MiWay | Puma Insurance

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1. Policy Details

Policy number*

Policy Product*

Mipet for Miway

Policy holder name*

ID Number*

Phone number*

2. Pet Details

Pet name*

Date of Birth*

Breed*

Pet type*

Cat

Dog

Gender*

Male

Female

3. Claim details

Type of claim*

First claim?*

Yes

No

Name of treating vet*

Would you like us to pay your vet directly?*

Yes

No

Date of treatment*

Date symptoms first manifested?*

What was the Vet's diagnosis?*

Has the condition been treated in the last 30 days?*

Yes

No

Did the illness/injury result in the death of the pet?*

Yes

No

Date of death*

Are you currently insured or have any other insurance policies in place which may cover this risk?*

Yes

No

Please advise who you are covered with*

What is the total amount of this claim?*

4. Please upload your claim documents

Detailed invoices/Vet bill*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 32 MB.

Full description of accident report*

Date of accident*

First Vet visit for accident*

5. Disclosure

Signature of Policy Holder*

Your Email Address*

Online Claim Submission Form

1. Policy Details

2. Pet Details

3. Claim details

4. Please upload your claim documents

5. Disclosure