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ATIAN - ASURANSI KUMPULAN Ya, indikasi rawat inap / Yes, indication of hospitalization Tidak, apakah pasien mendapat perawatan di ruang gawat darurat? No, did patient have emergency treatment? DEATH CLAIM FORM - GROUP INSURANCE Ya / Yes Semua pertanyaan pada Formulir Klaim & Surat Keterangan Dokter harus diisi dengan benar, lengkap dan jelas tanpa pembebanan kepada PT. Asuransi Jiwa Generali Indonesia. / All questions in this claim form & Attending Physician s Statement should be answered.

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