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PA Infectious disease Claim form 201610 indd

PA Infectious disease Claim form 201610 indd 2025

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The document is a personal accident/infectious diseases insurance claim form that outlines the process for submitting a claim. It includes important notices regarding the acceptance of the form, requirements for supporting documents, and personal details needed from both the policyholder and insured. The form also details the necessary information about the injury or disease, hospital admission, treatment history, and any other insurance coverage. Additionally, it contains a personal data collection statement explaining how personal data will be used and disclosed. The document concludes with a declaration section for signatures.

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