skip to main content

To file a claim, an application form must be fully and accurately completed by the policyholder or beneficiary. Each claim must be submitted with the original claim form and its requirements.

Steps for Claim Procedure

Chubb Life provides each policy with a claim form. However, you still can obtain a new one via any of the following ways:

  1. Through Chubb Life Care Hotline 14087
    Monday–Friday, 08.00 AM to 06.00 PM
  2. Visit Chubb Life Marketing Offices
  3. Send a Request Email to
  4. Download the e-form of Formulir Pengajuan Klaim
  5. Contact your respective agent.

List of Documents Needed for Claim Procedure

Policyholders need to complete the following documents:

  1. Formulir Pengajuan Klaim Kesehatan (FPKK)
  2. Formulir Pengajuan Klaim Jiwa (FPKJ)
  3. Copy of Policy Holder's identity card
  4. Original (or legalized copy of) Medical Records (resume) from the hospital filled and signed by Doctor
  5. Original (or legalized copy of) laboratory and radiology test results (if any)
  6. Original (or legalized copy of) hospitalization receipts and/or doctor bills
  7. Original (or legalized copy of) statement letter from Police if claim caused by traffic accident
  8. Original (or legalized copy of) statement letter from the Indonesian Embassy if the accident occurred overseas

Chubb Life provides additional claim forms which must be completed and attached with 7 listed documents above when policyholders want to make a claim for:

  1. Death Claim Submission: Formulir Klaim Meninggal (FKM)
  2. Disablement Claim Submission: Formulir Klaim Cacat (FKC)

Information for Hospital Provider

Click here to find out about PT Chubb Life Insurance Indonesia’s Hospital Provider List:

Consent Statement Document

Click here to find out about Consent Statement Document: Consent Statement Document