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16th November 2017, 11:51 AM
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Join Date: Aug 2012
Re: National Insurance Company Ltd Application Form

National Insurance Company Limited is a state owned general insurance company in India. Its catchline is Trusted Since 1906 in italic. The company headquartered at Kolkata was established in 1906 and nationalised in 1972

As you Asking for the Claim Form for the Medical Policy of the National Insurance Company Ltd Let me tell you that the Application Form Contains the Following Fields that Are As Follow

DETAILS OF PRIMARY INSURED
a) Policy no:
c) Company/ TPA ID No:
d) Name:
e) Address:
City:
Pin Code:
Pin Code:
DETAILS OF INSURANCE HISTORY
a) Currently covered by any other Mediclaim/ Health Insurance:
b) Date of commencement of first insurance without break:

SECTION B
c) If yes, company name:
Sum Insured (): d) Have you been hospitalized in the last four years since inception of the contract? Date:
DETAILS OF INSURED PERSON HOSPITALIZED
a) Name :
b) Gender : Male Female d) Date of Birth: e) Sum insured: i) CB (if any)
SECTION C
g) Occupation: Service Self Employed Homemaker Student Retired Other (Please specify)
h) Address (if different from above):
SECTION D
c) Hospitalization due to: Injury Illness Maternity d) Date of injury/ Date Disease first detected/ Date of Delivery:
e) Date of Admission: f) Time: g) Date of Discharge: h) Time:
i) If injury, give cause

Claim Form for the Medical Policy of the National Insurance Company Ltd






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