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Get E Meditek Claim Form

TPA Issuance of this form does not amount to admission of any liability under the policy on the part of the insurer. Particulars of the Principal Insured (Policy Holder) 1 Name of the Policy holder / Claimant 2 Policy Number 3 Address for communication 4 Telephone Number 5 Mobile Number 6 Email id Particulars of Third Party administrator 7 8 Name of the TPA UHID Number allotted by TPA Details of the Insured Member for whom the claim is preferred Name of the Insured Person Relation.

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