Get Seven Corners Lloyds Injury And Sickness Proof Of Loss Form

This guide provides clear and supportive instructions on completing the Seven Corners Lloyds Injury And Sickness Proof Of Loss Form online. By following these steps, users can ensure that they fill out the form thoroughly and correctly.

Follow the steps to accurately complete the online form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
2. Fill out the insurance carrier information. Ensure to provide the name of the insurance carrier, which is Certain Underwriters at Lloyd’s, London, and include the group name and your ID or certificate number.
3. Complete the Insured details section by providing the name, date of birth, and sex of the insured individual.
4. Next, provide the claimant's details, which include their name, date of birth, and sex.
5. Enter the current residence address and daytime phone number of the claimant to be contacted regarding this claim.
6. Fill in the permanent address in the home country and indicate the scheduled date of return to the home country.
7. If the claim is due to an accident, describe how, when, and where the accident occurred in the provided section.
8. If the claim is due to an illness, specify when and where symptoms first occurred, as well as the nature of the illness.
9. Indicate whether treatment was received at a student health center and provide any required documents confirming dates of treatment.
10. List the names and addresses of consulting physicians who provided treatment for the conditions claimed.
11. State whether the claimant has been treated for this illness before and provide relevant details if the answer is yes.
12. Include the name and address of the regular physician in the home country.
13. List any prescription medications currently being taken by the claimant.
14. Provide details of any other health insurance coverage, including the insurer's name, address, policy number, and certificate number.
15. Read and understand the authorization statement and sign the form, ensuring that it is dated correctly. If the claimant is a minor, an authorized representative's signature is required.
16. Finally, review the completed form for accuracy, then save the changes, download, print, or share the form as required.

Complete and submit your documents online to expedite your claim process.