INDIVIDUAL PERSONAL ACCIDENT
READY RECKONER
1
Index
Index
2
Insurability
3
Insurable persons ................................................................................................................. 3
Entry Age ............................................................................................................................. 4
Occupation Classes
5
Family Discount
6
Cumulative Bonus
6
Financial Underwriting
7
Special Cases
9
Endorsements
10
Risk Start Date
11
Premium Payment
11
Cheque Dishonor
12
Glossary
13
Renewal
14
Checklist for proposal form
14
Documentation Requirement
16
Claims Process
17
Claims Documents
18
Financial Questionaire
22
2
Accident or Accidental means a sudden, unforeseen and unexpected event caused by external, violent and
visible means (but does not include any illness or disease) which results in physical bodily injury (but does not
include mental, nervous or emotional disorders, depression or anxiety).
Personal Accident: A Personal Accident policy is intended to compensate for any financial loss caused by an
Accident.
Individual Personal Accident product is available in two Variants:
Product Variant
Available
Proposer
Sum
Insured
(Rs)
for
Standard
1.00 L ; 2.00 L ; 3.00 L ; 5.00 L ;
7.50 L ; 10.00 L ; 25.00 L ; 50.00 L
5.00 L ; 10.00 L ; 15.00 L ; 25.00 L ;
50.00 L ; 100.00 L ; 200.00 L ; 500.00 L
Premium
Sum Insured for
Adult
Dependant
Sum Insured for
Children
50% of Proposer
SI;
Max
Rs
50,00,000
25% of Proposer
SI;
Max
Rs
10,00,000
The minimum acceptable premium (per proposal form) for IPA applications is Rs.1000
Insurability
Insurable persons
(i) Self/Policyholder
(ii) Spouse
(iii) Children
(iv) Parents of the Policyholder

The dependents covered under the policy should be financially solely dependent on the proposer.

Combination allowed: 1 Policy Holder, 3 Adult Dependents (Spouse, 2 Parents) and 4 Children

Non-earning members (Student/Housewife/Househusband/Unemployed), cannot self propose on themselves
and Adult & Child Dependent logic would be applied for SI eligibility.

Unearned income members (Property landlord/Property owner/Retired) can propose on self and their
dependents, subject to maximum sum insured for policy holder not exceeding 50 lacs.

The AD SI has to be 50% of the Policyholder sum insured in a single policy . If earning spouse desires a
higher sum insured (more than 50%), then a separate policy should be issued to the earning spouse.

In case where two or more children are covered the Sum Insured for all the children must be same. Same Sum
Insured must be opted for both Parents if being covered.
3
Entry Age

Policy Holder: Minimum 18 years and Maximum 69 years

Adult Dependent: Minimum 18 years and Maximum 69 years

Child Dependent: Minimum 5 years and Maximum 21 years

Children below 5 years can be covered from 91st day onwards if both parents are covered with Apollo
Munich or any other insurer under an Individual Personal Accident Policy(Parent’s Personal Accident
Insurance policy details will be required)
o
o
Cover Ceasing Age: There is no maximum cover ceasing age
On renewal, the maximum sum insured available above 70 years of age is restricted upto Rs 5,00,000

Premium is calculated on completed years of age as on the last birthday

The insured person must live in India (Indian resident, NRI/Foreign national) may be insured irrespective of
nationality subject to

NRI/Foreign national living in India must submit passport and VISA copies; further VISA duration
of at least 6 months corresponding policy period requested.

NRI/PIO not living in India may be offered coverage subject to
o Proposal form has been completed in India
o All pages of passport and VISA copies with entry/exit stamps to India have been submitted
o Prior MUW approval before login
o
Nepalese and Bhutanese coming from Nepal and Bhutan respectively may be offered coverage
subject to
o Proposal form has been completed in India
o Latest Income Tax Return( ITR) proof
o Pan Card Copy
o Residence Proof In India
4
Occupation Classes
Apollo Munich has classified occupation and the premium varies in different occupation classes:

Occupation Class IPersons engaged in White collar non-hazardous occupations in office, showroom only. For example
Administration Manager, Clerk, Auditor, Accountant Lawyer etc.

