• The insured can contact Dhipaya Hotline at (66) 0-2696-3686 to receive medical treatment, in overseas hospitals around the world without the reserving of any payment, according to the coverage limit in the policy conditions.  
• In the event that the insured does not contact the company during the hospitalization abroad, the insured himself can reserve for the medical expenses in advance, and then bring English version of the document, receipt and medical certificate to claim for the reimbursement from the company later.  
• The company will reimburse in baht currency compared to the exchange rate on the date of the hospitalization.

     *The claim will be considered according to the policy conditions
     **It depends on the requirements or policies of medical facilities the insured receive the treatment in each different country."

1. A01-1 Form
2. Copy of insurance policy
3. E-Ticket or Boarding pass
4. Travel itinerary
   • Flight Depature and Flight Destination
   • Date and Time of traveling
5. Original medical Reciept from every hospital
6. Any evidence that you pay for medical fee such as debit card reciept, statement, or evidence of cash tranferation
7. Medical Certification
8. X-ray result including medical record (if any)

You can submit document as pdf file by scaning and send it to email [email protected] for preliminary check

1. Claim Form (A01-1) Pages 1 to 3 
2. Documents certifying the loss or damage (Property Irregularity Report) from the hotel management, the management of the carrier or airline in the case that the loss or damage is in the control of the hotel staff, the carrier or the airline 
3. Local police diaries at the scene of the accident in the event of loss or damage caused by severe coercion (English or Thai-English translation)  
4. List of the detail, model, brand, size, useful life and the price of the lost or damaged property 
5. A copy of receipt or proof of purchase of luggage or personal belongings (optional) 
6. Photos of damaged luggage or property 
7. Copies of proof of travel of the insured such as a copy of the flight ticket/ E-Ticket/ Boarding Pass/ a copy of the passport page with the entry-exit stamp on it 
8. A copy of the insured’s passport 
9. A copy of bank passbook (savings/ current) of the insured 

1. Compensation Claim Form (A01-1) Pages 1 to 3 
2. A copy of the passport of the insured 
3. A copy of the travel evidence of the insured that shows the travel time from the original schedule and actual time the flight takes off  
4. Documents confirming the delay from the airline or carrier that clearly explains the reason for the delay (Property Irregularity Report: PIR)  
5. A copy of bank passbook (savings/ current) of the insured

1. Claim Form (A01-1) Pages 1 to 3 stating the date and time of arrival at destination and the date and time of receiving the luggage from the airline 
2. Documents confirming the delay from the carrier (Property Irregularity Report : PIR)  
3. Original receipt of the purchases of necessary clothing or personal items (which clearly specifying each item.) 
4. A copy of the insured’s travel evidence, such as a copy of the flight ticket/ E-Ticket/ Boarding Pass/ a copy of the passport page with the entry-exit stamp on it 
5. A copy of the passport of the insured 
6. A copy of bank passbook (savings/ current) of the insured

1. Claim Form (A01-1) Pages 1 to 3 
2. Medical certificate or death certificate in case of cancellation of the trip due to death/ serious injury or illness of the insured or other family members 
3. Original receipt of damages from the cancellation of the trip (such as airfare, accommodation charge paid in advance by the insured) or the invoice of the additional fines that the insured has to pay, or proof of every item which needs the refund  
4. A copy of the passport of the insured  
5. A copy of the travel proof of the insured (who made a reservation in advance.) 
6. A copy of bank passbook (savings/ current) of the insured

1. Claim Form (A01-1) Pages 1 to 3 
2. Local police diaries where the incident occurred (English or other languages must be translated into Thai or English) 
3. Original receipt showing the cost of requesting temporary travel documents at an overseas embassy, and various expenses during the process to obtain new travel documents, such as travel expenses and additional accommodation costs.  
4. Original receipt when applying for a new passport in Thailand 
5. A copy of the insured’s travel evidence, such as a copy of the flight ticket/ E-Ticket/ Boarding Pass/ a copy of the passport page with the entry-exit stamp on it 
6. A copy of the passport of the insured 
7. A copy of bank passbook (savings/ current) of the insured

1. Claim Form (A01-1) Pages 1 to 3 
2. Documents confirming the incident from the airline or airport stating the cause and duration of the hijacking on the plane. 
3. A copy of the insured’s travel evidence, such as a copy of the flight ticket/ E-Ticket/ Boarding Pass/ a copy of the passport page with the entry-exit stamp on it 
4. A copy of the passport of the insured 
5. A copy of bank passbook (savings/ current) of the insured

1. Claim Form (A01-1) Pages 1 to 3 
2. A copy of regular records of the local police at the scene of the accident 
3. Medical certificate and receipt of medical expenses in the event that the insured have caused death or injury to others  
4. Repair receipt or the receipt used for reimbursement and a confirmation letter from the store in the event that it is necessary to purchase a particular item due to the damaged caused by the insured  
5. Subpoena or court order or decree (if any) 
6. A copy of the passport of the insured  
7. Photos and evidence showing loss or damage to the third parties  
8. A copy of the insured’s travel evidence, such as a copy of the flight ticket/ E-Ticket/ Boarding Pass/ a copy of the passport page with the entry-exit stamp on it 
9. A copy of bank passbook (savings/ current) of the insured

1. Claim Form (A01-1) Pages 1 to 3 
2. A copy of death certificate 
3. A copy of the autopsy report certified by the investigation officer, the owner of the case 
4. A copy of the daily record report on the case certified by the inquiry officer, the owner of the case 
5. A copy of ID card of the insured  
6. A copy of house registration of the insured with a “dead” disposition
7. A copy of the national ID card and a copy of the beneficiary’s house registration  
8. A copy of the passport of the insured 
9. A copy of the insured’s flight ticket and/or evidence of the insured’s travel 
10. A copy of bank passbook (savings/current) of the beneficiary/ legal heir  
11. A letter confirming the accident from a commercial airline (in case of an accident occurring while traveling on board) 

1. Claim Form (A01-1) Pages 1 to 3 
2. A report of physician’s opinion in the case of Disability Assessment (A04) 
3. A copy of the passport of the insured  
4. A copy of the insured’s flight ticket and/or evidence of traveling of the insured  
5. A copy of bank passbook (savings/ current) of the insured 
6. A letter confirming the accident from a commercial airline (in case of an accident occurring while traveling on board) 
7. A doctor’s opinion sheet in case of the eyesight loss assessment (A05) 

1. In case of claiming compensation according to other benefits in the policy, the insured is required to check the list of documents for claiming compensation from the policy details. 
2. The coverage depends on the policy that has been made with the company, and the relevant documents must be available in English or Thai language only.
3. The period to determine the payment will take 7-10 days after the company receiving all necessary documents. 
4. In the case that some documents used for claim consideration are receipts, the company will accept the original ones only.  
5. In the case that the insured is an adolescent, there are some additional documents required for the claim package as follows:
   • A copy of birth certificate 
   • A copy of bank passbook (savings/ current) of the minor’s father or mother to receive the compensation for their child. 
   • A copy of ID card of the minor’s father or mother to receive the compensation for their child.  

When you have already specified a claim form and prepared documents Please send the original package by registered mail or EMS to 
Personal Health and Accident Claims Department, 15th floor 
Dhipaya Insurance Public Company Limited 
1115 Rama 3 Road, Chong Nonsi, Subdistrict, Tannawa District, Bangkok 10120 

at Health Claims Department via Email: [email protected]