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Ambledown gap cover claim form

Ambledown claim form 2025

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The document is a GAP/GAP Plus Cover Claim Form underwritten by Hollard Life Assurance Company Limited. It outlines the procedures for submitting claims, including required details from the principal insured member, patient information, product selection, benefit categories, hospital admission details, payment instructions, and necessary declarations. The form emphasizes the importance of providing accurate documentation to avoid delays in claim processing.

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Click ‘Get Form’ to open the ambledown claim form in the editor.
Begin by filling in the 'Principal Insured Member Details' section. Enter your surname, initials, ID number, policy/member number, and contact details including postal address and phone numbers.
In the 'Family Doctor (GP) Details' section, provide your doctor's name and telephone number.
Complete the 'Patient Details' section with the patient's first names, surname, relationship to you, ID number, and medical aid information. Indicate if the claim is for a dependent child over 21 years of age.
Select your product type under 'Product Selection' by marking an X next to your coverage option.
Indicate the benefit category for which you are claiming by marking an X next to all applicable options.
Fill in details regarding hospital admissions and treatment dates in the 'Details of Hospital Admissions' section.
Provide your bank account details for payment instructions and ensure accuracy to avoid delays.
Finally, read through the declaration section carefully before signing and dating it at the bottom of the form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I claim from Ambledown?

How and when do I submit a claim? If you have a claim you wish to submit you are required to notify Ambledown within 6 months calculated from the first day of treatment/hospitalisation. A claim form can be obtained from your broker or from our website.

What does Ambledown cover?

The Ambledown Gap Cover Series is an Insurance Product that provides cover for you and your immediate family for the shortfall (Gap) resulting from any Medical Practitioner charging above the Medical Aid Tariff for authorised in-hospital surgical procedures and specified out of hospital procedures.

How do I claim my fidelity insurance?

General Insurance Claim Contact Us. Telephone : 800 842. Email : claims@fidelityunited.ae. Your Claim Registration. We will provide you with a Claim Ref No. Your Estimate. Our staff will create an estimate.

How do I claim gap insurance after an accident?

You can start by contacting the GAP insurance company or the dealer to see how to initiate your claim. Youll need the proper documentation to help prove the difference between the amount you owe on your loan or lease and the vehicles actual cash value.

How do I claim my reimbursement?

Here is the process, categorised into different steps for a clearer understanding: Intimate the insurance company. Pay bills and collect documents. Submit the claim form and documents. Let the insurance company verify and enquire.