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AXAMACAUAboutAXAPDFKBDOWNLOADAccidentalDeathorDismembermentHealthClaimReimbursementFormWethankyouinadvancefor providingustheAXAHealthDentalinsuranceIPID.YoucanfillitinandprintitatyourownconvenienceLayanannasabahAXAMandiri.Europeanand WorldwideTravelCoverIPIDmembershipnumberWewouldliketoshowyouadescriptionherebutthesitewon’tallowusDate:Themembermustcomplete thebackofthisformPolicyVerificationCashBack(Levels1,2,3)IPIDDownloadtheAXAreimbursementformviaatrustedsourcelikeorthecompany’ssite andtakeaprintoutifyouwishtosubmityourclaimviaoff-lineSubmityourclaimswitheaseEmployeeBenefits–HospitalisationClaimPDFWewouldliketo showyouadescriptionherebutthesitewon’tallowusDownloadDocumentThisformistobefilledoutbytheclaimantandpolicyownerMedicalDownload DocumentYoucandownloadanAcrobatReaderwritableversionofthisformfromthesiteIftheclaimantisunderyearsold,theparent/guardianshould accomplishitinbehalfoftheminor.Downloadformulirasuransikesehatan,jiwa,pengajuanklaim,perubahandatapolis,permohonan,danlain-lainMaintainthe privacyThisformistobefilledoutbytheclaimantandpolicyowner.ThisrequestforreimbursementissubjecttovalidationandapprovalPleasefindaclaimform forcompletionenclosedInsuredMembersInaddition,thefollowinginformationisneededtoprocessyourclaimProvidescoverageforemergencymedical expensesresultingfromanaccidentalinjuryorsicknessincurredwhileonthetripBookingconfirmation(E-ticket,proofofpurchaseofcruisetickets,trainpasses, etc)InvoicesfromallprovidersofmedicalservicesandsuppliesTreatmentplan,recommendedmedications,investigations,and/orprocedures/PrintIfthe claimantisunderyearsold,theparent/guardianshouldaccomplishitinbehalfoftheminorThisrequestThispartoftheclaimformaimsatgatheringadditional informationonthememberinordertofacilitatetheprocessingoftheclaimCashBack(Gold,SilverandBronze)IPIDSubmit,trackandmanageyour reimbursementclaimseasilyandsecurelyfromanywhereintheworld.ThispartofAXAMacau,DownloadLibrary,Claimforms,ProductBrochure.Easilyaccess ourProviderDirectBillingClaimFormCompletedclaimform