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Formulir

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Claim

Nasabah yang terhormat, bagi Anda yang ingin melakukan klaim terhadap polis, cukup isi formulir klaim di bawah ini, selanjutnya biarkan kami menindak lanjuti dan bekerja untuk Anda.

COMPLETE DATA DATA BELOW:

* Must be filled

TYPES OF POLICY

INDIVIDUAL

GROUP

Required Field

POLICY NUMBER

HOLDER NAME

Required field.

DATE OF BIRTH

SEX

Man

Woman

Required field.

PARTICIPANTS NAME

Required field.

TYPES OF CLAIM

Required field.

DATE OF THE INCIDENT

TELEPHONE

Required field.

VERIFICATION

Required field.

KANTOR PUSAT: Menara Jamsostek Lantai 5. Gedung Menara Utara.

Jl. Gatot Subroto No. 38 Jakarta Selatan, Daerah Khusus Ibukota Jakarta 12710 | Telepon: 021-22773108 | Fax: 021-22773109

PENJUALAN & PEMASARAN: Telepon: 021-22773108 | Fax: 021-22773109

LAYANAN PELANGGAN: Telepon: 021-22773110 | Fax: 021-22773109 | Email : care@capitallifesyariah.co.id

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