Get Download Bajaj Allianz Extra Care Claim Form - Insureatclick.com

Filling out the Bajaj Allianz Extra Care Claim Form is a straightforward process. This guide provides you with clear and supportive instructions to ensure you complete the form accurately and submit your claim successfully.

Follow the steps to fill out the form correctly

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Fill in the claim number in the designated space at the top of the form. This information is for Bajaj Allianz's use only.
3. In the policy details section, provide your policy number, start date, and end date of coverage accurately. Ensure all details match your documents.
4. Enter your Bajaj Allianz Claimant ID Card number in the required field.
5. Complete the personal details of the proposer by entering your name, email address, mobile contact number, and residential address.
6. In the claimant/patient details section, specify the name of the patient, their relationship with the proposer, date of birth, gender, and age.
7. For claim details, if applicable, indicate the total claimed amount and deductible amount. Make sure to write the claimed amount in words as well.
8. Provide details about the provisional diagnosis or nature of the disease.
9. Attach the specified checklist of documents including discharge summary, admission and discharge dates, bills with receipts, medical reports, and prescriptions.
10. Complete the consent requirement section to authorize Bajaj Allianz to access your medical records if needed. Fill in the patient’s name, admission dates, and relationship with the patient.
11. Sign and date the authorization form, and ensure that this form is attached in original to the claim documents.
12. Once all sections are filled in accurately, save your changes. You can then download, print, or share the completed form as needed.

Take the first step today and fill out your Bajaj Allianz Extra Care Claim Form online!