Copy of FIR (first information report)/Police Report. The claim form, along with bills, complete hospitalization documents should be sent to Bajaj Allianz for reimbursement purpose. Email id: bagichelp@bajajallianz.co.in. 2 Original Discharge Summary stating the date of admission, date of discharge, presenting complaints with duration ,clinical condition, detailed line of treatment, final diagnosis and past medical and surgical history with duration. I / We undertake to revoke the instruction for NEFT in the event of the business relationship Bajaj Allianz international travel insurance key features. CLAIM FORM FOR HEALTH INSURANCE POLICIES OTHER THAN TRAVEL AND PERSONAL ACCIDENT – PART A TO BE FILLED IN BY THE INSURED The issue of this form is not to be taken as an admission of liability Bajaj Allianz General Insurance Company Limited. If the claim is rejected, letter with details are to be shared with Insured. Bajaj Allianz General insurance co. ltd Ge Plaza, Airport Road yerawada, Pune 411006. PIR report (Property Irregularity Report) (to be obtained from the airline authorities). Duly Completed Personal Accident Claim Form signed by Nominee. Details of any insurance covering same loss. Avail the best treatment at 286+ cashless network hospitals in your area. Assistance service provider is to be intimated in the event of any treatment, non intimation may invalidate the claim. Claim Form (to be filled and signed by assignee), Original Paid receipts (hardcopy) in case of reimbursement claim, Death certificate/Post Mortem report/ Certificate of emblem in case its conducted, NEFT Form and Cancelled cheque stating assignee‘s Indian Bank account details (for reimbursement claim. Email id: bagichelp@bajajallianz.co.in. Attested copy of Death Certificate. Registered Address: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006 Bajaj Allianz General Insurance Company Limited nor constitute default of any terms and conditions of any agreement/MOU/ Claim/Refund/Other contract and or Lease agreement/Leave and license agreement with me/us. ��:��(T)(��}. Copies of correspondence with the Airline authorities/others certifying the delay & actual date and time of delivery of baggage. Disclaimer: By using above SMS services kindly note that you would be authorizing to receive call(s) / SMS from Bajaj Allianz Life Insurance Co. Ltd through its representatives on your tele-contact no with respect to the query for which you have requested call back even if it is registered under NCPR/NDNC registry with your telecom operator. Certificate from Golfer Association stating game points. Overall rating: 5 out of 5 based on 1 reviews. ?V$��-�ece�W�D���m����� �No¢=u���b�wݑ���)��њ&�� �> ����� �����(/�֗CN�ݖ�#�/y'�u���e^�Ws�.��-�o���^��p�N,���W��^��7�q��� ��_���D�6�WF8�5{s�M�%=h$��D R�U�T��R '$�#����/�t�Fa_cT )��9��xz3Z�Ҹ��8Q�Y�!��[ieǕk��l��֖�5�E�I�f��-I���'�� �ۺ���������c7�] G�t�A �|�S)i���7*iQ=�H��B�mR� �TJ��}��SR_FdU��#bd�^��J�� v� n#q��6Џhع�b��|�m�a�z��%]�����)��.k���\����q�p`� ��H{�׷[f,-��'LG�8���8�*�C�F��_n� ��#��> Fax no: 020-30512246. endobj Covering Letter detailing full statement of the facts of the incidence of theft. All bills and payment receipts towards transportation and lodging in overseas. NEFT Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details (for reimbursement claim). Certificates from overseas billers regarding cancellation charges if applicable. Tollfree: 1800-209-0144 | 1800-209-5858. we would not hold Bajaj Allianz General Insurance Company Limited responsible. NEFT Form (available at branch) Original Pre-printed cancelled cheque; Bank Statement (If cancelled cheque is non personalized) Standard ID proof of Proposer; 2 Once the required changes are done, the insurer will provide a confirmation . Original bill of purchase for the laptop. List of Documents. & Head Office : GE Plaza, Airport Road, Yerawada, Pune 411 006 Self-attested documents submitted : TRC FORM 10 F Bajaj Allianz Life Insurance - Critical Illness Claim Form DD/MM/YYYY Name of the Life Assured: *To be ticked if you are a tax resident in India under the Income-tax Act, 1961. Tollfree: 1800-209-0144 | 1800-209-5858. For senior citizens: seniorcitizen@bajajallianz.co.in. CLAIM FORM FOR HEALTH INSURANCE POLICIES OTHER THAN TRAVEL AND PERSONAL ACCIDENT – PART A TO BE FILLED IN BY THE INSURED The issue of this form is not to be taken as an admission of liability Bajaj Allianz General Insurance Company Limited. Details of local contact / relative in India who would arrange for the amount. Cashless hospitalization (for more … Bajaj Allianz travel insurance plans can be purchased from 6 months to 99 years without any medical reports. Insurer will inform about any deficiency within 7 days. During Bajaj Allianz Health Insurance Claim Settlement, Neft form is a Mandate Form for Electronic Transfer of Claim Payments. �!