Get Fillable Online Ample Co Vipul Claim Form - Vipul Medcorp ...

This guide provides clear, step-by-step instructions for completing the Fillable Online Ample Co Vipul Claim Form offered by Vipul MedCorp. Follow this user-friendly guide to ensure all necessary information is accurately filled in for your health insurance claim.

Follow the steps to successfully complete the claim form.

1. Click ‘Get Form’ button to access the fillable claim form and open it in your preferred editor.
2. Complete the 'Details of Primary Insured' section: Enter your policy number, certificate number, company or TPA ID number, name, address, city, state, pin code, phone number, and email ID in the required fields.
3. Fill out the 'Details of Insurance History': Indicate if you are currently covered by any other Mediclaim or health insurance, provide the date of commencement of your first insurance without a break, and if applicable, enter the company name, policy number, and sum insured.
4. Provide the 'Details of Insured Person Hospitalized': Enter the insured person's name, gender, age, date of birth, relationship to the primary insured, occupation, address, phone number, and email ID.
5. In the 'Details of Hospitalization' section: Provide the name of the hospital, room category occupied, reason for hospitalization, and relevant dates for admission, discharge, and any injuries.
6. Complete the 'Details of Claim' section, including treatment expenses claimed, and indicate any claim for domiciliary hospitalization or cash benefits.
7. Fill out the 'Details of Bills Enclosed': List all bills and receipts relevant to the claim along with amounts.
8. Enter your bank account details in the section provided, including PAN, account number, bank name, cheque details, and IFSC code.
9. Read and complete the declaration, providing the place, date, and your signature to affirm the accuracy of the information provided.
10. After completing the form, save your changes, then download or print the form for your records. You may also share the form if necessary.

Start filling out your Vipul claim form online today for a seamless submission process.