WITHOUT PREJUDICE.

CALL US ON 1860 425 3232 FOR ANY CLARIFICATIONS

REQUEST FOR ADDITIONAL INFORMATION

To DATE :15-DEC-18
ALPA RAJA CCN :835911
c/o TEAMLEASE BAJAJ
6TH FLOOR,
BMTC COMMERCIAL COMPLEX,
80 FEET ROAD,
KORAMANGALA CITY,
BENGALURU,
BENGALURU,
KARNATAKA,
560034,
8108440505.

Patient Name: ALPA RAJA

Patient Card ID: GHNI0100164287
Insured Empl ID: 1285549
Insured Name: ALPA RAJA
Corporate Name: TEAMLEASE BAJAJ
Insurance Company : National Insurance Co. Ltd.
Policy No.: 604500501710003047
Hospital Name, City: NALINI MATERNITY & SURGICAL HOME, Mumbai
DOA - DOD: 16-NOV-2018-19-NOV-2018
Relationship: SELF

We are in receipt of the hospitalization claim of ALPA RAJA in your Hospital

From the information/Documents which we have received, it is indicated that the patient is being admitted for the treatment of Single delivery by
caesarean section
To ascertain whether the above treatment / hospitalization would be covered under the health insurance plan of the beneficiary, we would require
the following information from the Treating doctor / Hospital :

* Kindly Submit
1. Complete discharge summary stating in detail obstetric history with gravida status( enclosed one is not acceptable)
2. Detail break up of maternity charges 52000/-
We request you to submit the above mentioned information/documents at the earliest for us to process the request.
No Signature is required as this is a computer generated document

Note: This is an auto generated letter,

Kindly ignore this letter if you have already submitted the above documents/details.

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