Get Personal Accident Death Claim Form.pdf. Claim Form

Filling out the Personal Accident Death Claim Form is an important step to ensure you can make a claim effectively. This guide will lead you through the process of completing the form with clarity and confidence.

Follow the steps to accurately fill out the claim form.

1. Click ‘Get Form’ button to obtain the form and open it in a suitable editor.
2. In the first section, provide the full name of the participant, their Ufone number, residential address, date of birth, business name and address, CNIC, and occupation. If there are multiple occupations, list all of them.
3. If applicable, for accidental disability, describe the date, time, and place of the accident or injury. Additionally, provide details about the cause and the injuries sustained.
4. List the names and addresses of any witnesses to the accident, if available.
5. Provide the name and address of the doctor who treated the participant.
6. State where and when a medical officer from the company can visit if necessary.
7. Indicate the period during which the participant has been completely disabled from attending to their business due to the accident. Also, mention if they continue to be totally disabled, or when they were able to resume some business activities.
8. Answer whether the participant has previously claimed or received compensation under any accident or sickness policy and provide the relevant details.
9. Declare if the participant is covered under any other plan, and if so, provide the names of those companies along with the amounts they are entitled to claim.
10. For accidental death claims, specify the date, time, and place of the incident. Also, elaborate on the cause of death and provide a brief description of how the accident occurred.
11. Detail the hospital and doctor that attended to the participant.
12. Mention if the police investigated the incident and provide the name of the police station and investigation officer. If a post mortem took place, attach a copy of the report.
13. After filling out the necessary sections, sign and date the form. Ensure all information is truthful and correct as per your knowledge.
14. Finally, save your changes, then download, print, or share the completed form as required.

Complete your Personal Accident Death Claim Form online to ensure a smooth claims process.