Claim Form - Damage

We are sorry to hear that your device has been damaged. To assist you in making a claim, we have
outlined the steps you must follow and a checklist to ensure the process is as smooth as possible.

Definitions:
Participant Member the individual (s) named on the Certificate who have purchased a
new Mobile Phone(s) and registered his/her line with the network
operator

Excess Fees Payable by the Participant Member. Excess Fees applies to the
insurance industry and comes into effect when you claim against
your insurance policy, it is the amount that you are liable for
contributing towards the replacement / repair costs of an item
that you claim

What you need to do:

1. The Participant Member must complete the claim form. Complete each section in as much
detail as possible.
2. Ensure that you have done your back up and remove the sim card from the phone
3. Pack the phone in a box, wrap it up for the courier to collect the damaged phone
4. Please submit the claim form to claims@tecprotec.com.my or fax to: 03-79549141
5. To download copy of the Terms and Conditions, please go to www.tecprotec.com.my/MAA

What happens next:

Our claims team will be in touch with you within 1 working day upon receiving the complete
documents. If you do not hear from us after 48 hours of submission, please email us at
claims@tecprotec.com.my

iPhone users:
1. If your iPhone is within the 1st year of warranty, upon verification, we will advise you to walk
in to Maxis Center to do a swap. Maxis will exchange your damage unit for you.
2. You will need to make advance payment to Maxis before they provide you with a replacement
unit – amount will be determined by Maxis personnel once they diagnose your phone. We will
than reimburse you the money
3. Upon receiving the receipt & supporting document, please forward to our team at
claims@tecprotec.com.my with your bank details (Full Name, Bank Account No, Bank Name)
for us to process the reimbursement
4. Please note there is an Excess Fees for all iPhone repairs. The total reimbursement will be
less the Excess Fees
5. Payment will be made within 14 days upon receiving the receipt from you
Other Phone Models:

1. We will arrange for the courier to collect the phone from you and send to the repairer
2. Once we receive the approval from the Underwriter, we will proceed to repair your phone
3. If you did not hear from us within 5 working days (upon collection of phone), it means that
there is no issue with your claim – your phone will be repaired and delivered to you within 7
working days. For iPhone / iPad users, there will be Excess Fees to be paid before we release
your repaired phone.
4. Should there be any changes, our team will contact you

Timeline:

Upon receiving complete documents and verification from our claims team:

Day 1 The courier will collect the phone from you

Day 2 Our repairer will receive your phone
Day 3 & 4 Our repairer will diagnose your phone and we will send the report for approval
Day 5 & 6 Your phone will be repaired and ready to be delivered to you
Day 7 You will receive your repaired phone

Timeline depends on the severity of the phone damage. Should there be any changes, our team will
update you accordingly.

Section A - Participant Member Details

Name of Participant Member :

Address :

Email address :
Date of birth :
Identification Card No :
Contact Telephone No : Alternate Telephone No :
Certificate No :
 Section B - Claimant Details
Please complete the section below if claimant is NOT the Participant Member
Name of claimant :
Address :

Contact Telephone No : Alternate Telephone No :

Identification Card No :
Relationship with the Policy Holder :
(please provide supporting document : eg; Marriage Cert, Birth Cert, Divorce Decree) :

Section C - The Mobile Phone/ Device

Particulars of the device to which this claim applies
Mobile Number :
Make (eg : iPhone 4) :
Model & Color (eg : 16G, Black) :
IMEI No : Date of Purchase :
Have you ever sustained a loss, or claimed against any insurer
in connection with mobile phones in the past five (5) years? Yes No
Do you have any other protection or insurance that would also
cover this device? Yes No
Who is your network operator (the company you pay your bills
to) for this device?

Section D – Claim Information

Please provide the full description of how Please select the relevant type of damage :
the damaged occurred?
Accidental Damage Liquid Damage

Date :
Time :
Location where damage occurred :
 Section E - Declaration
I declare the particulars given on this form are true and correct, and I have completed this form myself.
I agree that any device that cannot be repaired and is replaced becomes the property of MAA Takaful Bhd
and can be disposed or dealt with by the latter as necessary to mitigate the loss.

Signed : Dated :
THIS IS A LEGAL DOCUMENT. IT IS A CRIMINAL OFFENCE TO KNOWLINGLY GIVE FALSE OR MISLEADING INFORMATION.
Under the Theft Act 1968. Section 15 of the Theft Act 1968 states that; “A person who by any deception dishonestly obtains property belonging to
another, with the intention of permanently depriving the other of it, shall on conviction be liable to imprisonment for a term not exceeding ten years
If you fail to finalise your claim within 60 days of occurring, you will be requested to lodge a new claim in order to complete the process. It is a
condition in the Summary of Terms and Conditions that filing a false or fraudulent claim will invalidate the claim and result in the claim being
rejected.

Checklist
• You have the damage phone ready with you
• All sections of the claim form completed in full by Participant Member
• Claim form signed and dated by Participant Member
• Proof of purchase & completed claim form submitted
• Data backup, sim card removed and phone packed in a box

Section F - For office use: