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Bajaj Allianz Claim Form

For claim from Bajaj Allianz – Please download the form and sign on pages as mentioned in the link.

Bajaj claim form Part A for Insured – Sign on page 2
Bajaj claim form Part B – To be filled by Hospital – Sign on Page 1

Documents to be submitted along with claim form

All original documents

  • a) Prescriptions
  • b) Test reports (Please note only observation report is required, X-ray, CT Scan film is not required)
  • c) Discharge summary
  • d) Final Bill with Break up

For ex- medicine charges is Rs. 100,000 below that details of medicines should be given, same break up for all the expenses should be mentioned in the final bill

  • e) One ID proof
  • f) Aadhar card, Pan Card, any government id proof mentioning date of birth of insured)
  • g) Child Birth Certificate (in case of maternity)
  • if birth certificate is not there, provide discharge summary)
  • (h) One cancelled cheque of employee with name printed on it, if name is not printed on cheque than latest bank statement with cancelled cheque.