Accidental Death & Dismemberment

1. Please print and fully complete the Claim Notification Form. Once done, sign the form, and then mail the form, along with all applicable documents noted below, to the Claims department.
   
   Allianz Global Assistance Claims Department
   P.O. Box 277
   Waterloo, Ontario, Canada N2J 4A4
   
   
2. Police report including any witness statements
   
   
3. Coroner's report
   
   
4. Death Certificate
   
   
5. Emergency Room report, if applicable
   
   
6. In the event of death, please include a copy of the insured's Last Will & Testament, indicating Executorship.
   
   
7. Depending on the claim, additional information may be required.

To assist the processing of your claim, please provide the requested information, including a valid e-mail address. Please note that the security setting of your e-mail account needs to be properly set to avoid our e-mails being directed into your spam folders.