Icici lombard health care claim form filled sample 2026

1. Click ‘Get Form’ to open the ICICI Lombard Health Care Claim Form in the editor.
2. Begin with Part A, filling in your personal details in capital letters. Include your name, relationship to the proposer, and policy number.
3. Indicate the type of claim you are submitting: hospitalization expenses or cashless treatment. Ensure all mandatory fields are completed.
4. Provide details about the insured person, including their name, gender, occupation, and date of birth. Make sure to include contact information.
5. In section 5, describe the nature of the illness or injury and provide hospital admission details such as dates and room category.
6. Complete section 8 by detailing all treatment expenses claimed. List pre-hospitalization and post-hospitalization costs along with any ambulance charges.
7. Attach all required documents as indicated in section 10. Ensure that originals are provided for a smooth claims process.
8. Finally, review your entries for accuracy before signing and dating the declaration at the end of the form.

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