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Required Documents

Death Benefit Claim by Individual Policyholder Collapsed Expanded

Please submit all necessary documents related to claims within 30 (thirty) Days from the incurred date. Required documents are -

1. Form: Death Benefit Claim Form for Individual Policy (Click here to download: Bangla or English)
2. Death certificate: One of the followings will be accepted as valid death certificate -
i. Original or attested photocopy of Death Certificate issued by licensed Private hospital/ Government hospital where the deceased was treated.
ii. Original or attested photocopy of Death Certificate issued by the Municipal Body, either from Health Department of City Corporation/ Local Union Parishad Chairman/ Ward Commissioner/ Councilor (on his/her official printed letterhead).
3. Proof of Age: Age proof of both insured person and beneficiary must be submitted. If insured person and policyholder are different, than policyholder’s proof of age must be submitted as well. Any of thefollowings will be accepted as proof of age: i. Photocopy of National ID Card/ii. Photocopy of Passport/iii. Photocopy of Driving License/iv. Photocopy of Secondary School Certificate or equivalent examination
4. The Policy Document: Original policy document must be attached with this form unless it is already available with the company.

In case of Accidental Death, following additional documents are required:
i. Forensic Medicine Department/Police Station, (or), copy of Magistrate’s or Police Station Officer-in-Charge’s permission for burial without conducting post mortem (where applicable).i. Photocopy of Autopsy (Post-Mortem) Report from the concerned
ii. Photocopy of Police Report (FIR/ Final Police Report) (if available).
iii. Newspaper cutting (if any).

N.B. Company may ask for additional information and documents.

Accident or Sickness claim by Individual Policyholder Collapsed Expanded

Please submit all necessary documents related to claims within 30 (thirty) Days from the incurred date. Required documents are –

1. Accident or Sickness Claim Form for Individual Policy (Click here to download: Bangla or English)
2. Photocopy of Hospital Discharge Certificate with proper diagnosis, detailed case summary and daily follow-up notes along with issued itemized hospital bill (if any) that is signed by Hospital Authority.
3. Photocopy of registered (minimum MBBS) Doctor’s prescription with proper diagnosis of sickness/ Accident.
4. Photocopy of all diagnostic / investigation reports advised by the respective physician.
5. Photocopy of imaging reports (Like X-Ray, MRI or CT Scan, etc.) (where applicable).
6. All original bills and Vouchers (for Accidental Claims) and Itemized Hospital Bills (for Surgical Benefits).
7. For Critical Illness or Disability Benefit, Age Proof must be submitted. Any one of the following documents will be accepted as Proof of Age: (i. Photocopy of National ID Card/ii. Photocopy of Passport/iii. Photocopy of Driving License/iv. Photocopy of Certificates of S.S.C or equivalent examinations)
8. Photocopy of a blank Cheque leaf (MICR) (For EFT payments only).

N.B. Company may ask for additional information and documents.

Group Insurance Death Claim Collapsed Expanded

You are advised to submit separate claim application for each insured and for different benefit types. E.g. Out-patient / In-patient / Maternity / Dental / Optical / Policy Year. Also, please submit all necessary documents related to claims within 30 (thirty) Days from the incurred date.

Required documents are -
1. Completed Group Insurance Death Benefit Claim Form (Click here to download: Bangla or English)
2. Death certificate: Original or attested photocopy of Death Certificate issued by Licensed Private Hospital/ Government Hospital where the deceased was treated, or original or attested photocopy of Death Certificate issued by the Municipal Body, either from Health Department of City Corporation/ Local Union Parishad Chairman/ Ward Commissioner/ Councilor (on his/her Official Printed Letterhead)
3. Proof of Age: Both insured person and Beneficiary’s Age Proof must be submitted. Any of the following documents is accepted as Age Proof: i. Photocopy of National ID Card; ii. Photocopy of Passport; iii. Photocopy of Driving License; iv. Photocopy of Certificates of S.S.C or equivalent examinations

In case of Accidental Death, following additional documents are required:
1. Photocopy of Autopsy (Postmortem) Report from the concerned Forensic Medicine Department/Police Station, Or, copy of Magistrate’s or Police Station Officer-in-Charge’s permission for burial without conducting postmortem (where applicable).
2. Photocopy of Police Report (FIR/ Final Police Report) (if available).
3. Newspaper cutting (if any).

For claims against Credit Life Policy, following additional documents are required:
1. Photocopy of initial application for loan or credit card.
2. Transaction details/ statement showing bank or card account’s outstanding balance as on the date of death.

N.B. Company may ask for additional information and documents.

Group Insurance Medical Claim Collapsed Expanded

You are advised to submit separate claim application for each insured and for different benefit types. E.g. Out-patient / In-patient / Maternity / Dental / Optical / Policy Year. Also, please submit all necessary documents related to claims within 30 (thirty) Days from the incurred date. Required documents are -

1. Out-Patient Treatment
i. Group Insurance Medical Claim Form (Click here to download: Bangla or English)
ii. Original money receipt showing the attending physician's detailed charges along with his/her stamp and signature.
iii. Original itemized pharmacy bill showing the date of purchase, name of patient, quantity and name of drugs along with photocopy of physician's prescription.
iv. Original receipt showing charges for each of the Laboratory tests and other examinations done, supported by the respective physician's request to undergo examinations and photocopies of the results of examinations undertaken.

2. In-Patient Treatment
i. Group Insurance Medical Claim Form (Click here to download: Bangla or English)
ii. Itemized original hospital bill supported by the official receipt for the total amount paid.
iii. Original receipt showing attending Physician's/Surgeon's charges along with his stamp and signature.
iv. Photocopy of detailed hospital discharge report.

For Critical Illness or Disability Benefit, Proof of age must be submitted in addition to other requirements. Any of the following documents will be accepted as proof of age: Photocopy of National ID Card/Photocopy of Passport/Photocopy of Driving License/Photocopy of Certificates of S.S.C or equivalent examinations

N.B. Company may ask for additional information and documents.

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