The Insurance Claim Form is a crucial document used in Saudi Arabia when policyholders need to file a claim against their insurance policy. It serves as the primary mechanism for initiating the claims process and must comply with the regulatory framework established by the Saudi Central Bank (SAMA) and the Law on Supervision of Cooperative Insurance Companies. The form is designed to capture all essential information required for claim processing, including policyholder details, incident information, loss description, and supporting documentation. It incorporates elements ensuring compliance with Sharia principles, as all insurance (Takaful) operations in Saudi Arabia must adhere to Islamic financial principles. The document is structured to accommodate various types of insurance claims while maintaining consistency with SAMA's Insurance Claims Manual and anti-fraud regulations.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Your data doesn't train Genie's AI
You keep IP ownership聽of your docs
1. Claimant Information: Personal/corporate details of the policyholder filing the claim, including policy number, contact information, and identification details
2. Policy Details: Information about the insurance policy, including type of coverage, policy period, and any relevant endorsements
3. Incident Details: Comprehensive description of the incident including date, time, location, and circumstances leading to the claim
4. Loss Description: Detailed account of the loss or damage incurred, including estimated value
5. Previous Claims History: Declaration of any previous claims made under this or related policies
6. Third Party Details: Information about any third parties involved in the incident
7. Documentation Checklist: List of required supporting documents to be submitted with the claim
8. Declaration and Authorization: Claimant's declaration of truth and authorization for insurance company to investigate
1. Medical Information: Required for health insurance claims, including details of treatment, hospital information, and medical history
2. Vehicle Details: Required for motor insurance claims, including vehicle specifications, damage details, and police report information
3. Property Details: Required for property insurance claims, including building details, contents inventory, and security measures
4. Business Interruption: Required for commercial claims involving business losses, including financial impact details
5. Witness Statements: Optional section for claims where witnesses were present during the incident
6. Additional Insurances: Declaration of other insurance policies that might cover the same loss
7. Broker/Agent Details: Required if the claim is being submitted through an insurance intermediary
1. Schedule A - Supporting Documents: Detailed list of required documents based on claim type, including submission guidelines
2. Schedule B - Medical Report Template: Standardized template for medical professionals to complete for health-related claims
3. Schedule C - Damage Assessment Form: Detailed evaluation form for property or vehicle damage claims
4. Schedule D - Expense Record: Template for recording expenses related to the claim
5. Appendix 1 - Privacy Notice: Information about how personal data will be processed and protected
6. Appendix 2 - Claim Processing Timeline: Expected timeline and steps in the claim processing procedure
7. Appendix 3 - Terms and Conditions: General terms and conditions applying to the claim process
8. Appendix 4 - SAMA Rights Notice: Mandatory notice about claimant rights under Saudi insurance regulations
Find the exact document you need
Insurance Proposal
A SAMA-regulated and Shariah-compliant insurance application document used in Saudi Arabia to establish insurance coverage terms and conditions.
Download
Insurance Claim Form
A SAMA-compliant Insurance Claim Form for processing insurance claims in Saudi Arabia, adhering to local regulations and Sharia principles.
Download
Accident Claim Form
A Saudi Arabia-compliant form for filing insurance claims following vehicular accidents, adhering to local traffic laws and insurance regulations.
Download
Medical Claim Form
A comprehensive Medical Claim Form for use in Saudi Arabia, designed to process healthcare expense reimbursements in compliance with Saudi insurance regulations.
Download
Insurance Reimbursement Form
A SAMA-compliant insurance reimbursement claim form for use in Saudi Arabia, designed for processing various types of insurance claims and reimbursements.
Download
Insurance Verification Form
A Saudi Arabia-compliant form that officially verifies insurance coverage details and policy status under SAMA regulations.
Download
Car Insurance Form
A SAMA-compliant car insurance form for use in Saudi Arabia, detailing vehicle coverage terms and conditions under Saudi law and Shariah principles.
Download
Dental Claim Form
A standardized form for dental insurance claims in Saudi Arabia, compliant with local healthcare and insurance regulations.
Download
Subrogation Form
A legal document under Saudi Arabian law that transfers recovery rights from an insured party to their insurer following a claim payment, compliant with local regulations and Sharia principles.
Download
Insurance Declaration Form
A SAMA-compliant insurance declaration form used in Saudi Arabia for documenting risk factors and essential information for insurance coverage.
Download
骋别苍颈别鈥檚 Security Promise
Genie is the safest place to draft. Here鈥檚 how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; 骋别苍颈别鈥檚 AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)