MyClaims Non Motor - Notification

Zurich General Insurance Malaysia

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Non Motor Claim Registration

MYA Confirmation No/PNR No *

Insured’s Date of Birth *

Master Policy No *

Certificate of Insurance No *

Your Zurich Policy Number *

Policy number is required

Class

Name *

Client Type *

New IC No. *

Claimant's New IC *

- -

New IC is required

OLD IC/Passport No

Claimant's OLD IC/Passport No

Business Reg No

Email Address *

Hand Phone Number Claimant's Mobile Number

(Please include your country code)

Loss Date *

Loss State *

Description Of Loss *

(Where,Who,Why,What and How?)

Have you received compensation from other insurer to cover the damage or loss?

Other Insurer’s Name *

Compensation received *

Benefit Type *

Recovery Action *

Occupied As *

Risk Item *

Cause Of Loss *

Type Of Loss *

Source Of Estimation *

Estimate Loss Amount *

Was anyone Injured ? *

Injured Person Name *

Injured Person Tel No *

Injured Person ID Type *

Injured Person ID *

Claim Type *

Do you have any other Insurance to cover the damange or loss ?

Insurer

Please provide as much details as possible. Use the reverse side of the form if you wish to give more details or provide a sketch overview to give us a better understanding of the incident.

If your claim is payable directly to you please provide your bank name, account number and account holders name so we can transfer the funds electronically.

Bank Location *

(Country)

Bank Name *

Currency Code *

Bank Address *

SWIFT Code *

Account Number *

(Exclude Spaces & Symbols)

Account Holder Name *

Account Holder ID Type *

Account Holder ID *

If the payment is to a bank account outside of Malaysia, any overseas remittance fees will be borne by you.

At Zurich, we aim to provide a seamless and pleasant experience in servicing your claims. Hence, your feedback is valuable to us. Once your claim has been settled, we will send you an invitation to answer a survey. It will only take less than a minute.

All personal data collected will only be used for claims purposes including but not limited to data reporting and claims statistics for Zurich Insurance Malaysia Berhad and Zurich Group of Companies; and not for any other purposes. The information provided will be used in conjunction with the following Privacy Policy / Personal Data Protection Act (PDPA) notice that can be found at our website. For more information please visit our website at here www.zurich.com.my/PDPA .

I hereby allow Zurich Malaysia and/or its intermediaries to contact me on matters relating to this enquiry. For this Purpose, Zurich Insurance Malaysia Berhad, Zurich Takaful Malaysia Berhad and all other Zurich Insurance Group Subsidiaries operating in Malaysia, will also be referred to as ‘Zurich Malaysia’.

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