount refunded.
  3. Travel itinerary showing dates of journey and all persons covered.
  4. Invoice and receipt for charges incurred in amending or purchasing additional air ticket (for trip curtailment).
  5. Proof of relationship, if necessary.

TRIP CANCELLATION


Trip Cancellation Details


LOSS OF HOTEL FACILITIES


Loss Of Hotel Facilities Details

Documents Required

  1. Document from hotel verifying loss of facilities.
  2. Receipts, bills, documents showing amount paid.


RENTAL VEHICLE EXCESS


Rental Vehicle Excess Details

Documents Required

  1. Vehicle Rental Agreement.
  2. Police report if applicable.
  3. Receipts, bills, documents showing amount paid.

Upload Documents

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 thirty (30) 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.
  6. You may use one form for multiple claimants if within the same family and payment is to the same person.

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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