Checklist for claim submission Claim form duly completed and signed Self attested copy of valid age

proof (Passport / Driving Licence / PAN card* / class X certificate / Birth certificate) Self attested copy of identity proof (Passport / Driving Licence / PAN card / Voters identity card)^ Original Discharge summary Original Final Bill from Hospital with detailed break-up and paid receipt Original Laboratory Investigation reports Original bills of medicines purchased, or of any other investigation done outside hospital with reports and requisite prescriptions Original first consultation paper (in case disease is first time diagnosed) Original radiology films(if required) MLC/FIR copy attested by the concerned hospital / police station (if applicable) Original self-narration of incident in absence of MLC / FIR Invoice of major accessories in case billed and utilized during treatment (if not included in the final hospital bill) Indoor case paper/OT notes (if required) List of claims submitted along with claimed amounts(in case of multiple claims) Other documents:_____________________________________________ __________________

Available

Mandatory documents Yes

Desirable Desirable Yes Yes

* If PAN card captures the exact Date of Birth of the Customer ^ Self attested copy of identity proof of parent / guardian (if the member is a minor) If 'Mandatory' documents are not submitted then the Claims should not be accepted and should be returned to the customer