Get the free Critical Illness Claim Form - Part I. Claim Form

CRITICAL ILLNESS CLAIM FORM PART I (To be completed by Insured×Policy owner) Policy No. Name of Insured Contact Phone No. Age ID No. Sales Personnel (Name and Code) Sex Claim No. (For office use

How to fill out critical illness claim form

How to fill out a critical illness claim form:

1. Carefully read the form: Start by thoroughly reading the entire critical illness claim form. Understand the sections and requirements before filling it out.
2. Provide personal information: Begin by providing your personal information, including your full name, contact information, and policy number. Make sure to double-check the accuracy of the details you provide.
3. Indicate the date of diagnosis: Specify the date when your critical illness was diagnosed, as mentioned in your medical records. Provide any supporting documentation if required.
4. List the critical illnesses: Identify and list all the critical illnesses or conditions for which you are claiming benefits. Ensure you accurately include their names or codes, as indicated in the form.
5. Include medical information: Provide relevant medical details such as the name of the treating physician or specialist, their contact information, and the medical facility where you received treatment. Attach any supporting medical reports or test results, as requested.
6. Outline financial information: Declare the financial impact of the critical illness by indicating any medical expenses, loss of income, or other financial burdens you have incurred. Attach relevant receipts or documents to support your claim.
7. Read and sign the declaration: Carefully read through the declaration section of the form, which typically includes statements affirming the accuracy of the information provided. Sign and date the form once you are confident that all the information provided is complete and correct.

Who needs a critical illness claim form:

1. Individuals diagnosed with critical illnesses: Anyone who has been diagnosed with a critical illness and has an insurance policy that covers such illnesses may need to fill out a critical illness claim form. This form enables policyholders to request benefits related to their critical illness coverage.
2. Dependents or family members: In some cases, if a dependent or family member is eligible for coverage under a critical illness policy, they may also need to fill out a claim form on behalf of the insured individual. This usually applies to minors or individuals who are unable to complete the form themselves.
3. Executors or legal representatives: In unfortunate cases where the insured individual has passed away, the executor of their estate or their legal representatives may need to fill out a critical illness claim form to initiate the claims process on behalf of the deceased policyholder.

Note: It is essential to consult the specific policy terms and conditions or contact the insurance provider directly to determine who exactly needs to fill out the critical illness claim form in a particular scenario.

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