Daiichi Life Insurance (Cambodia) PLC.

  • ​How to Make a Claim

Inform Daiichi Life Insurance (Cambodia) about the Claim:

  • Upon the occurrence of an insured event, Beneficiary(ies) or Claimant(s) shall provide information and evidence to Daiichi Life via our Financial Advisor/Financial Planner, or our Call Center via (+855) 23 955 333/1800 201 202 (free of charge), or Daiichi Life Customer Service Center, or Claim Department at Head Office of Daiichi Life Insurance (Cambodia) PLC. or by email claim@dai-ichilife.com.kh from Monday to Friday, from 8:00 am – 5:00 pm (except on public holidays)

Digital Product Claim for Death and Total Permanent and Disability

Upon the occurrence of a​​ claim event, Beneficiary(ies) or Claimant(s) shall provide information and evidence by the any of method below:

1.By submit the Information, Document and Evidence by click here: Online Claim Submission

2.Submit the Soft Copy of Claim Request Form and Supporting Documents (Death / TPD Claim) below to Claim Department via email claim@dai-ichilife.com.kh . Or

3.Submit as hard copy of Claim Request Form and Supporting Documents (Death / TPD Claim) below at our Customer Center at H-Silver Building N420 Ground floor, Street 271, Sangkat Tumnob Tuek, Khan Chamkarmon, Phnom Penh.

 

+ Documents Required
Claim Type
Document required
Death Claim- Due to Accident
  • Claim Request Form (Company Form, for claim submit as soft or hard copy only)
  • Copy of Death Certificate issued by hospital or competent authority
  • Copy ID Card/Passport of Beneficiary/Claimant
  • Birth Certificate, Marriage Certificate, or other supporting documents that prove relationship between Life Insured and Beneficiary/ Claimant
  • Medical report​​ from doctor in case of death in the registered hospital or registered clinic
  • Copy of Police Report
  • Consent Letter of Beneficiary or Heir to Disclose Personal Data (If any, Company form)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Confirmation letter or other documents are required if they are important for claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)
  • Copy of Autopsy examination report (if any)
Death Claim- Due to Illness
  • Claim Request Form (Company Form, for claim submit as soft or hard copy only)
  • Copy of Death Certificate issued by hospital or competent authority
  • Copy ID Card/Passport of Beneficiary/Claimant
  • Medical Report
  • Consent Letter of Beneficiary or Heir to Disclose Personal Data (If any, Company form)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Confirmation letter or other documents are required if they are important for claim evaluation process. The    cost(s) for obtaining such documents will be borne by the claimant(s)
  • Copy of Autopsy examination report (if any)
Total Permanent and Disability Claim- Due to Accident
  • Claim Request Form (Company Form, for claim submit as soft or hard copy)
  • Confirmation Letter about Total and Permanent Disability (TPD) issued by Hospital
  • Copy of Police Report
  • Consent Letter of Beneficiary or Heir to Disclose Personal Data (If any, Company form)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Confirmation letter or other documents are required if they are important for claim evaluation process.
  • The cost(s) for obtaining such documents will be borne by the claimant(s)
Total Permanent and Disability Claim- Due to Illness
  • Claim Request Form (Company Form, for claim submit as soft or hard copy)
  • Confirmation Letter about Total and Permanent Disability (TPD) issued by Hospital
  • Medical Report
  • Consent Letter of Beneficiary or Heir to Disclose Personal Data (If any, Company form)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Confirmation letter or other documents are required if they are important for claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)

 

+ Form to Download
No Form Remark
1 Claim Request Form(For Digital Product) Download Form
4 Consent Letter of Beneficiary or Heir to Disclose Personal Data Download Form
5 Consent Letter for the Disclosure of Information Related to Medical History Download Form

Death and Total Permanent and Disability Claim

+ Documents Required
Claim Type
Document required
Death Claim- Due to Accident
  • Claim Request Form for Death and TPD (Company Form)
  • Original Life Insurance Certificate
  • Certified true copy of Death Certificate
  • Copy of ID Card/ Passport /Birth Certificate of Beneficiary or Claimant
  • Proof of relationship of Life insured and beneficiary or claimant (Marriage Certificate, Family Book, Birth Certificate)
  • Medical report
  • Copy of Police Report
  • Consent letter for the disclosure of Information Related to Medical Claim (Company form)
  • Confirmation letters or other documents are required if they are important for the claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)
  • Copy of Autopsy examination report (if any)
Death Claim- Due to Illness
  • Claim Request Form for Death and TPD (Company Form)
  • Physician Report for Death (Company Form) (Filled by Doctor with Signature and Hospital Stamp)
  • Original Life Insurance Certificate
  • Certified true copy of Death Certificate
  • Copy of ID Card/ Passport /Birth Certificate of Beneficiary or Claimant
  • Proof of relationship of Life insured and beneficiary or claimant (Marriage Certificate, Family Book, Birth Certificate)
  • Medical Report
  • Consent Letter for the Disclosure of Information Related to Medical History (Company Form)
  • Confirmation letters or other documents are required if they are important for the claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)
Total Permanent and Disability Claim- Due to Accident
  • Claim Request Form for Death and TPD (Company Form)
  • Confirmation Letter about Total and Permanent Disability (TPD) issued by Registered Hospital
  • Original Life Insurance Certificate
  • Copy of Police Report
  • Physician report for TPD (Company Form)(Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (Company Form)
  • Confirmation letters or other documents are required if they are important for the claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)
Total Permanent and Disability Claim- Due to Illness
  • Claim Request Form for Death and TPD (Company Form)
    Original Life Insurance Certificate
  • Confirmation Letter about Total and Permanent Disability (TPD) issued by register Hospital
  • Medical Report
  • Physician report for TPD (Company Form)(Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (Company Form)
  • Confirmation letters or other documents are required if they are important for the claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)

