Downloads / Forms

1. Medical Claim
   1. Hospital & Surgical Claim Form

2. Family Claim
   1. Family Claims Form
   2. Claim Release Form
   3. Family Claim Medical Report
   4. Attending Physician Statement For Death Claim
   5. Attending Physician Statement For Total/Partial Permanent Disability Claim
   6. Attending Physician Statement For Comprehensive Personal Accident Benefit (CPAB)
   7. Attending Physician Statement For Cancer
   8. Attending Physician Statement For Encephalitis or Bacterial Meningitis
   9. Attending Physician Statement For Kidney Failure
   10. Attending Physician Statement For Stroke
   11. Attending Physician Statement For Heart Disease
   12. Attending Physician Statement For Systemic Lupus Erythematosus (SLE)

Request to Change

1. Request for Change Form (Alliance Bank)
2. Request for Change Form (Ambank)
3. Request for Change Form (Bank Kerjasama Rakyat Malaysia)
4. Request for Change Form (Bank Muamalat Malaysia)