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
| Medicine | Rs 100,000 |
| Break up should be mentioned in final bill | |
| Injections name | Rs 30000 |
| Antibiotics name | Rs 20000 |
| Medicine name | Rs 50000 |
- 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.