Please complete this form to obtain reimbursement of eligible medical expenses from Allianz Worldwide Care. Please use one Claim Form per person and per condition.
Claim Form - Editable (WORD Version)
Claim Form - (PDF Version)
For further details on our claims process, please see our ‘
How to Claim’ guidelines.
Allianz Worldwide Care offers policy documents in English, German, French, Spanish or Italian. However, for the convenience of our members, we also offer our Claim Form in the following languages:
Arabic Claim Form - (PDF Version)
Brazilian Portugese Claim Form - (PDF Version)
Bulgarian Claim Form - (PDF Version)
Latvian Claim Form - (PDF Version)
Russian Claim Form - (PDF Version)
