File a claim

File a claim
File a claim

Windscreen claim form

A. Policy information

Policyholder's full name

Policy/Certificate no.

B. Claimant details

Full name



Mobile no.

Correspondence address

C. Circumstances of windscreen damage

Type of policy

Vehicle number

Date of loss/accident

Country of accident?

Tell us how it happened

Which glass sustained damage? You may select more than one*

Do you intend to repair or replace your windscreen?

Interested in mobile repair service

Did you know?

You can get $100 cash when you choose to repair your windscreen instead of replace it!

Please select your damage

Name of workshop

D. Declaration, authorization & customer's data privacy consent

[Declaration] I/We confirm that I am/We are the claimant and/or the Policyholder and I/We declare that all the particulars given above are to the best of my/our knowledge true and correct.

[Authorization] I / We hereby consent to and authorize the medical practitioner involved in the claimant’s care to discuss and disclose treatment details and discharge arrangements with and to HSBC Life (Singapore) Pte. Ltd. I/We agree that a copy of this consent shall have the validity of the original.

[Customer’s Data Privacy Consent] In connection with my/our and/or the claimant’s claims, I/We give consent for HSBC Life (Singapore) Pte. Ltd. and their respective representatives or agents to collect, use, store, transfer and/or disclose the information (including that provided by sources other than myself) concerning me/us and/or the claimant, to or with all such persons (including any member of the HSBC Group or any third party service provider, and whether within or outside of Singapore and the Policyholder when claiming under a Group Policy) for the purpose of enabling HSBC Life and their respective representatives or agents to provide me/us and/or the claimant (where applicable) with services required of an insurance provider, including the evaluating, processing, administering and/or managing my/our and/or the claimant’s claims or the Policyholder Group Policy(ies) with HSBC Life (as the case may be), and for the purposes set out in HSBC Life’s Data Privacy Policy which can be found at (“Purposes”).

E. Final steps

Upload supporting documents
Please attach the relevant supporting documents with your claims submission to expedite claim processing.

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Please review and ensure all details are accurate before you proceed.

Thank you!

Thank you for your online Windscreen claim notification. Our claims officer is reviewing your submission and will update your claim status within the next 2 business days. Please quote our reference number when corresponding with us.