Welcome to Fill in Claims Information

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

Apologies, we are currently unable to handle your request.

Information of Notified Person

Name

Error Mandatory field

Last name

Error Mandatory field

Telephone

Error Mandatory field

Please fill information

Error Invalid

Error Mandatory field

Information of Insured Person

Name

Error Mandatory field

Last name

Error Mandatory field

Policy Number

ID Number

Date of loss

Error Mandatory field

Place of loss

Error Mandatory field

How was the loss caused

Error Mandatory field

List of damaged/Symptoms of illness

Error Mandatory field

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

Enter the text from the box. 60 seconds remaining. Can't read the text? Reload text

Enter Label

Error Mandatory field

Sorry, that does not match the text in the box. Please try again.

Form sent successfully.

The form could not be sent due to an error.