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Insurance Claims Application Form
A. DETAIL OF CLAIMS
MICI Policy Number / Cover Note Number
*
Please add your registered MICI Policy Number / Cover Note Number
Claim Category
*
Choose an option
Personal / Individual Insurance
Business Insurance
Select what type of claim
Insurance to Claim
*
Choose an option
Personal Accident Insurance
CTPL Insurance
Comprehensive Insurance
Pet Insurance
Phone Insurance
Fire and Property Insurance
Marine Insurance
Desktop Insurance (PC Protect+)
Select the insurance product you'd like to file a claim.
Brief Description of Loss
*
0 / 180
Date of Loss
*
Place of Loss
*
B. CLAIM APPLICANT DETAILS
First Name
*
Middle Name
Last Name
*
Email Address
*
Mobile Number
*
Company Name
*
Company Landline
Privacy Policy / Terms & Conditions
*
Yes, I agree with the privacy policy and terms and conditions. By agreeing to submit the indicated information above, the policyholder agrees that all the information is true and the incident for the claim has happened within the Philippines. Metropolitan Insurance Company Inc. (MICI) would not be held liable for false information. Any form of misleading information can lead to further delays in processing your claims or inquiries.
Submit Claim
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