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    claims_requirements

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    rouf7867
    claim data

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    © All Rights Reserved
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    claims_requirements

    Uploaded by

    rouf7867
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    claim data

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    claim data

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    0 views2 pages

    claims_requirements

    Uploaded by

    rouf7867
    claim data

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Claim Requirements

    Instruction:

    All questions in the claim form must be answered fully and accurately and the form
    should bear signature of an Officer authorized in this behalf by the Participant.

    Death Claims:

    • Death claim form


    • Last attending physician’s statement
    • A duly attested photo-copy of certificate of death issued by a Local Body/ or
    Burial Certificate
    • If the death was the result of the causes other than natural such as accident,
    suicide or homicide, the following additional documents will be submitted to
    DFTL: (1) A certified copy of FIR or Police Report containing full details as to
    how when and where the incident took place. OR (2) Original or attested copy of
    Postmortem report.
    • An attested photo-copy of the National Identity Card.
    • A Documentary proof of age.
    • Any other documents required by DFTL.
    Accidental Disability

    CLAIMS FORMS
    ‰ Accidental Claim Form:
    Ensure that all the required information is provided and it is signed by the
    employer/ authorized officer
    ‰ ATTENDING SURGEON’S STATEMENT
    This form is to be filled-in by last attending physician / clinic / hospital of the
    accidentee
    ‰ Employee Statement
    This form is to be filled-in by employee himself in the event of accident, mention
    of date & time of accident, with witness is necessary

    OTHER REQUIREMENTS
    ‰ x-rays, medical investigations reports
    • An attested photocopy of NIC
    • Age proof
    • A photocopy of application form

    Natural Disability

    CLAIMS FORMS

    ‰ ND Claim Form:
    Ensure that all the required information is provided and it is signed by the
    employer/ authorized officer

    ‰ ATTENDING SURGEON’S STATEMENT


    This form is to be filled-in by last attending physician / clinic / hospital of the
    employee

    ‰ Employee Statement

    This form is to be filled-in by employee himself

    OTHER REQUIREMENTS

    • X-rays, medical investigations reports


    • An attested photocopy of NIC
    • Age proof
    • A photocopy of application form
    • Retirement letter
    • A photocopy of medical Board Certificate

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