(For Health Claims)

DESCRIPTION

INFORMATION TO BE PROVIDED BY CLAIMANT / CALLER

Name of the Insured (as per Policy)

Beneficiarys Name
From :
To :

Policy Number & Period of Insurance

TPA Health Card Number
Employee ID (For Group Health Insurance)
Name of TPA
Date & Time of Hospitalization
Hospital Name
Hospital Contact Details(complete address)
Disease
Plan of Treatment
Date of Admission
Date of Discharge

CLIENT INFORMATION
Contact Person's Name
Contact nos. Landline and Mobile
Email id

FOR REGISTRATION OF CLAIMS (any one of the three options below giving the above details)
Email this i-CLAIM template (duly filled in) to
Call Centre Toll Free Numbers
Call Centre Helpline Numbers
(standard charges applicable)

contactclaims@universalsompo.com
1-800-22-4030 (For MTNL & BSNL Lines)
1-800-200-4030 (For Reliance & others)
+91-22-27639800 / +91-22-39133700