Unofficial Sukoon helper

Reimbursement claim form

Fill in your details, then download a completed PDF. Everything runs in your browser — nothing is sent to a server.

Not affiliated with or endorsed by Sukoon Insurance.

1.Claimant details

Full name*

Card number*

Phone number*

Email address*

Save my details for next time

Hospital or doctor name

Date of treatment

Amount claimed

AED

Skip this if you don't have the amount yet

Treatment was in the UAE

To be completed by the treating doctor.

Treatment type

In patientAdmitted to the hospital for at least one overnight stayOut patientTreated and discharged the same day, without an overnight stay

Work-related injury

YesNo

Chief complaint

The main symptom or reason for the visit

Diagnosis

As written by the doctor, using an ICD-10 compliant code

Treatment received

Consultation, blood tests, physiotherapy, medication