Get Workmens Compensation Takaful Claim Form

Filing a workmen's compensation takaful claim form online can seem daunting, but with the right guidance, it becomes a manageable task. This guide will provide you with clear and detailed instructions to help you navigate through each section of the form effectively.

Follow the steps to complete the online form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the claim number and PMD number. These identifiers are crucial for processing your claim efficiently.
3. In the 'The Employer' section, fill in the name of the participant holder, location of risk, nature of business, and complete address. Include the PMD number as required.
4. In the 'The Injured Person' section, start by recording the injured person's name, local address, age and sex. Ensure accuracy in these personal details.
5. Next, provide the full address of the injured person and their father, along with their occupation. Clearly state if the injured person was engaged in that occupation at the time of the accident.
6. Indicate whether the injured person is in your direct employment, or provide the contractor's details if applicable. Note the date the injured person started working for you.
7. Report on the hospital where the injured person was treated, whether they were an inpatient or outpatient, and their discharge status.
8. State whether a medical examination took place and if a report is available. If the examination was not done, mention if a free medical examination was offered.
9. Include information about the injured person returning to work, their status regarding partial work capacity, and the estimated duration of their disablement.
10. In the 'The Accident' section, date and time of the accident, as well as the location must be clearly stated. Note when you received notice of the accident.
11. Detail the cause of the accident, including any machinery involved, its safety measures, and the nature of work being conducted at the time.
12. Describe the injury sustained, including the areas affected and whether the injury was on the right or left side of the body.
13. Indicate if the injured person was under the influence of drugs or alcohol at the time of the incident, and mention any misconduct that may have contributed to the accident.
14. List any witnesses to the accident, providing their names and any relevant comments.
15. In 'The Statement of Wages' section, record the injured person's average monthly earnings prior to the accident, ensuring to follow the provided instructions carefully.
16. Finally, review all information entered for accuracy. Once satisfied, save your changes, and proceed to download, print, or share the form as needed.

Complete your documents online today to ensure a smooth claim process.