Follow the steps to fill out the claim form effectively.

1. Press the ‘Get Form’ button to access the Hospitalisation Claim Form SECTION 1 - Solluco - Direct Solluco Co. The form will open in an editor for you to begin filling it out.
2. In the POLICYHOLDER section, provide your personal details including your name, postal address, email address, and contact information. Make sure to accurately enter your policy number.
3. Fill out the details of the illness in section 5a. Include the nature of the illness, when the patient first became aware of it, and whether this condition has been experienced before. If applicable, provide treatment details.
4. If the claim is related to pregnancy, complete section 5b with the approximate date of conception and any related information.
5. For accidents (section 5c), provide the date of the accident, details surrounding the event, and any injuries sustained.
6. In the PATIENT section, enter details about the patient, including their relationship to the policyholder, occupation, and necessary identification numbers.
7. Complete the GENERAL PRACTITIONER section with your family doctor’s details, including their name, contact information, and address.
8. In the HOSPITAL section, enter the hospital’s name and details of the admission and discharge dates and times. Ensure to attach necessary documents like the hospital account.
9. Provide any electronic funds transfer details in section 7, including the account number and bank name, or include a bank statement if the details differ from your debit order.
10. Review the DECLARATION AND AUTHORISATION section to certify the accuracy of your banking information and the truthfulness of the provided details. Ensure the signature and date are included.
11. Once all sections are complete and verified for accuracy, save the changes to your document. You may then download, print, or share the completed form as necessary for submission.

Take the next step in your claim process by filling out the Hospitalisation Claim Form online today.