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Get Bupa Cash Plan Claim

Where applicable. Benefits are paid as a percentage of the receipted amount up to your cash plan s annual benefit limit. Amount paid Receipt date Receipt amount in words Pounds Pence D D M M Y Y E. Maternity or adoption Please submit a copy of the full birth/adoption certificate(s) in support of your claim. Child s forename Surname Your date of birth D D M M Y Y Gender D D M M Y Y Gender D D M M Y Y Child s forename Surname Date of birth F. Dental inj.

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