Reimbursement Claim Reference Number: (99707283)

(Please quote this reference number in all future correspondence)

E-card Claims Plan hospitalzation Hospitals

Date : 04 Dec 2019

To,

Darwin Tittus A,
S/O Alphonse, No 3
Plot No 5, Reddiyar Nagar, Balaji Nager Extn, Korattur,Chennai-600076

Dear Member,

Employee ID 1

Employee Name Darwin Tittus A

Medi Assist ID 4000760927

Policy Holder Darwin Tittus A

Insurer Claim No TP00373080019900000030

Insurer Member ID PO10313945

On scrutiny of the documents submitted by you, we note the following documents / information are not available.

FROM THE TREATED DOCTOR : EXACT AETIOLOGY OF THE PRESENT ADMITTED AILMENT ( PARALYSIS) ALSO KINDLY PROVIDE THE
HISTORY OF DIABETIC MELLITUS & HYPERTENSION.
FROM INSURED : KINDLY PROVIDE THE FOLLOWINGS: 1. PHOTO COPY OF THE HOSPITAL REGISTRATION CERTIFICATE.

Please furnish the above-mentioned documents / information within 10 days from the date of this letter to us or servicing branch office of your insurer.

It shall be the sole responsibility of the insured to submit the required claim documents.
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