Get Universal Claim Form Pdf

Filling out the Universal Claim Form Pdf online can seem daunting, but with the right guidance, you can complete it efficiently and accurately. This guide provides clear, step-by-step instructions to help you navigate through each section of the form.

Follow the steps to effectively complete the claim form

1. Click the ‘Get Form’ button to obtain the form and open it in your PDF editor.
2. Begin by entering the details of the insured in Section A. Fill in the first name, middle name, and last name. Ensure that you provide the name of the insured person for whom the claim is being made, along with their relationship to the insured and their date of birth. You will also need to select their sex and provide a valid email address and communication address, including the city, district, pin code, state, and contact numbers.
3. In Section B, input the policy number and the period of insurance. Specify the health card number and the sum insured amount.
4. Section C inquires about any other policies you may hold. If applicable, indicate whether you have been insured under any other medicinal insurance, and if yes, enclose photocopies of previous policies.
5. Proceed to Section D to enter details of any previous claims made for the same beneficiary. Provide the previous claim number, the diagnosis, and the admission and discharge dates, as well as any details about whether the claim was paid or repudiated.
6. In Section E, describe the nature of illness or injury, including symptoms and signs. Record the dates of incidence, admission, discharge, and specify the type of admission (emergency or planned).
7. Section F requires you to enter the details of the hospital where treatment was received. Include the hospital's name, address, city, district, pin code, state, and contact details.
8. In Section G, list all current claim bills under various expense categories, such as pre-hospitalization, hospitalization, and post-hospitalization expenses. Provide descriptions, bill dates, bill numbers, and the amounts claimed.
9. Complete Section H by confirming the enclosures you are submitting with your claim form, such as the claim form itself, discharge summary, hospitalization bills, and other relevant documents.
10. Section I requests the insured's declaration. Read the statement carefully, date it, and provide your signature along with your name.
11. Section J contains the attending medical practitioner's declaration. This section should be filled out by the treating medical practitioner and requires their signature and stamp.
12. Fill out any additional information in Section L if necessary. Confirm that all information is accurate to the best of your knowledge before signing.
13. After completing all sections, be sure to save your changes, and then you may download, print, or share the completed form as needed.

Complete your Universal Claim Form Pdf online today to ensure a smooth claims process!