Occupation Class II
Persons engaged in Semi-hazardous occupations with duties in a supervisory capacity, and not a machine
operator of any type, or doing manual work. For example Agriculture Engineer, Air Traffic Controller, Auto
Engineer etc.

Occupation Class III
Persons engaged in manual labour, Skilled or semi-skilled workers using light / heavy machinery. For example
Yoga/Aerobics Instructor, Air Steward, Air Hostess, Aircraft Maintenance, Baker , Cargo Deliveryman etc.

Occupation Class IV
Any occupation not falling into any category above will be declined risk. For example Brickmaker, Builder`s
Labourers, Building Site Labourer, Chemical Industry workers etc.

Occupation Class V
Unearned or no earning category. For example Househusband, Housewife, Retired, Student
Product
variant
Standard
Premium
Occupation Class of
Policy Holder
Base Plan
TTD*
(for
earning
PH/spouse)
I


II


III

X
IV
X
X
NA
V

X
Policy holder,
,Children
Adult
Dependent
I


Adult
Dependent,
II


Policy Holder,
children
III
X
X
IV
X
X
V

X
Adult
Dependent,
Insurable Person
Policy Holder, Adult Dependent ,
Children
NA
Policy Holder,
Children,
*TTD coverage is not applicable for children, Non Earning Spouse and Dependent Parents. They can be offered only
base plan
5
Revised occupation class list- Refer to the document
Family Discount
A discount of 10% on the Gross Premium is available, if two or more members are covered under one policy.
Cumulative Bonus

The policy carries a cumulative bonus of 5% for every claim free year subject to a maximum of 50% of the
Accidental Death Sum Insured. In case a claim is made during a policy year, the cumulative bonus would
reduce by 5% in the following year.

The cumulative bonus will be applicable for Accidental Death, Permanent Total Disablement and
Permanent Partial Disablement Sum Insured only (Cumulative Bonus will reflect against the Accidental
Death Benefit on the policy schedule).

There will be No transfer of Cumulative Bonus from other insurers
6
Financial Underwriting
Benefit
Annual Income
Accidental Death
Up to 10 times of annual income
Temporary Total Disablement
Up to 2 times of annual income subject to a max. of
5.00 L for Standard and 15.00L for Premium

The maximum allowed Accidental SI is 10 times of annual income for the salaried class.
o In case of salaried person, current annual salary would be the basis of maximum SI eligibility.

Accidental Death SI Eligibility calculation for Self Employed/Businessman (Proprietorship/Partnership)
o
o
o

Upto 50 Lacs sum insured - 20 times the Annual income or Accidental Death SI of 50L, whichever
is lower.
Above 50 Lacs sum Insured- 10 times the annual income
In case of businessman, the income as reflected in the recent ITR or the average income of last 3
consecutive years, whichever is higher shall be considered for maximum AD SI eligibility.
Accidental Death SI Eligibility calculation for Unearned income members (Property landlord/Property
owner/Retired)
o
Maximum Sum Insured 50 lacs- 10 times the annual unearned income or Accidental Death SI of
50 lacs whichever is lower
o
In case of unearned income member, the income reflected in the recent ITR or the average
income of last 3 consecutive years, whichever is higher shall be considered for maximum
Accidental Death SI eligibility


TTD SI cannot be more than the Accidental Death SI.

