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A form used to apply for an insurance policy, renew a policy or to claim one is known as an Insurance form.


There are different kinds of forms such as ECS claim payments, Health Insurance, fire claim, fidelity guarantee claim, extra care claim, employers liability claim, critical illness cover, cashless form, burglary claim, agency application, etc.

Every form has its own unique purpose, terms, tenure and way of filling. But all the forms generally have a similar pattern of details that are asked such as; complete and legal personal details of the applicant, if it’s an application for a new or renewal of a policy then the details of the individual or things related to the policy or if it is a claim then the reasons for the claim are to be mentioned; for example: if it is a health insurance then complete details of the individual related to their health, terms and conditions followed by the declaration and the applicant’s signature. In some cases a signature of the witness might also be required.




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New York Record of Employment – IA12.3 - PDF Template

The IA12.3 Record of Employment is a document intended to declare that the employee’s job was insured and the employee is entitled to apply for Unemployment Insurance Benefits upon the forcible layoff or termination from a job when the said employee is at no fault. This form also serves as a certificate, however, not as …

Bajaj Allianz Mandate Form for ECS Claim Payments - PDF Template

The following is a form for receiving your claims from Bajaj Allianz in the form of direct bank transfer, this form is amended from. All the details in this form are very important they have to be filled very carefully and correctly. The details to be filled in the form are as follows. Full name …


Bajaj Allianz Health Insurance Claim Form - PDF Template

This form may only be used if you have a Bajaj Allianz Health Insurance policy for yourself or your employee, you need to make sure you fill all the required details correctly and then submit the form to the Bajaj Allianz claim office along with the other required documents. HEALTH INSURANCE CLAIM FORM ALL FIELDS …

Bajaj Allianz Fire Claim Form - PDF Template

If your Bajaj Allianz Policy covers fire losses then you may fill this form and submit it to the Bajaj Allianz Claim office along with the other required documents. Such as police complaint records, fire brigade intimation proofs etc. This form may only be used to claim the loss caused by fire if you have …

Bajaj Allianz Fedelity Guarantee Insurance Claim Form - PDF Template

This Bajaj Allianz Fedelity Guarantee policy pays for the financial loss sustained as a result of the dishonesty / fraudulent act of an employee.  The loss is payable up to the limit specified for an employee according to the policy guidelines. This policy does not pay more than one claim in respect of liability/loss arising out …

Bajaj Allianz Extra Care Claim Form - PDF Template

Use this claim form only if you have a Bajaj Allianz Extra Care Health insurance policy. For more details about this policy lookup at the Bajaj Allianz website. Bajaj Allianz General Insurance Company Limited Regd. Office & Head Office : GE Plaza, Airport Road, Yerawada, Pune – 411 006 1 Name of the Individual 2 …

Bajaj Allianz Employers Liability Claim Form - PDF Template

This form must be filled by an Employer to claim for an injury of an Employee. This form is only valid if the Employer has a active Employee Insurance Policy from Bajaj Allianz and the Employee is injured while working for the employee. EMPLOYERS’ LIABILITY CLAIM FORM Policy no ____________________________________________ Particulars of accident to be …

Bajaj Allianz Critical Illness Cover Form - PDF Template

For a claim of a Critical illness you need to fill this form and submit it to the Bajaj Allianz claim office. This form is only valid if your current Bajaj Allianz Health Insurance policy covers Critical Illness. Regd. Office: Bombay Pune Road, Akrudi, Pune 411 035 & Head Office: GESCO Plaza, Airport Road, Yerawada, …

Bajaj Allianz Cashless Form - PDF Template

For a request of a Cashless Hospitalization of your Health Insurance Policy scan or fax the completed first two pages of this form to the Bajaj Allianz Claim office numbers at Fax: 020-30512224/6/7 or you can also submit the copies manually by visiting the claim office. This form is only valid if you have a Bajaj …

Bajaj Allianz Burglary Claim Form - PDF Template

You must prepare Bajaj Allianz Burglary Claim Form to report a break in and file a claim to the Bajaj Allianz Burglary authorities. This form has 11 parts requiring various particulars about the insurance policy, event of break in, and the property. Please complete all 11 parts accurately and truthfully. Signature of a neutral adult …

Bajaj Allianz Agency Application Form - PDF Template

This is a Bajaj Allianz Agency Application Form, which is used when you want to apply to join Allianz Bajaj a life insurance company as an insurance agent. This form contains all the details that you need to fill out, the company can screen you as a candidate and decide if they want to call …

Bajaj Allianz Accident Claim Form - PDF Template

This form can be used when you want to file for a Claim of an Accident according to the Policy guidelines. Fill and submit this form to the Bajaj Allianz Cliam Office along with all the required documents. Regd. Office: Bombay Pune Road, Akrudi, Pune 411 035 & Head Office: GESCO Plaza, Airport Road, Yerawada, …

Bajaj Allainz Hospital Cash Daily Allowance Policy - PDF Template

Complete and Submit this form to the Bajaj Allainz Claim Office to request for a Daily Hospital Cash Allowance according to your Policy guidelines. Preview this Form Bajaj Allianz General Insurance Company Limited Head Office : GE Plaza, Airport Road, Yerawada, Pune – 411 006 HOSPITAL CASH DAILY ALLOWANCE POLICYHOSPITAL CASH DAILY ALLOWANCE POLICY Claim …