Fill in Claims Infomation-Motor

Welcome to Fill in Claims Information (Motor)

Please fill information in the below form for further investigation and service.

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License Plate

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Please provide the complete vehicle registration number, including the province, e.g., 9กข9999 Bangkok.

Information of the insured vehicle's driver at the location of the accident

Name

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Last Name

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Telephone

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กรุณากรอกเบอร์โทร 10 หลัก (เช่น 0811234567)

Date Of Birth*

Day/Month/Year

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Information of Insured Person

Date of loss*

Day/Month/Year

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Time of loss

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Please enter the time in the HH:MM format, e.g., 14:30.

Place of loss

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how was the loss caused

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File Upload

*Allianz Ayudhya General Insurance reserve the right to request the original document.
*6 maximum files which total size is less than 30MB.
*We prefer formats in .jpg, .png, .pdf, .doc, .xlsx, .pptx

File Upload

“I here by give my consent to collect, use and disclose my personal data for the purpose of advertising, conducting marketing analysis, proposing and offering about products, services and other privilege programs provided by the Company, companies in Allianz Group, or the Company’s contracting parties, and for other purposes as specified in the” Privacy Notice

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Enter Label

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