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Notify Liability Claim

LIABILITY CLAIM NOTIFICATION

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1. INSURED DETAILS


Telephone No
Date & Time of Loss

DD/MM/YYYY

{{!Jun 2019}}

The entered date is invalid. Please enter a valid date.

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2. PERSONAL INJURY


Has any person (s) sustained any injuries or died as a result of the Occurrence?

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3. PROPERTY DAMAGE


Has any occurrence caused damage to property?

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DECLARATION

  • The claim will be formally registered once written intimation is received by the company
  • List of documents & forms will be provided considering policy status is in-force on the date of event
  • Allianz Insurance Lanka Ltd reserves the right to ask for more documents and information’s to consider the claim
  • Claim proceeds are payable as per terms and conditions in the policy document
  • Notifications of claim, submission of claim forms and/or claim documents to the Company shall not be construed as admission of liability by the company
  • By submitting this form, you accept above terms and conditions.

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