I hereby warrant the truth of the foregoing particulars in every respect& I agree that if I have made or shall make any false or untrue statement, | |
suppression or concealment my right to claim reimbursement of the expenses shall be absolutely for feited. I further declare that in respect of the | |
above treatment no benefits are admissible under any other Medical Scheme or Insurance. | |
I authorize EAST WEST ASSIST PVT. LTD (TPA) / United India Insurance Co. Ltd. | |
to obtain/verify any medical record or information from hospital authorities necessary to process the claim on my behalf. | |
it is complesory is give bank details because bank bill transfer the claim amount to your bank account by neft | |