A. Policy Information

B. Claimant Details

Note: A separate claim submission is required for each individual claimant under the same policy.

C. What happened during the trip?

Have you or any insured person previously made a claim under a travel policy? If yes, please specify below:

D. Documents Required for Claim Assessment

Copy of Flight/Travel Itinerary
Copy of boarding pass/air tickets/passport
Medical report from the attending doctor abroad
All original medical invoices and receipts
Admission/Discharge Report
Original invoice/receipt for charges inccured in amending or purchasing additional air ticket/accommodation
A copy of flight itinerary indicating the original flight details
Booking invoice with terms and conditions, and payment receipts
Confirmation from airline / travel agents with regards to the change of flight details
A written confirmation or Report from Airline on duration of diversion or delay and reason
A written confirmation from Airline confirming the overbooked or misconnected flight details and when the next alternative transportation is made available
Written confirmation from airline/ travel agents/ other service providers indicating non-refundable amount incurred
A copy of your hospitalization bill
A copy of the death certificate of the family member (if applicable)
Receipt for the Loss / Damage Equipment
Loss report / police report made within 24hours
Receipt of the replace/repair receipt for the damage Equipment
Property irregularity report carrier/airline
Photographs of damaged items
Any other supporting documents

E. Declaration, Authorization & Customer's Data Privacy Consent


In addition to the declaration and authorisation provided above, I/we agree and consent to the Company, its related corporations (collectively, the "Companies", as well as their respective representatives and agents collecting, using, disclosing and sharing amongst themselves my/our personal data, and disclosing such personal data to the Companies' authorised service providers and relevant third parties for purposes reasonably required by the Companies to evaluate, admit, process and/or administer my/our claims. These purposes are set out in HL Assurance Pte Ltd Privacy Statement, which is assessable at: https://www.hlas.com.sg/PolicyOnPersonalData.aspx and which I/we confirm I/we have read and understood.

F. Payment Details

Please provide your bank details for us to accelerate your claims payment process by direct transfer to your bank account.
Notification of payment will be sent to your email address stated in your details. The company shall :
(i) be discharged from all liability under this claim and
(ii) not be liable for any and all losses incurred by you, as a result of you providing the company with inaccurate bank account number under this section for the payment of this claim.