Claim Intimation Form

 

Fillout this form below to contact us. We will reply as soon as possible.

indicates required fields
Insured Name
Insured Company Name
TPA Name
Policy No.
Card ID no.
Cell Number
Email id
Patient Name
Sex
Hospital Name
Hospital Address
Admission Date
Diagnosis
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Terms and Conditions:-

*We are not the insurance company or TPA it is only add on facility to you.
*Intimate the claim within 24 hours of hospitalization.
*Non submission of the claim intimation within stipulated time of the policy terms will be result as claim NO CLAIM.
*Kindly contact Corporate Cell in hospital for Cashless Facility.