> Private Car
> Personal Accident
> Group Personal Accident
> Liability & Financial Lines
> Corporate Travel
> Commercial Motor
> Work Injury
Please complete the Domestic Maid Medical Claim Form that is available in our website and mail it to ERGO Insurance Pte. Ltd together with the following supporting documents:
For Claims below $200 (Original documents are not required), please submit through our website, Or email to email@example.com
Simply submit your claims via our online claim portal by following simple steps indicated below.
*Note: Each claim is unique and will be assessed based on its merit. We would, from time to time, request further information from you, for us to assess your claim. You do not need to send us original documents, however we require you to keep all original documents for 6 months from the date of submission, in the event we need to sight them. We would like to remind you, that we will deny claims that are either dishonest or of fraudulent nature, and such claims will be referred to the appropriate authorities.
Name of Policyholder*
Bank SWIFT Code*
Account Holder's Name*
Please provide your bank details for faster claims processing. Once approved, your claim amount will be credited into your bank account.
We will only credit into the Policyholder’s/Insured Person’s account.
Notification of payment will be sent to your email address stated in your details. The company shall:
(i) be discharged from all liability under this claim and
(ii) not be liable for any and all losses incurred by you, as a result of you providing the company with inaccurate bank account number under this section for the payment of this claim.
Claim Form* (jpg, png, tif, gif, pdf, zip) Please download, complete claim form and upload here
Medical report or inpatient discharge summary* (jpg, png, tif, gif, pdf, zip)
Copy of maid's work permit* (jpg, png, tif, gif, pdf, zip)
Original medical bills and certificates (not applicable for outpatient claims) (jpg, png, tif, gif, pdf, zip)
Referral letters (if any) (jpg, png, tif, gif, pdf, zip)
Copy of contractual agreement between you and the maid, stating the maid’s monthly salary (not applicable for outpatient claims) (jpg, png, tif, gif, pdf, zip)
Monthly levy to MOM (not applicable for outpatient claims) (jpg, png, tif, gif, pdf, zip)
Any other supporting document (1) (jpg, png, tif, gif, pdf, zip)
Any other supporting document (2) (jpg, png, tif, gif, pdf, zip)
Imp Note: The acceptance of this online claim form does NOT constitute an admission of liability by ERGO Insurance Pte Ltd. or waiver of its rights.
Phone: +65 6829 9199/ +65 98276193 (office hours)
Fax: +65 6829 9247
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