TTD Sum Insured will be as per the Plan opted. If Proposer Opts for 50 Lacs Premium variant, he will be
offered 15 Lacs TTD benefit and His earning spouse will be offered 15 Lacs of TTD benefit as well provided
that both satisfy the TTD income eligibility criteria
o TTD Income Criteria – Two times the annual income
o Refer PA Rating Card for TTD SI under various Plans
Reduction in only Accidental Death Sum Insured and not TTD Sum Insured is allowed subject to
eligibility and product specifications
 Enhancement of only TTD Sum Insured is allowed subject to eligibility and product specification.
 In the event , TTD Income Criteria is not met for Earning Spouse, TTD SI for her will be reduced in
accordance to TTD Income Criteria to the SI available lower than then Twice the annual income.
7
o
For example
Proposer Detaills
Accidental Death Sum Insured required – 1Crore (Premium Variant)
TTD Sum Insured – 15Lakhs
Annual Income as per current ITR – Rs. 31, 97,666
Earning Spouse
AD Sum Insured – 50 Lakhs
TTD Sum insured as per the plan opted– 15 Lakhs
Annual Income as per current ITR – Rs.100, 840
Eligible TTD Benefit – Lower of Twice the annual income (201,680) or 15 Lakhs = 201680
Sum Insured available lower than 201,680 = Rs. 200,000
TTD offered = Rs. 200,000



No Income proof required where AD sum insured asked for is less than or equal to Rs 25,00,000 (Twenty
five Lakhs
If the proposed SI for an Individual is more than Rs 25, 00,000 (Twenty Five Lakhs), income proof for the
immediate preceding financial year(s) shall be required.
The acceptable income proofs can be any of the below:
Salaried



Businessmen
Last FY/AY
Form 16
Last FY/AY
ITR
Last
3
months’
salary slips


Agricultural Income
ITR
audited P&L account of the
company along with Article of
Association providing the details
of shareholding pattern (in
partnership firms) OR the most
recent partnership deed


ITR
Form J(7/12)
/
CA
certificate
/Mandi
receipt
Income
from
agency commission

Form 16A
 Proposal forms will be accepted and logged in even if last year ITR is enclosed( in case of
businessmen) and the last 3 months salary slip(for salaried). Additional documents can be called for
wherever required.
 In event of availability of only 1 year’s income evidence, it must be ascertained that the same is of the
most recent financial year.
 In case of Sum Insured more than 50.00L the underwriter may call for a ‘Financial Questionnaire’ on a
case to case basis.
 Only earned income shall be considered for SI eligibility calculation.
 Unearned income like rent, investment and interest income shall be considered only for Unearned
income members such as Property landlord/Property owner/Retired persons.
8
 In case a client has multiple occupations, then worse of the occupation would be considered for
occupation classification and premium calculation/cover grant decision.
Special Cases
Housewives without income may be allowed AD SI basis Husband’s Personal Accident coverage as per the
following:
Husband can’t propose for spouse if he is not covering self as Policy Holder, giving proof of coverage elsewhere.
Housewives may be allowed an AD SI of 50% of the Husband’s AD SI, subject to a maximum of 25 Lakhs in case of
standard variant and 50 Lacs in case of premium variant. No TTD will be given.
Students - As per parents cover i.e. not more than 25% of parents cover subject to maximum of 10 lacs. In certain
cases, SI upto the amount of education loan may be considered. Loan documents would be required to
substantiate the cover sought.
Employer employee
1.
2.
3.
4.
Employee needs to be the proposer and insured in the policy
Employer may pay the premium on employee’s behalf using single cheque (not more than 50 policies
using single cheque)
List of employees getting covered under the scheme along with following details (on company’s
letterhead) needs to be submitted along with the completed proposal form from employee
a. Designation with department
b. Exact nature of duties
c. Annual income/CTC
d. Cover sought
Refund (if any) automatically be made in the name of proposer (i.e. employee) only
Retired Persons:

Retired Individuals, having an income (Pension or otherwise) may be considered for an Individual PA policy.

The Retired person has to be the proposer in the IPA policy

Occupation Class to be considered is AC5 (AD premium as per class I, No TTD).

