Bajaj Allianz Claim Form

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.