Individual Claims - Allianz Malaysia (2024)

Claim documents for hospital admission

Claimant’s Statement (Hospitalisation and Surgical Claim)
Download form
Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
E-Payment Authorisation Form (if not submitted previously)
Download form
Updating of e-Invoice Details (if not submitted previously)
Download form

Medical Report (Hospitalisation Claim)
Download form
Original Receipts
Original Final Tax Invoices
Itemised Bills / Detailed Bills indicating:
- Doctor’s Fee
- Medicine Charges (including medicine name, unit price, prescribed quantity and supply duration)
- Test/Investigation Charges
Diagnostic Reports, for example:
- Magnetic Resonance Imaging (MRI)
- X-ray
- Histopathology Examination (HPE)
- Blood Test
- Computed Tomography (CT) Scan
- Coronary Angiogram
- Electrocardiography (ECG)
For Overseas Treatment (not required for Singapore and Brunei) please include:
Proof of Life Assured leaving Malaysia:
- Life Assured’s Passport Copy indicating date of departure from Malaysia
- Boarding Pass
- Travel Ticket Details
Following supporting documents in English:
- Medical Report
- Original Receipts
- Original Final Tax Invoices / Final Bills
- Itemised Bills / Detailed Bills
- Diagnostic Reports
See Also
Life Insurance: Info for First Time Buyers

Claimant’s Statement (Hospitalisation and Surgical Claim)
Please indicate "Hospital Income Benefit" on Claimant's Statement.
Download form
Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
E-Payment Authorisation Form (if not submitted previously)
Download form
Updating of e-Invoice Details (if not submitted previously)
Download form

Medical Report (Hospitalisation Claim)
Download form
Inpatient Bills indicating:
- Date of admission and discharge
- Number of days of Room and Board charged by hospital
Diagnostic Reports for example
- Magnetic Resonance Imaging (MRI)
- X-ray
- Histopathology Examination (HPE)
- Blood Test
- Computed Tomography (CT) Scan
- Coronary Angiogram
- Electrocardiography (ECG)

Claim documents for pre & post hospitalisation treatment, outpatient treatment

Claimant's Statement (Outpatient Treatment Claim)
Download form
Claimant’s NRIC (Both Sides) / Passport Copy, duly certified (if not submitted previously)
E-Payment Authorisation Form (if not submitted previously)
Download form
Updating of e-Invoice Details (if not submitted previously)
Download form

Original Receipts
Original Final Tax Invoices
Itemised Bills / Detailed Bills indicating:
- Doctor’s Fee
- Medicine Charges (including medicine name, unit price, prescribed quantity and supply duration)
- Test / Investigation Charges
Diagnostic Reports, for example:
- Magnetic Resonance Imaging (MRI)
- X-ray
- Histopathology Examination (HPE)
- Blood Test
- Computed Tomography (CT) Scan
- Coronary Angiogram
- Electrocardiography (ECG)
For Outpatient Accident Treatment only:
- Medical Report (Accident Claim)
Only necessary when total claim amount exceeds RM500. If total claim amount is RM500 or below, diagnosis, date and cause of accident have to be endorsed by the treating doctor on the bills (with signature and clinic’s official stamp)
Download form
For Overseas Treatment (not required for Singapore and Brunei) please include
Proof of Life Assured leaving Malaysia:
- Life Assured’s Passport Copy indicating date of departure from Malaysia
- Boarding Pass
- Travel Ticket Details
Following supporting documents in English:
- Medical Report
- Original Receipts
- Original Final Tax Invoices/Final Bills
- Itemised Bills/Detailed Bills
- Diagnostic Reports

*Note:Outpatient Dengue or Enteric Fever Treatment is only coverable for MediSafe Infinite, MediSafe Infinite Xtra and MediEssential Plans.