For Pension income : TTD will not be allowed

For any other income(Like salary/consultancy, etc.): TTD will have to be opted for(as per the general rule)

Proposal Form- If the Proposal Form declares occupation as “Retired” and annual Income of Rs XXX—this
will be treated as pension income and processed accordingly.
9
Endorsements
Endorsements
Type
Policy Cancellation
Pre-Inception
Documents
Required
PostInception/Renewal
-
-
Allowed
Change of Plan
Allowed
Change in Sum
Insured
Allowed
Letter from the
Client
Premium
payment.
Letter from
Client,
Premium
payment.
Documents
Required
Letter from the client.
No paid claims.
Short period refund
Allowed only at
Renewal
-
Allowed only at
Renewal subject to
underwriting
Proposal Form from
the client,
Premium payment
Addition of Member
Deletion of Member
Policy Period change
DE corrections
(Name, Address,
Nominee
etc)
Address /Nominee
change
Allowed
Allowed
Allowed for newly
married spouse &
newborn
children after waiting
period
Letter from the Client.
No paid claims.
Short period scale
refund
Allowed
Letter from the
Client
Allowed
Allowed
Letter from the
Client,
Premium
payment.
Not Allowed
-
Allowed
Letter from the
Client
Allowed
Letter from the Client
Allowed
Letter from the Client
Allowed subject to
Letter from the Client,
UW
Premium payment.
Approval
Documentary
evidence
Allowed
Allowed subject to
Change of DOB,
Occupation
Proposal Form
from the Client
Premium
payment.
UW
Approval
Letter from the
Client
Letter from the
Client.
Premium
payment,
Documentary
evidence
10
Risk Start Date Logic
Risk start date would be later of the Proposal sign date, Login date, Requirement completion date
Example 1)
Payment made through cheque dated 21.12.2010
Requested Start date 21.12.2010
Proposal sign date 20.12.2010
Application received date at AMUNICH office 25.12.2010
Start date should be 25.12.2010 as application form received at AMUNICH is 25.12.2010
Example 2)
Payment made through cheque dated 15.07.2010
Requested Start date 21.07.2010
Proposal sign date 21.07.2010
Application received date at AMUNICH office 26.07.2010
Start date should be 26.07.2010 as application form received at AMUNICH is 26.07.2010
Premium Payment
 Cash,Demand Draft,Cheques ,Debit cards / Credit cards are accepted for new business and renewal
 Cash would be accepted where ever Fresh (New Business ) PA is sold to our existing customer (EH/OR etc)
 Cash can be accepted for PA fresh (NewBusiness) case where photo ID proof for the proposer and all adult
dependents is provided
 Payments are acceptable from Self /Proposer
 Payment may also be made by Father, Mother, Son, Daughter or Spouse of proposer if it’s a
 i. Renewal of existing policy
 ii. New business case and
1.
Proposer is one of the insured AND
2.
Consent from proposer is in place for payment made by one of the defined relationship above
AND
3.
No TTD is opted by any of the insured OR
4.
TTD is opted, but income proof is submitted for insureds including proposer who have opted for
TTD
 Third Party cheques are not acceptable for Individual Personal Accident Applications except from relations
mentioned above as per the conditions listed and in case of employer employee.
11
Partnership Firm

In case premium is being paid from partnership firm’s account, cheque must be signed by authorized
signatory
Proprietorship Firm
We can accept the premium if client is paying through his Proprietorship/Authorize Mandate Account
Joint Account

