Get Lic Form No 3784 Revised 2020-2025

Filling out Lic Form No 3784 Revised online can be a straightforward process when guided correctly. This document serves as a claim form to be completed by the medical attendant of a deceased individual and requires specific details to facilitate the claim under a policy.

Follow the steps to complete your Lic Form No 3784 Revised online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in the personal details of the deceased in section one. Include their full name, address, and occupation. Ensure that all information is accurate and clearly presented.
3. In the second section, indicate the apparent age of the deceased at the time of death. If applicable, describe the relationship you had with the deceased and any distinguishing marks for identification purposes.
4. Section three requires you to provide the time, date, and place of death. Be precise in your entries, as these details are crucial for the claim.
5. In section four, detail the exact cause of death by providing the primary and secondary causes. Include whether the causes were confirmed by post-mortem examination or inferred through symptoms and how long the deceased had been suffering.
6. Continue to section five where you will describe the deceased's habits, confirming if they were sober and temperate, and if there are any reasons to suspect intemperate habits contributed to their health issues.
7. In section six, document any other diseases that preceded or co-occurred with the primary cause of death, including treatment history.
8. For section seven, disclose if any other medical practitioners or hospitals were consulted prior to your consultation, along with their respective names and addresses.
9. Section eight requires you to state your relationship to the deceased as their usual medical attendant, or provide details of the usual attendant if you were not.
10. In section nine, record any treatments you provided to the deceased during the preceding three years related to their last illness.
11. Address section ten by indicating if an inquest or formal inquiry was conducted concerning the death and detail any findings.
12. Section eleven allows you to add any final remarks or additional information concerning the deceased's medical history and lifestyle.
13. After completing the form, review all entries for accuracy. Save your changes and select the option to download, print, or share the form as needed.

Submit your completed Lic Form No 3784 Revised online to ensure a smooth claims process.