Follow the steps to successfully complete your claim form.

1. Press the ‘Get Form’ button to access the claim form and open it for completion.
2. Fill in the main member personal details. Start by entering your membership number, title (choose from Mr, Mrs, Miss, Ms, or specify another), first name(s), surname, address, postcode, date of birth, telephone number, mobile number, and email address.
3. Indicate who the claim is for by selecting whether it is for the main member, partner, or child dependant. If it is for a child dependant, fill in their date of birth and name.
4. Specify if the claim is a result of a third-party accident or injury by ticking yes or no accordingly.
5. In the cash plan claim details section, list all receipted claims. Enter the relevant letter reference for each benefit you are claiming, referring to your table of cover for details.
6. Enter the treatment dates and amounts for your claims, ensuring all entries are clear and accurate.
7. For dental injury claims, provide the date of treatment and details of the accident. Attach a certified receipt from the dental professional.
8. If applicable, complete the funeral grant section by including a certified copy of the death certificate and any required supporting documents.
9. Fill in the payment details. State the account holder's name, bank name, sort code, and account number where payments should be deposited.
10. Review the hospital use section, ensuring it is filled out by the hospital if relevant to your claim.
11. Read through the member declaration carefully before signing. Ensure all information on the form is accurate and complete.
12. Attach all relevant copies of receipts and documents required for your claim and check that all necessary sections have been completed.
13. Finally, save your changes, and download, print, or share the completed form as required.

Complete your Bupa claims online today for a streamlined process.