Khairat Care Claim Application

Complete the Claim Form for us to verify and process your claim request.

Person Covered Information

First Name *

Last Name *

NRIC *

Details of Claimant

Please ensure the Claimant's details match the Beneficiary details nominated by the Person Covered. If there is any discrepancy we will attempt to verify the authenticity of the Claimant before approval of the claim.

First Name *

Last Name *

NRIC *

Relationship with Person Covered *

Mobile Number *

Phone

Email address *

Payment Details

Name of Bank *

Bank Account Name *

Bank Account Number *

Supporting Documents Required

Please make sure all documents uploads are in PDF format.

Copy of NRIC of Person Covered *

Copy of NRIC of Claimant *

Certificate of Death of Person Covered *

Burial Certificate of Person Covered

Please be informed that all supporting claims documents must be duly certified by authorised parties. In addition, for claims incurred outside Malaysia, the confirmation of claim event and all other related documents issued by the Foreign Authority must be certified by Malaysian Embassy in the relevant foreign country.

I declare and agree that the information and documents submitted are true and correct