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General
Claims
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DOMESTIC HELPER
Policy Information
Policy No.
Invalid Policy No.
Policyholder
Please provide a valid Holder Name.
Insured Helper
Please provide a valid Insured Name.
Claimant Name
Please provide a valid Claimant Name.
Contact Information
Contact Person
Please provide a valid Contact Person.
Email
Invalid Email Address.
Mobile No.
Invalid Mobile No.
Preferred Contact Method
Email
Mail
IMPORTANT:
THIS eCLAIM FORM SHOULD BE SUBMITTED BY THE POLICYHOLDER / INSURED PERSON.
Claims Information
Are you making / Will you make any other insurance claim as a result of this incident?
Yes, please state details
No
Name of the Insurance Company
This field is required
Policy No.
This field is required
Claims Type
Employees' Compensation
Personal Accident
Repatriation Expenses
Clinical Expenses
Surgical & Hospitalization Expenses
Dental Expenses
Loss of Services Cash Allowance
Replacement of Helper Expenses
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Products
Domestic Helper
HomeCare
Office & Shop
Travel
