Get Suraksha Application Form

This guide provides you with essential steps to fill out the Suraksha Application Form online. With clear instructions and a user-friendly approach, you can navigate each section effectively and ensure all information is accurately provided.

Follow the steps to complete your application form smoothly.

1. Click ‘Get Form’ button to obtain the form and open it in the specified digital format.
2. Begin with Section A, where you will enter information pertaining to the insured and claimant. Provide their names, relationship, date of birth, contact details, and address in the required fields.
3. Proceed to Section B. Input the policy number and the period of insurance along with the total sum insured.
4. In Section C, respond to the inquiry about other policies by selecting 'Yes' or 'No.' If applicable, attach copies of previous policies.
5. Move to Section D, detailing the nature of the disease or injury, date and place of incidence, and any witnesses.
6. For Section E, note if the insured was moved to the hospital, including admission and discharge dates and times, along with hospital details.
7. Fill out Section F, where a medical practitioner must certify the treatment details, including their signature and qualifications.
8. In Section G, list each component of the claimed amount, ensuring the total claimed amount is calculated accurately.
9. Refer to Section H which requires you to attach necessary documents. Ensure each document is ready for submission.
10. In Section I, the employer's declaration must be completed if applicable. This includes details of employment and consent for information verification.
11. Complete your declaration in Section J if applicable, providing nominee details if the insured individual has passed away.
12. Finally, review all sections thoroughly for accuracy, then save your changes and opt to download, print, or share the completed form as needed.

Start filling out your application form online today to ensure a smooth claims process.