Even if the proposer has a joint account with the name of the proposer and the other account holder showing
on the face of the cheque, it would be accepted only if signed by the proposer or one of the defined
relationship (if allowed as per specified conditions).
Cheque Dishonor
 The cheque has to be drawn in favour of Apollo Munich Health Insurance Company Limited only.
 In course of a cheque dishonor, the application or policy is cancelled. There are two options for the customer
o
The customer has to sign a declaration [(available at branches – indicating his health
status/occupation status has not changed and he agrees to change the policy start date to new
date of payment and pay again within 7 days of the cheque dishonor.
o
Customer can fill up a new proposal form and apply again if the above is not fulfilled within 7
days..
 For both the above cases, payment will be accepted only by Debit Card/Credit Card. Cheque will not be
accepted again or represented.
12
Glossary
Insurable interest: Insurable interest exists when an insured person derives a financial or other kind of benefit
from the continuous existence or well-being of the insured subject. A person has an insurable interest in
something when loss-of or damage-to that thing would cause the person to suffer a financial loss. E.g. Parents
have insurable interest in their children; Husband has insurable interest in his wife and vice versa, etc.
Insurability: Insurability means whether a particular client can be insurable by an insurance company, because of
the quality assigned pertaining to the risk that a given client would have. An individual with very low insurability
may be said to be uninsurable, and an insurance company will refuse to issue a policy to such an applicant.
Material fact: Is a fact whose expression/concealment would reasonably result in a different decision of entering
into contract of insurance. The principle of “utmost good faith” requires anyone seeking insurance to disclose all
the material facts about the risk that he knows, or should know. Right to decide if the given fact is material or not
vests with insurer, and not the insured. Hence every fact pertaining to the risk needs to be disclosed to the insurer
prior to the formation of insurance contract. E.g. Insured declaration of not suffering from diabetes when he
actually is may result in policy issuance, instead of refusal of the policy if the fact would have been disclosed to the
insurer beforehand.
Nondisclosure: Failure or refusal to declare or reveal part or full information that is required to be declared or
revealed. E.g. Non-disclosure of past medical history of diabetes; Non-disclosure of past medical history of
diabetes with disclosure of past medical history of hypertension.
Misrepresentation: Means a false statement of fact made by one party to another party, which has the effect of
inducing that party into the contract. E.g. Wrong date of birth provided to get categorized for medicals free
issuance (Non-medical- Age & Sum insured basis) OR if falling outside entry age criterion of the product.
Earned income: Income ought to be earned by active participation in employment or self employment (Business)
activity. E.g. Salaried class, managing partner of the firm, Proprietor, etc.
Unearned income: Income which may continue even without active participation by its recipient. E.g. Rental
income, Pension income, etc.
Sum assured: is the fixed amount payable to the beneficiary on occurrence of insured event as per policy terms
and conditions. E.g. Critical illness benefit, Term life insurance, etc.
13
Renewals
Apollo Munich policy’s renewal request can be accepted maximum up to 60 days prior to policy expiry date
Grace Period allowed -30 days post expiry of policy
Checklist for Proposal Form
Basic Checks
All questions must be answered as per advice in the proposal form.
i) Any overwriting or corrections must be counter signed by the proposer. Use of whitener is not allowed.
Proposal Form
Name and address:
a) Name and address should be correctly filled in with 6 digit PIN code.
b) Either mobile or Telephone number should be mentioned. Mobile number should contain 10 digits, and landline
number should have correct STD code of the city as prefix & contain correct number of digits. Total digits in the
landline number should be 11 including the STD code. (E.g. Gurgaon landline number containing 7 digits, or Metro
number with 8 digits).
c) E mail address should be provided (if any).
d) Salutations:
Age
0 – 15
16 and above
0 – 12
13 – 21
22 and above
For Married
For Divorcee/Single
Title
Master
Mr
Baby
Miss
Ms
Mrs
Ms
Gender
Male
Male
Female
Female
Female
Female
Female
Nationality
Nationality should be mentioned. If nationality mentioned is other than Indian, refer guidelines below.

The insured person must live in India (Indian resident, NRI/Foreign national) may be insured irrespective of
nationality subject to

NRI/Foreign national living in India must submit passport and VISA copies; further VISA duration
of at least 6 months corresponding policy period requested.

