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      • I'm looking for...

        • lump sum health insuranceRecommended
        • Critical Illness Insurance
        • Kids health insurance
        • Health Insurance for People Older Than 50 Years
        • Additional Health Insurance for Welfare
        • Group health Insurance
        • Expat Health Insurance
        • Still unsure? Try looking for insurance
      • Recommended plan

        Premium Plan Cover THB 30 million up

        • FlexCare PlanNew
      • Standard Plan Cover THB 10-30 million

        • Superior Health Plan
        • My Health Plus Rider - Double CareBest selling
      • Value Plan Cover not exceeding THB 5 million

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Forms Download

What you'll find on this page

  • Life Insurance Forms
  • Non-Life Insurance Forms
  • Forms Download (Aetna)
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    1 of 2

    Life Insurance Forms

    Letter of Consent - Disclose personal information of the Insured 206 KB
    Direct Debit and Direct Credit request form 88 KB
    OPD Claim Form 283 KB
    AI-IPD-PA-CI Claim Form 291 KB
    Payment Form (This form only available in Thai) 226 KB
    New cheque Issuance Request Form 108 KB
    Death Claim Form 2 MB
    TPD Claim Form 1 MB
    Complaint Receipt Form (This form only available in Thai) 78 KB
    Letter to express your intent to buy My First Class @BDMS and to cancel MHP MHPE 83 KB
    W-8 BEN (For non U.S. citizen or resident) 71 KB
    W-8BEN-E (For non U.S. entity) 312 KB
    W-9 (For U.S. entity or U.S. citizen or resident) 143 KB

    2 of 2

    Non-Life Insurance Forms

    Complaint Receipt Form 941 KB
    Appoint Policyholder to be Beneficiary Form 182 KB
    Employee Benefits Manual 289 KB
    Agreement on the use of Group Insurance ID Cards 123 KB
    AI-IPD-PA-CI Claim Form 291 KB
    Enrollment Request Listing Form for Group Life Insurance (New Business) 123 KB
    Enrollment Request Listing Form for Group Life Insurance (New Business) 1 MB
    Group Personal Accident Application Form (Policy holder) 172 KB
    OPD Claim Form 283 KB
    AI-IPD-PA-CI Claim Form 291 KB
    Death Claim Form 2 MB

    Forms Download (Aetna)

    Letter of Assignment Form 168 KB
    Claim Reimbursement Form for members 209 KB
    Consent Form 215 KB
    Physical Attending Report 402 KB
    OPD Form 157 KB
    Pre-Arrangement Form 141 KB
    Admission Form 155 KB
    HB Incentive Claim Reimbursement Form 140 KB
    ATH Medical Claim Form 1009 KB
    ATH Dental Claim Form 983 KB
    ATH Personal Accident Claim Form 870 KB
    ATH Compassionate Emergency Visit Form 764 KB
    ATH Mortal Remains Claim Form 793 KB
    ATH Maternity Claim Form 744 KB
    Payment Form 995 KB
    Application for Debiting a Deposit Bank Account 162 KB
    Beneficiary changing request form 155 KB
    Power of attorney form 165 KB
    Letter of Consent of Automatic Recurring Payment 506 KB
    Request form for the payment of insurance premiums certificate of Health and Personal Accident Insurance 140 KB
    Hospital and Clinic List 1 MB
    Request to amend information 211 KB
    Upgrade form 182 KB
    Membership Handbook-Individual Health Insurance 1 MB
    UltraCare Plan guide – Individual 5 MB
    UltraCare Plan guide – Group 5 MB
    Superior Health 1 MB
    Savvy Health 1 MB
    Beyond Care Plan 754 KB
    Max Care Plan 982 KB
    Basic Care Plan 754 KB
    Care Plus Plan 264 KB
    Care Anywhere Plan 1 MB
    Employee Care Plus Plan 336 KB
    Extra Value Plan 841 KB
    Travel Insurance 1016 KB
    my health Allianz Ayudhya Leaflet 986 KB

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    Plan

    Application Form

    Basic Care
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    (Maximum Benefit per policy year)
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    Personal Health and Accident Insurance Policy (Top-Up)

    Employee Care Plus

    Personal Health and Accident Insurance Policy (Worksite)

    Max Care

    Personal Health and Accident Insurance Policy

    Savvy Health

    Health and Accident Special Plus Insurance Policy
    Extra Value Plan Form 197 KB
    Travel Insurance Form 468 KB
    Superior Health 1 MB
    Savvy Health 1010 KB
    Beyond Care 1 MB
    Max Care 1 MB
    Basic Care 1 MB
    Care Plus 999 KB
    Care Anywhere 1006 KB
    Extra value (telesales) 1 MB
    Extra Value 1 MB
    Extra Value Plus 1 MB
    Personal Care and Beyond Personal Care 1 MB
    Platinum and Platinum+ 1 MB
    vHealth vCare 959 KB
    Extra Care 966 KB
    Employee Plus 1 MB
    Maximum Limit Per Year 980 KB
    Maximum Limit Per Year (Telesales) 800 KB
    Accident Plus 1 MB
    Worldwide Travel Health Insurance Policy 7 MB
    Smarter Health 1 MB
    Exclusive Care @BDMS 1 MB

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