Claim Form En Notice: JavaScript is required for this content. Fields marked with an * are required Welcome to Online Claims Notification service. Welcome to Online Claims Notification service. Please fill information in the below form for further investigation and service. Policy Type * Motor Claim Personal Accident Claim Travel Claim Property Claim Financial loss for hire-purchase motorcycle (MLM) Claim Transport Claim Miscellaneous Claim Fire insurance claim License Plate * เส้นแบ่งหน้าจอ Copy Information of Notified Person Information of Notified Person Name * Last name * Telephone * Email * เส้นแบ่งหน้าจอ Information of Insured Person Information of Insured Person Name * Last name * Policy Number ID Number Date of loss * Place of loss * How was the loss caused * List of damaged/Symptoms of illness* * File Upload Select Files Cancel *Allianz Ayudhya General Insurance reserve the right to request the original document.*8 maximum files which each file’s size is less than 3MB.*We prefer formats in .jpg, .pdf, .doc “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 * If you are a human seeing this field, please leave it empty.
