Claims Forms

• Death claim application form (Form 'A')
• Attending physician's statement (Form 'C')
• Employer Certificate (Form 'E')
• NEFT mandate form

RiderAn attachment to a policy that modifies its conditions by expanding or restricting benefits or excluding certain conditions from coverage. Claims

• Dreaded Disease RiderAn attachment to a policy that modifies its conditions by expanding or restricting benefits or excluding certain conditions from coverage./ Critical Illness Benefit
  • Dread disease / critical illness benefit form (Form 'AA')
  • Attending physician’s statement for dread disease / critical illness benefit (Form ’DD’)
• Disability Benefits (Personal Accident Benefit / Waiver of PremiumA regular payment made to the insurance company to keep the policy in force. / Payer RiderAn attachment to a policy that modifies its conditions by expanding or restricting benefits or excluding certain conditions from coverage. Disability)
  • Disability benefit claim form (Form ‘DA’)
  • Attending physician’s statement - disability claim form (Form 'TD')
• Terminal illnessA disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a relatively short period of time. benefits
  • Terminal illness claim form (Form 'TA')
  • Attending physician's statement form (Form 'TC')

Life Line Series Claims Forms

• Medicash, Medicash Plus and Health Family Floater
  • Authorization letter Request Note
  • Claim reimbursement form for medicash and medicash plus (Form 'MA')
• Wellness and Wellness Plus
  • Wellness and wellness plus claim form (Form 'WA')
  • APS for wellness and wellness plus claim form (Form 'WD')
• Safety Net
  • Death benefits (Including accidental death benefits):
    • Death claim application form (Form 'A')
    • Attending physician's statement (Form 'C')
    • Employer Certificate (Form 'E')
    • NEFT mandate form
  • Accelerated critical illnessIncludes a range of illnesses that affect your health majorly, during a defined period of time. benefits:
    • Dread disease / critical illness benefit form (Form 'AA')
    • Attending physician’s statement for dread disease / critical illness benefit (Form 'DD')
  • Additional total permanent disability benefit:
    • Disability benefit claim form (Form 'DA')
    • Attending physician's statement - disability claim form (Form ‘TD’)

• Claimant's statement - GTL employer-employee
• Claimant's statement - EDLI
• Claimant's statement - gratuity
• Claimant's statement - form 'Affinity'
• NEFT mandate form
• Claimant's statement - Life Shield
• Claimant's statement - Credit Life
• Burial Cremation Form - Form 'B'
• Attending Physician's Statement - Form 'C'