-�z���lڽV@1y�]�C�)�ya�/�-u�މ�n���AA�QDN�n����? Free Bajaj Allianz Mandate Form for ECS Claim Payments - PDF Form Download. NEFT form and Cancelled cheque stating insured’s / Claimant Indian Bank account details. endobj NEFT Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details (for reimbursement claim). 2 Original Discharge Summary stating the date of admission, date of discharge, presenting complaints with duration ,clinical condition, detailed line of treatment, final diagnosis and past medical and surgical history with duration. 3. CLAIM FORM FOR HEALTH INSURANCE POLICIES OTHER THAN TRAVEL AND PERSONAL ACCIDENT – PART A TO BE FILLED IN BY THE INSURED The issue of this form is not to be taken as an admission of liability Email id:-customercare@bajajallianz.co.in Toll free no:1800-209-5858 020-30305858 (To be filled in block letters) DETAILS OF PRIMARY INSURED This benefit shall be extended if the claim under medical expense section 2 is admissible and hospitalization is for completed 24 hours. OPD Claims & claims other then In-Patient will be reimbursed upon return to India. Regd. J�}3�tK�|�(-,� IRDAI Registration No.113 Regd. It can be a perfect shield against financial stress caused by any life event. Bajaj Allianz Life Insurance Death Claim Form ... Cancelled cheque with printed name and account details of Claimant Attested passbook copyof bank NEFT form attested bybank Additional documents in case of Suicide / Accident - (FIR and Post Mortem Report is mandatory) What is the ECS Mandate? Yes you can extend your travel insurance while being abroad. Claim Form – (to be filled and signed by insured). Bajaj Allianz Life Insurance Death Claim Form • Claims under multiple policies may be registered by filling a single form & providing all applicable policy numbers. Know More Letter from the airlines stating reason and duration of delay. wtJ9 �ۇ��A�a�4,|T�\�͢1�v�t$�]��P��"�) ��+�՝��/�S�!��B4u��3���`���8(�38��w��4f�P�w���2�m��5[ NEFT Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details. Bajaj Allianz General Insurance Company Ltd. GE Plaza, Airport Road, Yerawada, Pune 411 006. Receipts related to expenses incurred to obtain a new passport. Fax no: 020-30512246. ]?c��&���A�0� ��}�T�:l�^Z.�E��BD��ӐL^��$|�m[$P��H~�GЛ��o��4������N�`qZ���np�L<8td2���GG �0[��K�Ec��D Bajaj Allianz General Insurance Company. In case inability to provide deductible amount from insured same can be deducted from your cashless bill. �|��0��k��DrmA7u�n�a�ٰ�LX9'�|@��F��]�K"Dg�ηu�o@��!��4��9q~@��V? Deductible amount as per policy schedule to be issued with DD/ Cheque in favour of Bajaj Allianz General Insurance Company Ltd (in case of complete cashless subject to confirmation of admissibility from “Us”. ), NEFT Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details, PIR report (Property Irregularity Report) (to be obtained from the airline authorities), Letter from the airlines accepting the liability for loss, Proof of compensation received form airlines, NEFT form and Cancelled cheque stating insured’s / Claimant Indian Bank account details. u�����6a����o��+9�f7`�O�ī��h�j����կN�1��Ȝ��a��Uha�-?A:�~I8Z�F^��X����X� �^*�P�H� �3��E�5�&daT�@���}a˄��S��6�]Vh�/A�A�'5�����F��S�D���� v�g$7o_�q��xj}ګ�5g0�5���31]�´}u�z��>z*�IM�tĀ �g�0W5s�2�2o���-\%J�v���H�� �t��k&봞V����[�5�Ol�̱��fU^�o#�%N_T���8Q��(���D�s���x�G�(,��A:��T]�.,zhJU�Z���ٴ[�_\���!E�?�]�]�u�`j� %�4:5�������04��h���̠X¶ ���ljє Certificate from overseas biller regarding cancellation charges. This form may only be used if you have a Bajaj Allianz Health Insurance policy for yourself or your employee, you need to make sure you fill all the required details correctly and then submit the form to the Bajaj Allianz claim office along with the other required documents. Policy period, Number of members, Age and Sum assured are … �xPO{:��/٥sO:VZC. Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details (for reimbursement claim). NEFT form and Cancelled cheque stating insured’s / Claimant Indian Bank account details. Copy of FIR (filed with the local police authorities), Claim Form (to be filled and signed by insured), Release of Medical Information Form (ROMIF) BAJAJ and AGA (to be filled and signed by insured) to obtain the medical records from facility, Medical records/Consultation Papers/Investigation Reports in case any hospitalization, Death certificate/Post Mortem report in case its conducted (In case of Death), Certificate from Civil surgeon certifying the extent and percentage of disability (For Disability claims), NEFT form and Cancelled cheque stating insured’s (nominee in case of death claim) Claimant Indian Bank account details, Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India, Attending Physician Statement (to be filled and signed by overseas treating doctor), Medical records/Consultation Papers/Investigation Reports. �x�ot�¹�(te;'ݺE(ԥȤ���Z��hX��ݴ����H*��� �cq�,n��8H`��А��qRN��Vf�>��l�1�mY�`QH�v�F~e����qߟ�Y�����;�-iT5����): �r�/t+� Ȩ����i��R��K鎺?##��L�k}�4�|L��p�Ϻc�-N���ʹu=V�=)���NU�)Y>U��b�Q�U�i$��M��>�2�ke7L1�x�㻠���V$�'.k)W��j��ݢ�A*M��2��E9��@:�Dd@8A����a0:?�D�s�Ś�CJ����8w���4Ԥ�U��֤���IO��i�S���8���a Z�i��A�v�Ḱ�o7�߲p �J���zT$}=��ұ v�1ݠP$�������Iؤp�9��!�@�b����G������_�hx�����]�uݳ|=9�Ooҩ�? Overall rating: 5 out of 5 based on 1 reviews. Bajaj Travel insurance extension/renewal while outside India Indian overseas travelers who are stranded outside India due to coronavirus and are unable to travel back want to extend or renew Bajaj Allianz travel insurance online.These travelers can complete the Bajaj Allianz international travel insurance renewal request form online and we will try to get an approval for you. Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India. All prescriptions, investigation reports & medicine bills are to be kept handy. ڗte��p�ۧ��1&_�p�M�߽r��t�k�v� For senior citizens: seniorcitizen@bajajallianz.co.in. Mandate Form for Electronic Transfer of Claim Payments . All bills and payment receipts towards transportation and lodging(incurred overseas) if applicable. Branch IFSC Code for NEFT Branch IFSC Code for RTGS Name of the Account Holder : ... Bajaj Allianz General Insurance Company Limited, in excess of (i) the amount due to me, or (ii) in excess of Claim Form (to be filled and signed by insured) Hospitalization discharge summary/consultation papers of insured if applicable. <>>> • I / We undertake to revoke the instruction for NEFT in the event of the business relationship expiring and or being ‘terminated’ and further hereby specifically authorize Bajaj Allianz General Insurance Company Limited, Letter from the airlines stating reason for cancellation. Download (PDF, 16KB) Filed Under: Bajaj Allianz, Bajaj Allianz health insurance, General Insurance. Covering Letter detailing full statement of the facts of the incident and overseas bank details. Medical document and discharge summary stating hospitalization details and need for pre or postponement of Trip. Policy does not cover traveling abroad for obtaining medical treatment & travelling against medical advice. 2 0 obj The claim file has to be submitted at the below mentioned addresses within 30 days from after the date of loss. ]��pH�`}7u��М��9}s��C��zo�N�+{T�@� y��W]��"ݞ�8\á' � ���2��l� !�VnX6"w���皷܇N��ւ�Aw��݂�@����?�lO�e��m�\�A��96x]���ח��ї��l�\ Details of local investigation and survey of loss in case carried out by insured. Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India. It offers you an all-encompassing life cover with multiple variants and benefits. 3 0 obj Regd. Cashless will be extended for all in-patient treatments only when service provider is intimated & pre approval obtained (as per policy T & C). If the claim is approved, amount will be transferred within 30 days. Fax no: 020-30512246. }r7�(ӣt��)t���ӛϻ��������ٛ��y��=ߙ�r��>��v,��q&�B���K�}��|�;���O��͋�~: H/j��=S�k�@V�6K]���zWb����0�ҽ]�s�l��ַ�-�l���.�,�;���9����ϣ���ћ��u�W�'�%�_�������>���cy���p�~���������v5��'��iuv|bCE���\��Ϗ�����E��a^c����7vw]���I��{WS�ʅ~Lo�s0q�TJ ln��[�J�������@���@�BZ����h4U�^����Y�q` ���ACk���ڽu]���������{f��{�g��� 7��lj/t�9;v��à;.Y�d.y����; ����~:ތ�)��M3� �p� • I / We undertake to revoke the instruction for NEFT in the event of the business relationship expiring and or being ‘terminated’ and further hereby specifically authorize Bajaj Allianz General Insurance Company Limited, Tollfree: 1800-209-0144 | 1800-209-5858. Duly filled claim forms along with all necessary documents are to be submitted within prescribed timelines. Regd. "��I�v�gzPȃ�l��"LЄ=�-ʽ6x����:�C��ۓz��k�����s��@Y)�C���]�D�Gp�p}w��ɰ�X��Xx� C6{1p�8$��m�H����1.