Have a question?
Call us at
+962 6 593 0912
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.
- CL-2 : Final Proof Of Loss
- CL-3 : Employer’s Statement
- 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
- CL-20 : Partial Disability / Accidental Dismemberment Claim Report – Physician & Claimant Statement Form
- In Patient Medical Reimbursement Claim Form
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 +962 6 5930049 or send the form to
Customer Care
American Life Insurance Company,
Jabal Amman – Fourth circle.
Building number 91 Zahran Street
PO box 1307
Amman 11118 Jordan
- Change of address form
- Request for policy change (CSC 27) - Arabic
- Request for policy change (CSC 27) - English
- Application and health certificate (CSC 19) - Arabic
- Application and health certificate (CSC 19) - English
- Re-instatement and declaration of health condition (CSC 20) - Arabic
- Re-instatement and declaration of health condition (CSC 20) - English
- Appointment of irrevocable beneficiary (POS A27) - Arabic
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