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Interglobal medical claim form 2014

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Further information about how to complete this form can be found in the Claims procedures. Your claim will be processed by InterGlobal Limited on behalf of the insurer. Failure to complete all sections of this form may result in delays. 1 January 2014 Claim form for medical treatment reimbursements Please complete clearly in BLOCK CAPITALS* Are you submitting this claim as a scanned copy Yes No One form must be completed for each patient for each medical condition treated* Sections A to D and s ...

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