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G Personal Accident Claim Form The company does not admit liability by the issuance of this form. The issued form must be completed and returned within seven (7) days of receipt. No claim can be admitted unless Medical Certificate from a duly qualified and Registered Medical Practitioner, on the form annexed be furnished at expense of Insured. Claims Fax No : 6225 9887 Insured Insured: Age: NRIC No: Policy No: Sum Insured: Address: Tel No/email: Occupation : A.

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