Alico claim form 2026

1. Click ‘Get Form’ to open the alico claim form in the editor.
2. Begin by filling out the Employee’s Section. Enter your full name, date of birth, nationality, and contact number. Ensure all fields marked with an asterisk are completed.
3. Next, provide the Patient’s information including their full name and date of birth. Fill in the policy and certificate numbers as indicated on your medical card.
4. Select your preferred reimbursement method: Wire Transfer or Cheque. If opting for Wire Transfer, include your bank details such as bank name and IBAN.
5. In the Employer’s Section, enter the employer's claim number and ensure it is signed and stamped appropriately.
6. Review all sections for completeness. Attach any required original documents as specified in the Claim Submission Requirements section.
7. Finally, sign the authorization statement confirming that all information provided is accurate before submitting your claim.

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