��7��E@��u07 ��E�og�~��ſ�t��H̕���=a�ba���[���L��(��m?� <> All the grievances are closed within the stipulated time frame of 15 days. Regd. Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India. stream Bajaj Allianz Life Smart Protect Goal is a complete term plan with new-age features in line with your evolving needs. ]�/�h�0ھ�"mI�8���u�@�B�YPa`��LN��јW �b����0Fb�:� 3. Bajaj Allianz Health Insurance Neft Mandate Form. It is used by financial institutions for making payments such as salary, pension, dividend interest, and deduction of EMIs for loans. New passport copy or certificate of travel issued. ����ֶu�g9R��H�W*8�k�>�?9�:����EG�%L��l��%%/h^�����6u�ǰ��+��-*���?��ϯa��Y>ODx��K'�2#��rz�fʨ��w.ؼ���"O?��ɗZ� f�|�gB�Ė% G+�t8���3J��(�?�C鑞�����F G�g� a�):��kd��M���*�@�`Q7X�X����K;���}ֶ[�ނF ��fPw`�Fa���KFD�'嫮��*� Death . Post receiving of all required info, the claim will be processed within 30 days. NEFT Form; Copy of address proof (Ration card or electricity bill copy). Detailed self explanatory note stating scenario arises in to third party loss. : 022-66700001), Insurance is a subject matter of solicitation, The information you share on this site could be shared with insurers, By clicking on the "GET A CALL" button, I accept the, The insured or legal representative, immediately within 7 days from the date of loss, To register a claim/seek assistance through the above contact points, the following information has to be provided to the customer support executive:-. �*��!��f�k:F�ǚ1�'"}d.��N�:�#Ś{�6$�!�#" Duly completed claim form and NEFT form, signed by the Claimant. Passport and Visa copy exit Stamp from India. <> 1 Duly filled and signed Bajaj Allianz Health Insurance Claim Form. For senior citizens: seniorcitizen@bajajallianz.co.in. Copy of Receipt towards the advance payment of tuition fee, Letter regarding the inability of the student to continue semester duly acknowledged by the school, All bills and payment receipts towards transportation. The treatment is to be intimated with respective service providers within prescribed timelines. 4 0 obj Bajaj Allianz Star Package Health Insurance Plan Premium calculator. �lJ{����%O���ÀS�r���! It’s available just at … %���� Mandate Form for Electronic Transfer of Claim Payments . Invoices / Bills supporting the claim amount, Original Paid receipts if paid (hardcopy) in case of reimbursement claim. You can calculate the premium using Bajaj Allianz Star Package premium calculator. Tracking Health Insurance network hospital at InsuranceDekho is much simpler and convenient. Maximum coverage up to $1million depending on the age and plan you select. 5.0 rating based on 12,345 ratings. GLOSSARY - PULL SMS TABLE; No Service Type Keyword Send To ; 1: For Callback for service related queries : SUPPORTPOLICY NO : 8108222251: 2: For Callback for renewal premiu IRDA Direct Broker License: IRDA/DB 407/08 | Code: 386 | Valid till : 13/11/2023 |, The name and telephone numbers of the hospital at which treatment is being obtained, The fact or matter giving rise to the need for medical treatment. NEFT Form and Cancelled cheque stating insured’s / Claimant Indian Bank account details (for reimbursement claim). Travel policies can initially be purchased for 6 months and can be renewed for another 6 months provided that the policy holder is in good health, no claims on the existing policy and the policy has not expired. 3 All documents should be self attested and submitted at Bajaj Allianz General Insurance Co. Ltd, GE Plaza, Airport Road, Yerawada, Pune, 411006. Email id: bagichelp@bajajallianz.co.in. The claim file is to be prepared with ref to check list & to be submitted upon return to India. x��}i�%7����ާEfc��c�(��t �O�w�|��̪��kܿ~E�I������.��I�HQIQ��叻o�}����v�իݛwowl�v_�y�������_���?�b�w��{!� &�F�8����7/�~��]�'O}�PB�nImDj@�u�B(�׻0�����o^���|��>h�?�}�4�2U��T��U����E_. 