Income Protection Insurance (Claim Form)

Please click the following button to download the claim form and submit it offline. Download Claim Form

  • To be completed by the Life Insured or Claimant in BLOCK letters.
  • Please answer all questions, use "not applicable" (N/A) as appropriate instead of leaving it blank. Counter-sign where amendments/alterations are made in the form.
  • The filing of this claim form is not to be construed as an admission of liabilities by the Company.
  • Please click here to see the documents that are required to make a claim.

Policy Holder Details

Claim Details



Description of the claim

Please refer to the required list of documents to support your claim

Accidental Death






Hospital Cash

Involuntary Loss of Employment

I hereby confirm that I have been terminated from my employment as of date of termination mentioned above and I am currently not employed. I undertake that I will inform Orient Insurance PJSC immediately should I be re-employed.

I am aware and acknowledge that the ILOE claim will discontinue once I am re-employed

Authorization: I hereby authorize any physician, hospital, insurer/medical information bureau or other organization or person having any records, data or information as may be requested by Orient Insurance or their representative. I understand that in executing this authorization, I waiver the right for such information to be privileged. A Photocopy or scanned copy of this authorization shall be considered as effective and valid as original

Upload Documents (Passport copy, Emirates ID etc. Maximum Size allowed = 2 MB, Formats allowed = pdf, jpg, jpeg, png, gif, tif.)