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Bfil Head Office, Hyderabad

This document is a claim intimation form for an insurance policy held by BFIL. It provides key details about the claim, including the employee and patient names, diagnosis, hospital information, admission date, treating doctor, and employee contact details. The form notes that HR at BFIL was notified of the claim on a certain date and includes space for an authorized HR representative to sign off.

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Piyush Mishra
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
115 views

Bfil Head Office, Hyderabad

This document is a claim intimation form for an insurance policy held by BFIL. It provides key details about the claim, including the employee and patient names, diagnosis, hospital information, admission date, treating doctor, and employee contact details. The form notes that HR at BFIL was notified of the claim on a certain date and includes space for an authorized HR representative to sign off.

Uploaded by

Piyush Mishra
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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BFIL

Head office, Hyderabad

CLAIM INTIMATION

Corporate Name: BFIL

Policy no:

Employee Name:

Patient Name:

Employee Code:

MDID Number:

Diagnosis:

Hospital Name:

Hospital City:

Date of Admission:

Treating Doctor Name:

Employee Contact Number:

Employee Email ID:

Intimation received by HR on

FOR BFIL

Authorized HR Name,Signature with round seal of RO

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