5.0 rating based on 12,345 ratings. Copy of the court order and proof of payment of the bail bond. Original Paid receipts (hardcopy) in case of reimbursement claim. CLAIM FORM- PART B TO BE FILLED IN BY THE HOSPITAL The issue of this form is not to be taken as admission of liability Please include the original preauthorization request form in lieu of PART-A DETAILS OF HOSPITAL Bajaj Allianz General Insurance Company Limited. Mandate Form for Electronic Transfer of Claim Payments Office Code Name To Bajaj Allianz General Insurance Company Ltd i-track Number Partner ID To be filled by Office Full Name Shri / Smt / Kum / M/s As appears in your bank account Full Address Contact / Mobile No Bank Name Branch Name Address Branch Tel No Contact No Branch IFSC Code for NEFT Name of the Account Holder As per Bank … All the grievances are closed within the stipulated time frame of 15 days. Registered Address: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006 Search for the best hospital for cashless facility across India from the health insurance hospital list of Bajaj Allianz. endobj fa�^G��!��R0Zi�� �f�m��W�={�y4氛 List of Documents. Electronic Clearance Service (ECS) is an electronic mode of transferring funds from your bank account to another. Free Bajaj Allianz Mandate Form for ECS Claim Payments - PDF Form Download. Registered Address: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006 :���jݸp we would not hold Bajaj Allianz General Insurance Company Limited responsible. Bajaj Allianz Life Smart Protect Goal Plan is a comprehensive term plan, offered at a competitive premium to save you from the financial uncertainties in life. Hospitalization discharge summary/consultation papers of insured if applicable. %PDF-1.5 Passport and Visa copy with Entry Stamp Overseas and exit Stamp from India. Self-attested documents submitted : TRC FORM 10 F Bajaj Allianz Life Insurance - Critical Illness Claim Form DD/MM/YYYY Name of the Life Assured: *To be ticked if you are a tax resident in India under the Income-tax Act, 1961. Letter from Hotel mentioning reason for non accommodation and compensation received (if any), Bills/invoices and receipt raised against the accommodation or transportation, Duly Signed Claim Form detailing exact circumstances, Medical records /Consultation Papers/Investigation Reports of hospitalisation of sponsor, Letter from school authority stating about the balance tuition fee for the course, Death certificate of the sponsor in case deceased, Duly filled Medical sickness or  Personal Accident claim form, Certificate from the doctor treating the insured mentioning the requirement of necessary attendant & reasons for the same Travel tickets in original along with  the copy of the visa & passport, Any other documents relevant to the incident, including Summons, Legal Notice, etc, Accidental Death & Dismemberment (Common Carrier), Our Claims Dept. First Consultation letter from the Doctor; Duly completed claim form and NEFT Form signed by the Claimant; Original Hospital Discharge Card; Original Hospital Bill giving detailed break up of all expense heads mentioned in the bill. To . During Bajaj Allianz Health Insurance Claim Settlement, Neft form is a Mandate Form for Electronic Transfer of Claim Payments. 1 Duly filled and signed Bajaj Allianz Health Insurance Claim Form. Download (PDF, 16KB) Filed Under: Bajaj Allianz , Bajaj Allianz health insurance , General Insurance will advise on documentation upon receipt of claim notification. 1 0 obj <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.56 842.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Duly Signed Claim Form stating exact circumstances of loss. ��Ef���{Q��NW��Dn2�P�� Bajaj Allianz Life Insurance Death Claim Form ... 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Just at … Bajaj Allianz Health Insurance network hospital at InsuranceDekho is much simpler convenient... Is approved, amount will be reimbursed upon return to India deductible amount from same!, signed by insured ) Copies of Boarding Pass/Ticket/Baggage Tags out by insured ) Copies Boarding! Be processed within 30 days and Cancelled cheque stating insured ’ s available just at … Bajaj General... Simpler and convenient payment receipts towards transportation and lodging in Overseas the below mentioned addresses within days! Hospitals in your area based on 1 reviews or any judicial order against. The delay & actual date and time of delivery of baggage, Airport Road Yerawada, Pune 411 006 insured... Hospitalization section comprises: first consultation letter from the doctor Form attested by Bank authorities, along with all documents. Form stating exact circumstances of loss be filled and signed by insured ) Copies Boarding! 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