NRI/PIO not living in India may be offered coverage subject to
o Proposal form has been completed in India
o All pages of passport and VISA copies with entry/exit stamps to India have been submitted
o Prior MUW approval before login
14
o
Nepalese and Bhutanese coming from Nepal and Bhutan respectively may be offered coverage
subject to
o Proposal form has been completed in India
o Latest Income Tax Return( ITR) proof
o Pan Card Copy
o Residence Proof In India
Income details: Annual income of the proposer needs to be mentioned at required place.
Occupation: Occupation and designation should be clearly mentioned in the proposal form. The nature of duties
should be clearly highlighted for the purpose of occupational class classification.
Relationship: Relationship of Insured to Proposer should be mentioned in the respective column. Allowable
relationships include Self, Spouse, Father, Mother, Son and Daughter only.
Nominee details: Name, Address and Relationship of nominee with proposer needs to be mentioned in the
column provided. The nominee mentioned in the proposal form must be an immediate relative of the primary
proposer only (Father, Mother, Spouse, Brother, Sister, Son or Daughter). For all other proposed insured (other
than the proposer) the nominee shall be the proposer him/herself.
All declarations: All declarations must be signed by the proposer. If signed in vernacular language or thumb
impression, vernacular declaration needs to be completed with witness name & signature.
If payor and proposer are the same, check the signatures on cheque & application form if payment mode is
cheque. If not matching, please get declaration from the proposer on usage of different signatures for the
insurance application and cheque, if not provided in additional information column. This declaration must carry
both the signatures used.
Premium payment (amount, mode and payer details): Payment details viz Instrument details, Name of the payer,
Bank details, Date and Amount to be mentioned in the column
Existing insurance details: Previous insurance policy No, Name of the insurer, Insurance coverage period, sum
insured and claims details (if any) should be mentioned in the column provided.
15
Documentation Requirement
Address Proof
Address on proposal should match with that on the address proof submitted. List of acceptable address proof
i) Address & Contact Number Proof on Company Letter Head / Employee ID cards
ii) Telephone Bill , Post Paid Mobile Bill, Broadband Bill
iii) Rent Agreement/ Lease Agreement/ Property Tax / Water Tax /House Tax/ Electricity bill
iv) Driver‟s license/Passport/ Gas Connection/Ration Card /Arms & ammunition License
v) Bank Statement / Bank Passbook / Fixed Deposit Certificate / Credit Card Statement
vi) Any Life Insurance: Premium Receipt / Welcome letter /Policy Bond etc..
vii) Last year‟s Health Policy document (Portability cases)
viii) Any vehicle RC Copy
ix) Pan Card Intimation letter / Voter Id Card/ Income Tax Returns
x) PPF /NSC /any other Investment Certificate
xi) Any Government issued document for Address Proof (from Gram Panchayat etc)
xii) Monthly Maintains bills for Bldg Society/ Chwals/Flats/Plots
xiii) Regiment Certificate for Army Personnel
xiv) In absence of above an Affidavit from the Customer for Address & Telephone Number confirmation
List of acceptable standard address proof is as per the circular shared by operations department. Any subsequent
circular shall supersede this list.
Note:
i. Address proof is compulsory for Agency, Partnership, AES and Digital (offline cases)
ii. Any Bill or Statement for Bank, Credit Card, Mobile, Bank Pass Book etc. That is submitted to us, should not be
more than 3 months old from Bill Generation date or Bill Payment date.
Financial Questionnaire
In case of Sum Insured more than 50.00L the underwriter may call for a ‘Financial Questionnaire’ on a case to case
basis.( enclosed as annexure)
Income Proof
Income proof is required only for sum Insured 25 lacs & above.
The acceptable income proofs can be any of the below:
Salaried
Businessmen
Agricultural Income
16
Income
from
agency commission



Last FY/AY
Form 16
Last FY/AY
ITR
Last
3
months’
salary slips


ITR
audited P&L account of the
company along with Article of
Association providing the details
of shareholding pattern (in
partnership firms) OR the most
recent partnership deed


ITR
Form J(7/12)
/
CA
certificate
/Mandi
receipt

Form 16A
CLAIM PROCESS
A customer will have to intimate the Apollo Munich as per the requirements in the policy:
Written notice of claims with full particulars must be given to the company immediately

Intimation in case of Accidental Death and Permanent Total Disability
o In case of death written notice must, unless reasonable cause is shown, be so given before
internment or cremation and in any case, within one calendar month after the death.
o In the event of loss of sight or amputation of limbs, written notice thereof must be given within
10 days after such loss of sight or amputation.

The process starts with receipt of information on a probable claim. The format for this intimation is
predefined and would be available as part of the policy kit to the member. It will also be available on the
website of Apollo Munich.

The information will be received / retrieved by the claims inward team and later entered into the system.
A unique claim intimation number will be generated from the system. This number would be later
mapped with the ‘actual’ claim automatically.

For the normal claims intimations, will send the insured a claim form along with an acknowledgement
letter / email / SMS stating that the claim intimation has been received by the Apollo Munich. The claim
form would be auto generated and would be pre-filled with all the relevant details of the insured.

