{1}
##LOC[OK]##
{1}
##LOC[OK]##
##LOC[Cancel]##
{1}
##LOC[OK]##
##LOC[Cancel]##
CLAIM AND CUSTOMER INFO
1
CUSTOMER INFO
2
Send OTP
3
OTP VERIFICATION
1
CLAIM INFORMATION
2
DOCUMENT UPLOAD
3
TERMS AND CONDITIONS
4
FINAL SUMMARY
Customer Info
Policy No
*
Passport No./Iqama No.
*
OTP VERIFICATION
Mobileno
*
Email ID
*
Choose OTP
*
EMail OTP
Mobile OTP
OTP will be sent your mobile and Email
سيتم إرسال رمز التحقق إلى هاتفك الجوال والبريد الإلكتروني
Send OTP
OTP VERIFICATION
Please Enter OTP
OTP has been sent your mobile and Email
تم إرسال رمز التحقق إلى هاتفك الجوال والبريد الإلكتروني
CLAIM DETAILS
Policy No
*
Qutation No
First Name
Middle Name
Last Name
First Name (Ar)
Last Name (Ar)
Email ID
National ID/Iqama ID
Gender
Select
Male
Female
Other
Mobileno
Date of Birth
Nationality
Passport No
City
DOCUMENT UPLOAD
DocumentUpload
*
Document Upload
Please upload all documents related to your accident that you want to claim
TERMS AND CONDITIONS
I declare that the information given and all attachment are clear and correct. According to the established rules of gathering and exchanging the Travel insurance information, I agree to grant Walaa Cooperative Insurance Company the right to use, disclose and exchange the insurance information with the relevant authorities for all details relating to this claim.
Upon receiving the compensation entitled for me subject to the attached estimates and the policy conditions through transfer to my entered account, I, hereby discharge and clear Walaa Cooperative Insurance Company completely and finally of all responsibilities which may entail from this claim whether currently or in the future. I also acknowledge that I have been compensated.
FINAL SUMMARY
Thank you
Claim Request Number
National ID/Iqama ID
Policy No
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SUMMARY DETAILS
Customer Info
Policy No
Qutation No
First Name
Middle Name
Last Name
First Name (Ar)
Last Name (Ar)
Claim Info
Email ID
National ID
Gender
Mobileno
Date of Birth
Nationality
Passport No
City
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