Call Me Back
Search
Call Me Back

Notify Liability Claim

LIABILITY CLAIM NOTIFICATION

Form sent successfully.

Apologies, we are currently unable to handle your request. Please try again.

Warning - The E-Mail Address configured for this form is either unverified or invalid. Please verify the E-Mail Address and try again later.

A verification E-Mail was sent to the following E-Mail addresses:

Kindly check the corresponding inbox for a verification E-Mail and verify it.

Warning - The page URL seems to be incorrect. Kindly check the URL and try again.

1. INSURED DETAILS


Telephone No
Date & Time of Loss

DD/MM/YYYY

{{!Jun 2019}}

Error The entered date is invalid. Please enter a valid date.

Error Mandatory field

2. PERSONAL INJURY


Has any person (s) sustained any injuries or died as a result of the Occurrence?

Error Mandatory field

3. PROPERTY DAMAGE


Has any occurrence caused damage to property?

Error Mandatory field

Enter the text from the box. 60 seconds remaining. Can't read the text?

DECLARATION

  • The claim will be formally registered once written intimation is received by the company
  • List of documents & forms will be provided considering policy status is in-force on the date of event
  • Allianz Insurance Lanka Ltd reserves the right to ask for more documents and information’s to consider the claim
  • Claim proceeds are payable as per terms and conditions in the policy document
  • Notifications of claim, submission of claim forms and/or claim documents to the Company shall not be construed as admission of liability by the company
  • By submitting this form, you accept above terms and conditions.

How can we help you?

Need individual support or more information?