Accidental Insurance Policy

accidental insurance policyDeclaration Form – Accidental Insurance Policy

I___________________

S/o, ___________________

D/o,___________________

Age___________________

R/o___________________

Hereby agreed to take insurance policy provided with my handset ___________________(make and model)___________________by Hotspot free of cost as complementary.

My personal details are as under

NAME: ___________________

FATHER NAME: ___________________

AGE (must above 18years):___________________

ADDRESS: ___________________

PERSONAL ID: ___________________

NOMINEE: ___________________

SIGNATURE: ___________________

THE SALIENT FEATURES OF THE POLICY

THIS POLICY HAS BEEN ISSUED TO HOTSPOT___________________LTD, BY UNITED INDIA INSURANCE COMPANY LIMITED ,86 HAPUR ROAD, MEERUT (UP)

POLICY NO 2505004217P100951262

VALIDITY OF POLICY IS 15-4-2017 TO 14-4-2018

COVER

THIS POLICY IS ONLY FOR ACCIDENTAL DEATH COVER MEANS ACCIDENT CAUSED BY EXTERNAL VIOLENT AND VISIBLE MEANS. RESULTING INTO DEATH

SUM INSURED 500,000/-

HOW TO MAKE CLAIM IN CASE OF ACCIDENT HAPPENS AFTER TAKING THE COVER

THE NOMINEE OR HIS REPRESENTATIVE WILL SEND IMMEDIATE NOTICE TO INSURANCE CO ON THE ADDRESS GIVEN OR SEND MAIL

DOCUMENTS REQUIRED TO GET CLAIM SETTLED

  1. INTIMATION LETTER OR MAIL
  2. COPY OF FIR
  3. COPY OF POST MORTEM REPORT
  4. DEATH CERTIFICATE ISSUED BY THE COMPETENT AUTHORITIES
  5. CREMATION CERTIFICATE
  6. CLAIM FORM TO BE COMPLETED BY THE NOMINEE
  7. COPY OF INVOICE OF HANDSET PURCHASED BY THE INSURED PERSON
  8. HOSPITAL DISCHARGE SUMMARY WHERE THE INSURED HAS BEEN TREATED AFTER ACCIDENT.

IN CASE OF HELP FOLLOWING PERSONNELS CAN BE CONTACTED

  1. K. DANIEL MAIL ID – daniel@uiic.co.in
  2. VINESH KUMAR MAIL ID – vineshkumar@uiic.co.in
  3. S.L. JAIN MAIL ID – sljain.primeasso@gmail.com

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