 

+ Form to Download
No Form Remark
1 Claim Request Form-Death/TPD Download Form
2 Physician Report-Death Download Form
3 Physician Report-TPD Download Form
4 Consent Letter for the Disclosure of Information Related to Medical History Download Form

Critical Illness / Infectious / Hospitalization Claim

+ Documents Required
Claim Type
Document required
Hospital Care / Hospital Allowance Benefits

+Hospital Admission due to Accident

  • Claim Request Form for Critical Illness / Infectious / Hospitalization (Company Form)
  • Physician Report for Critical Illness / Infectious / Hospitalization (Company Form, Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (Company Form)
  • Discharge Letter (Specified the Admission and Discharge Date and Time)
  • All supporting documents during the treatment and original invoice
  • Copy of ID card or Passport
  • Copy of Life Insurance Certificate
  • Copy of Police Report (if any)
  • Other documents are required if they are important for the claim evaluation process

+Hospital Admission due to Critical Illness

  • Claim Request Form for Critical Illness / Infectious / Hospitalization (Company Form)
  • Physician Report for Critical Illness / Infectious / Hospitalization (Company Form, Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (Company Form)
  • Discharge Letter (Specified the Admission and Discharge Date and Time)
  • All supporting documents during the treatment and original invoice
  • All treatment reports regarding critical illness
  • Biopsy Result (for cancer)
  • Copy of ID card or passport
  • Copy of Insurance Certificate
  • Copy of Police Report (if any)
  • Other documents are required if they are important for the claim evaluation process.
Early and Late Critical Illness – Family Care
  • Claim Request Form for Critical Illness / Infectious / Hospitalization (Company Form)
  • Physician Report for Critical Illness / Infectious / Hospitalization (Company Form, Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Medical Report certified the condition/level of critical illness issued by registered hospital
  • All supporting documents during the treatment and original invoice
  • Biopsy Result (for cancer)
  • All treatment reports regarding critical illness
  • Copy of ID card or passport
  • Copy of Insurance Certificate
  • Other documents are required if they are important for the claim evaluation process
Infectious Disease
  • Claim Request Form for Critical Illness / Infectious / Hospitalization (Company Form)
  • Physician Report for Critical Illness / Infectious / Hospitalization (Company Form, Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Medical Report with confirmed diagnosis of infectious issued by registered hospital or Clinic
  • Medical result confirmed by specific test of infectious disease.
  • Copy of ID card or passport
  • Copy of Insurance Certificate
  • Confirmation letters or other documents are required if they are important for the claim evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)

 

+ Form to Download
No Form Remark
1 Claim Request Form - Critical Illness/Infectious/Hospitalization Download Form
2 Physician Report - Critical Illness/Infectious/Hospitalization Download Form
3 Consent Letter for the Disclosure of Information Related to Medical History Download Form

Accidental Partial Dismemberment and Burns Claim

+ Documents Required

 

Claim Type
Document required
Accidental Partial Dismemberment and Burns

+ Accidental Partial Dismemberment

  • Claim Request Form for Accidental Partial Dismemberment and Burns (Company Form)
  • Physician Report-Accidental Partial Dismemberment (Company Form, Filled by Doctor
    with Signature and Hospital Stamp)
  • Confirmation Letter about Partial Dismemberment issued by Registered Hospital
  • Copy of Life Insurance Certificate
  • Copy of Police Report (if any)
  • Consent Letter for the Disclosure of Information Related to Medical History (Company Form)
  • Confirmation letters or other documents are required if they are important for the claim
    evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)

+ Accidental Burns

  • Claim Request Form for Accidental Partial Dismemberment and Burns (Company Form)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Medical Certificate with confirmed cause and degree of Burns issued by registered
    hospital or clinic
  • Copy of ID card or passport
  • Copy of Insurance Certificate
  • Copy of Police Report (if any)
  • Confirmation letters or other documents are required if they are important for the claim
    evaluation process. The cost(s) for obtaining such documents will be borne by the claimant(s)

 

+ Form to Download
No Form Remark
1 Claim Request Form - Accidental Partial Disbursement/Burns Download Form
2 Physician Report - Accidental Partial Dismemberment Download Form
3 Consent Letter for the Disclosure of Information Related to Medical History Download Form