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Dear Claimant:
Greetings from Chartered Life. We have received your submitted Medical Claim Documents. Thanks!
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Dear Claimant:
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Member No ?
(Example :4054BHL994-1)
Name of Employee :
Name Of Patient ?
Relation ?
Mobile No ?
(Example : 01723000000 )
Claim Type
<----- Select Claim Type ----->
IPD
General OPD
Optical OPD
Dental OPD
Normal delivery (Maternity)
Caesarean delivery (Maternity)
Legal Abortion/Miscarriage (Maternity)
Maternity
Death Claim (AD,PPD,PTD,CIC)
Hospital Accomodation ?
Consultant’s Fee ?
Routine Investigations ?
Medicines ?
Surgical Charges ?
Ancillary Services ?
Others ?
Total ?
Any Message For us ?
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Image File
File Name