Have a question?
Call us in Bahrain at +973 17 311 884.
Alternatively, you can call our Customer Service unit at
+971 6 556 2566
Find a Form
Here you can find a comprehensive set of forms that will help you in making changes to your policy or in filing a claim. To download a form, just click on a link below.
The following forms are in PDF format, so please make sure you have Adobe Acrobat Reader in order to view these forms.
Claim Forms
Select a claim form from the links below. If you need help on which form to use for your claim, visit our “Make a Claim” section. Here we have outlined the process and the documentation requirement for every type of claim.
- Final Proof of loss
- CL-2 : Final Proof Of Loss (Statement of Physician)
- Accident Benefits-Employer’s Statement (English)
- Accident Benefits- Employer's Statement (Arabic)
- Form 321 - Permanent Total Disability – Claimant Statement
- Form 322 - Permanent Total Disability – Physician’s Statement
- CL-39 : Proof of Death – Claimant Statement
- CL-40 : Proof of Death – Physician’s Statement (English)
- CL-40: Proof of Death - Physician's Statement (Arabic)
- CL-20 : Partial Disability / Accidental Dismemberment Claim Report – Physician & Claimant Statement Form
- In Patient Medical Reimbursement Claim Form
- Flight Delays Claim Form
- Baggage Delays / Baggage Loss Claim Form
- Disbursement Authorization
- Beneficiary Endorsement
Individual Policies
You can use the forms provided here to amend your existing policy or to take advantage of some of your policy features. Download the appropriate form, complete and sign the same and then just fax or mail it to our Customer Service Department.
Fax us on +971 6 556 2577 or send the form to
Customer Care
American Life Insurance Company,
Crescent Tower Bldg, 15th Floor,
PO Box 5984, Sharjah, UAE.
- Change of Address Form
- Declaration & Undertaking regarding a Lost Policy Form (English)
- Declaration & Undertaking regarding a Lost Policy Form (Arabic)
- Policy Loan Request Form
- Policy Loan Request Form - Part II
- Policy Maturity and Release Form (English)
- Policy Maturity and Release Form (Arabic)
- Policy Surrender and Release Form
- Policy Partial Maturity and Release Form (English)
- Policy Partial Maturity and Release Form (Arabic)
- Policy Partial Surrender and Release Form
- Premium Allocation Form
- Request for Policy Change - Life (Change of Name, Beneficiary, Method of premium payment) (English)
- Request for Policy Change - Life (Change of Name, Beneficiary, Method of premium payment) (Arabic)
- Request for Policy Change - Personal Accident (Change of Name, Beneficiary, Method of premium payment)
- Request for Transfers Between Sub accounts
- Request for addition of Recovery Benefit Plan Rider
- Specimen of Signature
Group Policies
If you hold an Alico policy through your employer, use the forms provided below to make a claim or to request a pre-determination approval. Please note that some of these forms may require verification by your HR Department.
- Indemnity medical Claim Form
- Indemnity medical Claim Form- HSBC Clients
- Individual Enrollment Form
- Pre-determination Approval Request Form
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Providing for your family & business
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Saving for your child's future.
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Reassurance when you travel