How to fill out a claim form?

How to fill out a claim form?

Filling out a claim form accurately is crucial for ensuring the smooth processing of your insurance claim.
Here's a step-by-step guide on how to fill out a group insurance claim form:

Step 1: Download the claim form from the Pazcare app. We have inserted a sample claim form below and highlighted each section of the claim form in red for your convenience.



Step 2: In section A (shown below), fill out the following details:
  1. Policy Number 
  2. Company / TPA ID No.
  3. Name
  4. Address (including City, State, and PIN code)
  5. Phone Number
  6. Email ID


Step 3: Skip Section B

Step 4: In section C (shown below), fill out the following details:
  1. Name
  2. Gender
  3. Age
  4. Date of Birth
  5. Relationship to primary insured
  6. Occupation
  7. Address (If it is the same as Section A, please enter "Same as above")


Step 5: In section D (shown below), fill out the following details:
  1. Name of Hospital
  2. Room category
  3. Hospitalisation due to
  4. Date of injury/disease first detected/delivery
  5. Date of admission
  6. Date of discharge


Step 6: In section E (shown below), fill out the following details:
  1. Enter the expenses breakup and the total expense incurred at the end 
  2. Check the claim documents submitted from the checklist


Step 7: In section F (shown below), write the amount against:
  1. Hospital Main Bill
  2. Pre-Hospitalisation Bills
  3. Post-Hospitalisation Bills
  4. Pharmacy bills


Step 8: In section G (shown below), fill out the following details:
  1. PAN
  2. Account Number
  3. Bank Name and Branch
  4. IFSC Code


Step 9: In section H (shown below), fill out the following details:
  1. Date
  2. Place 
  3. Signature of the insured


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