PT Asuransi Allianz Life Indonesia

Individual Life Insurance

• Policy Changes Form

          > Policy Changes Form - Finansial
          > Policy Changes Form - Non Finansial
          > Top Up,Switching and Fund Apportionment Form
          > Withdrawal and Surrender Form
          > Advance Premium Form

• Claim Form

          > Individual Life Insurance Claim Form
          > Death Cause Statement by doctor
          > Power of Attorney to Disclose Medical Records
          > Accidental Death Claim Form
          > Notification of Account Number
          > Extended Medical Report

• Letter of attorney Form

          > Authorization letter for Premium Payment through Credit
             Card
          > Letter of Attorney Form Auto Debit Danamon
          > Letter of Attorney Form
          > Form Debit Mandiri Bank
          > Cancellation Form Debit Mandiri Bank
          > Guide of Admission Filling Letter of Attorney Form Auto
             Debit Danamon
          > Letter of Attorney Auto Debit BCA Revised
          > Letter of Cancellation Debit Credit Card
          > Letter of Cancellation Statement Auto Debit

• Critical Illness Form

> Anemia Aplastis	> Operasi Scoliosis Idiopatik
> Cronh's Disease	> Pankreatitis Kronis
> Application Form CI	> Lungs Diseases
> Disclose Medical Records	> Kawasaki
> Kidney Failure	> Cronic Liver
> Hepatitis Fulminant	> Rheumatoid Artritis
> HIV	> Scleroderma Progresif
> Heart Attack	> Eritematosus Sistemik
> Cancer	> Stroke
> Paralysis	> Letter of attorney RS Medistra
> Gangrene	> Letter of attorney RS Kelapa Gading
> Cyst Illness	> Requirement CI
> Coma	> Transplantation of body Vital
> Burn	> Serious Head Trauma
> Bakterial Meningitis	> Deaf - mute - blindess
> Multiple Sclerosis	> Benign Brain Tumor
> Muscular Dystrophy - Poliomyelitis

Individual Health Insurance

> Insurance claim requirement for individual health
> Individual Health Insurance Inpatient Claim Form
> Individual Health Insurance Outpatient Claim Form
> Application Form Individual Health Insurance
> Tell Us Your Address Change

Group Health Insurance

> Insurance claim requirement for group health
> Group Health Insurance Inpatient Claim Form
> Group Health Insurance Outpatient Claim Form