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UNITED INDIA INSURANCE COMPANY LIMITED. Registered & Head Office, 24 - Whites Road, Chennai - 600 014. Motor Claim Form The issue of this form is not to be taken as Admission of Liability Instructions for filling the form: Complete all relevant details fully.
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Documents include claim form issued by insurer, discharge summary of hospital, doctor's certificates and prescriptions, final hospital bills, laboratory and other investigation reports and bills, pharmacy bills and all related documents.
Standard Claim form for all policies | UIIC. United India Insurance Co. Ltd. to Administer Upgraded integrated Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) scheme in Maharashtra. Click here for more information.
We hereby declare that the information furnished in this Claim Form is true & correct to the best of our knowledge and belief. If we have made any false or untrue statement, suppression or concealment of any material fact, our right to claim under this claim shall be forfeited.
DECLARATION BY THE INSURED: I hereby declare that the information furnished in the claim form is true & correct to the best of my knowledge and belief. If I have made any false or untrue statement, suppression or concealment of any material fact with respect to questions asked in relation to this claim, my right to claim reimbursement shall be forfeited, I also consent & authorize TPA / Insurance Company, to seek necessary medical information / documents from any hospital / Medical ...
UNITED INDIA INSURANCE CO. LTD. DO. No.-0,1, bt S" T. Macq. 620 Annexure GROUP PERSONAL ACCIDENT/ AIR ACCIDENT CLAIM FORM Submission o! this far fs not br token as an admission of Jiobðlity
UNITED INDIA INSURANCE COMPANY LIMITED REGISTERED & HEAD OFFICE: 24, WHITES ROAD, CHENNAI-600014
TOP UP MEDICARE CLAIM FORM. Policy No. . Issue of this form does not amount to admission of any liability under the claim on the part of the insurers. Please give the following information correctly and completely to enable the Company to process your claim promptly.
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