Personal Accident Insurance Claim

Claim Online

Click the button below to visit the Claim Form. Complete the form and click a button to submit it to us.

Personal Accident Claim Form

Download PDF

icon-claim1-2x Step 1: Download PDF form
icon-claim2-2x Step 2: Fill in details & Save PDF
  • The documents you download is a editable PDF, please fill your details directly to the form and Save! Therefore, you can easily email them back to us.

icon-claim3-2x Step 3: Submit Online
  • Before submitting, please prepare all evident files and saved PDF forms. Then, please send all documents to the following email address: axathai@axa.co.th to complete your online claim.

Personal Accident Insurance Claim Guideline

motor-2x-03 Hospital services within contract
motor-2x-05 Hospital services outside contract
motor-2x-07 The insured must submit the following documents for Claim Benefits;
  1. Accident Claims Form
  2. Original Receipt
  3. Doctor Certificate
  4. Copy of ID. Card of the insured
  5. Copy of Insurance Card. In case of the insured as a child. Please attach a copy of the parents ID. card (father or mother).
  6. If the insured want to transfer to bank account. Please attach a copy of book bank with certified the document.
  7. Any other documents the Company may require if necessary.
  8. Please mentioned if you would the original receipts return in case you can claim to the other insurance.
  1. Completed dismemberment claim form
  2. Medical Report
  3. Medical certificate (Issued by a doctor / hospital) or completed claim form (Medical Certificate section)
  4. Copy of police report of the Office of Royal Thai Police with the authorize signature from the police officer in charge of the case
  5. Signed copies of the identification cards and house registration of the insured and beneficiaries
  6. Any other documents the Company may require if necessary.
motor-2x-12 Claiming for Death Benefits from an accident
  1. Completed Death claim form
  2. Copy of police report of the Office of Royal Thai Police with the authorize signature from the police officer in charge of the case
  3. Death Certificate with the approval signature of the officer in charge of the case
  4. Copy of autopsy report with the approval signature of the police officer in charge of the case
  5. Copy of identification and house registration with the official changes that state the insured is deceased
  6. Any other documents the Company may require if necessary.
  1. Copy of identification and house registration of Beneficiary specific in policy In case specific in policy is “statutory heir”: Signed copy of identification and house registration of the insured’s parent
  2. Signed copy of Marriage Registration
  3. Signed copy of Beneficiaries’ Birth Certificate
  4. In case beneficiaries is company, please enclosed the signed copy of the Affidavit letter and identification by the Managing Director.
  5. In case the beneficiaries is company and would like the indemnity to heir, please enclosed the Company Registration Certificate (not less than 6 months) by the authorized person
  6. In case the anonymous beneficiaries, please enclosed the trustee letter by the court to be the authorized person and able to get the indemnity.
  7. Photo of the Funeral Ceremony (if any)
  8. Any other documents the Company may require if necessary
  1. Application Form
  2. Work Hour Memo
motor-2x-13 Contact information

AXA Insurance Thailand (Personal Accident Claims)
1168/67 23rd Fl., Lumpini Tower Rama IV Rd., Tungmahamek, Sathorn - Bangkok, 10120

Phone: 0-2118-8111
Fax: 0-2679-9792
E-mail: paclaims@axa.co.th

motor-2x-14 Indemnification
motor-2x-18 Contact Guideline as following;
  • The customer service on Monday - Friday call 0-2118-8111
  • After business hours and holidays, please contact AXA Hotline for 24 Hours call 0-2206-5488

AXA Insurance Thailand 23rd Fl., Lumpini Tower
1168/67 Rama IV Rd., Tungmahamek, Sathorn - Bangkok, 10120 or AXA Insurance Brach