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Sub Banner Unduh Formulir Klaim

We provide the best claims service
We help process your claim quickly and easily

Tabs Unduh Formulir

  • SUPPORTING DOCUMENT

  • CLAIM FORMS

  • Claim Delivery Address

Title Unduh Formulir Klaim

Download the Claim Form

To facilitate the administration process and speed up the services we provide, the forms you need are attached in submitting new applications, claims and others.

Asset Publisher

Claim Form Individu
1. Pembatalan Polis.pdf
2. Formulir No Claim Bonus.pdf
3. Form Surat Kuasa.pdf
4. Form Pengajuan Klaim.pdf

Asset Publisher

Group Insurance Customer
1. Form Dana Tunai Harian.pdf
2. Surat Keterangan Dokter Untuk Klaim Meninggal Dunia.pdf
3. Form Kronologis Klaim Meninggal Dunia.pdf
4. Formulir Rawat Inap.pdf
5. Formulir Klaim Rawat Jalan.pdf
6. Formulir Konfirmasi Peserta
7. Formulir Pengajuan Klaim Prospens.pdf

Asset Publisher

Risk Claim Form
1. Surat Kuasa Permintaan Data Medis.pdf
2. Surat Keterangan Dokter Untuk Klaim Meninggal Dunia.pdf
3. Formulir Rawat Jalan.pdf
4. Formulir Rawat Inap.pdf
5. Formulir Meninggal Dunia Dokter.pdf
6. Formulir Klaim Rawat Jalan.pdf
7. Form TPD Tertanggung.pdf
8. Form Tambahan Klaim untuk TPD (diisi oleh dokter).pdf
9. Form Surat Kuasa.pdf
10. Form Rawat Inap (diisi oleh Dokter).pdf
11. Form Pertanyaan Tambahan Untuk Kecelakaan Cidera.pdf
12. Form Pengajuan Klaim.pdf
13. Form Kronologis Klaim Meninggal Dunia.pdf
14. Form Klaim Britama Rencana.pdf
15. Form Critical Illness Dokter.pdf

BRILife Contacts

  • 1500087
  • 0811-935-0087 (text only)
  • cs@brilife.co.id

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PT Asuransi BRI Life is licensed and supervised by the Financial Services Authority

PT Asuransi BRI Life is licensed and supervised by the Financial Services Authority
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