..:: Ericson Insurance TPA Pvt. Ltd ::..

May I Help You

Kindly upload duly filled up forms or fax it on 022-25270200.

Kindly upload duly filled up forms & send your all originals at our Head office address :

To,

Claim Settlement Dept.

Ericson Insurance TPA Pvt. Ltd
11-C, Corporate Park,
S. T. Road, Chembur,
Mumbai-400071, Maharashtra.

Tel: 022-25280280

Please be noted that your final settlement will take place after receiving & verification of all original documents.

UHID

Policy No

Corporate Name

Emp. Code

Patient Name

Claim Type

Date of Admission

Exp. length of stay

Appr. Expenses

Complaints

Hospital Code

Hospital Name

Hospital Address

Intimation given by

Rel. with Patient

Contact No

Remarks

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