Dai-ichi Life Insurance (Cambodia) PLC.

  • ​How to Make a Claim

Inform Dai-ichi Life Insurance (Cambodia) about the Claim:

  • Upon the occurrence of an insured event, Beneficiary(ies) or Claimant(s) shall provide information and evidence to Dai-ichi Life via our Financial Advisor/Financial Planner, or our Call Center via (+855) 23 955 333/1800 201 202 (free of charge), or Dai-ichi Life Customer Service Center, or Claim Department at Head Office of Dai-ichi 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 (Company Form)
  • Original Life Certificate
  • 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)
  • Original Life Certificate
  • 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)
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
  • Original Life Certificate
  • 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)
  • Original Life Certificate
  • 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 Download Form
2 Consent Letter of Beneficiary or Heir to Disclose Personal Data Download Form
3 Consent Letter for the Disclosure of Information Related to Medical History Download Form

Critical Illness Claim

+ Documents Required
Claim Type
Document required
Hospital Care

+Hospital Admission due to Accident

  • Claim Form for Injury/Critical Illness
  • Physician Report (Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any,
    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 Insurance Certificate
  • Copy of Policy Report (if any)
  • Other documents are required if they are important for claim evaluation process

+Hospital Admission due to Critical Illness

  • Claim Form for Injury/Critical Illness
  • Physician Report (Filled by Doctor with Signature and Hospital Stamp)
  • Consent Letter for the Disclosure of Information Related to Medical History (If any, Company Form)
  • Discharge Letter (Specified the Admission and Discharge Date and Time)
  • All supporting documents during the treatment and original invoice
  • All treatment report regarding critical illness
  • The result of biopsy
  • Copy of ID card or passport
  • Copy of Insurance Certificate
  • Copy of Policy Report (if any)
  • Other documents are required if they are important for claim evaluation process
Early and Late Critical Illness- Family Care
  • Claim Form for Injury/Critical Illness
  • Physician Report (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 city or provincial hospital
  • All supporting documents during the treatment and original invoice
  • The result of biopsy
  • All treatment report regarding critical illness
  • Copy of ID card or passport
  • Copy of Insurance Certificate
  • Other documents are required if they are important for claim evaluation process

 

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