- Download the Medical Record Declaration Permission consent form here
- Fill in the consent form and attach the copy of your passport (only first page) total 5 copies (sign with wet signature in both documents)
- Submit the documents to address stated below
(Please submit the documents via registered postal mail or EMS to prevent loss of items)
Claim Department - Health Insurance: Investigation Unit
Allianz Ayudhya General Insurance Public Company Limited
898 Ploenchit Tower, Ploenchit Road, Khwang Lumpini, Khet Pathumwan, Bangkok 10330
Should you have any queries, please do not hesitate to contact our Customer Service Team at 1292 press 4 on every working day or email: [email protected]