For claim intimations received in-person, it will be acknowledged by the reception of the Apollo Munich. If
intimation is in time and provided documents sufficient, a respective additional note will be added in the
acknowledgement letter.
17
Documents Required for Claims Processing
List – I (Accidental Death)

Duly filled and signed Claim Form

Policy copy

Copy of FIR (First Information Report) /Spot Panchnama / Inquest Panchnama

Death Certificate

Original death summary

Post Mortem Report (in case of death)

Original legal heir certificate (in case nomination has not been filed by deceased)

In case of dispute over nominee or legal heir certificate, a succession certificate would be requested
which would supersede all other documents
List – II (Permanent Total Disablement/Permanent Partial Disablement/Temporary Total Disablement/
Permanent Serious Disablement)

Duly filled and signed Claim Form

Policy Copy

Copy of FIR (First Information Report)

Original treating doctor certificate describing disablement

Original Discharge summary from the hospital

Original photograph of the injured reflecting disablement

Prescription and consultation papers

Leave certificate from the employer (If Employed)
18

Disability Certificate issued by Civil Surgeon or equivalent as authorised by State Government

Medical reports, case histories, investigation reports, treatment papers as applicable.
List – III (Transportation of Mortal Remains)
 All Documents of List – I, plus

Original Bills and payment receipt of transportation
List – IV (Cremation Ceremony)
 All Documents of List – I, plus

Original Bills and payment receipt
List – V (Emergency Ambulance Charges)
 All documents of List – I or List - II , plus

Original Bills and payment receipt

Treating Doctor’s consultation indicating Emergency care
List – VI (Education Fund)
 All documents of List – I or List - II , plus

Study Certificate from the school of the dependent child mentioning the parent’s name
List – VII (Family Transportation)
 All documents of List – I or List - II , plus

Original Bills and payment receipt

Proof of the immediate family member such as Ration Card
List –VIII (Purchase of Blood)
 All documents of List – I or List - II , plus

Original Bills and payment receipt

Prescription of the doctor mentioning the indication
List – IX (Transportation of Imported Medicine)
 All documents of List – I or List - II , plus

Prescription of the doctor mentioning the indication

Bill of Loading

Original Medicine bill and payment receipt

Reason for Import
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List –X (Cost of Wheel Chair / Crutches)
 All documents of List - II , plus

Original Bills and payment receipt

Prescription of the doctor mentioning the indication
List –XI (Accident Hospital Cash)
 Duly filled and signed Claim Form

Policy Copy

Copy of the Discharge Summary

Copy of First Information Report (FIR) / Medico-Legal certificate (MLC)

If MLC not done, Treating doctor certificate giving details of Injury Sustained
List –XII (Accident Medical Expenses / Hospitalization -Inpatient)
 Same as the documents of List – II , -plus

Medical Bills with Prescription

Medical Investigations report with prescription

First Consultation and subsequent prescription
List –XIII (Accident Hospitalization – Inpatient and Outpatient)
 Same as the documents of List – XII except discharge summary
List –XIV (Broken Bones)
 Same as the documents of List – II , -plus

X-ray reports and films reflecting the fracture/s
List –XV (Widowhood Cover)
 Same as the documents of List – I , -plus
Marriage certificate
List –XVI (Marriage Expenses for Children)
 All documents of List – I or List - II , plus

Proof of unmarried dependent Children [Affidavit and Age proof]
List –XVII (Common Carrier)
 Duly filled and signed Claim Form
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
Policy Copy

Original Ticket

Copy of the Documents proving transportation of the insured in the carrier
List –XVII (Coma)
 Duly filled and signed Claim Form

Policy Copy

Copy of FIR (First Information Report)

Prescription and consultation papers mentioning neurological findings

Investigations report / neurological assessment report

Clinical summary of the comatose patient from the treating Neurophysician /Neurosurgeon

Proof of hospitalization
List –XVII (Modification of Residence/Vehicle)
 All documents of List - II , plus

Original Bills and payment receipt
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