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Maashak Claim Declaration


We are providing you with a Claim Form to fill in case you have to report any loss or damage covered under your policy.

In this Department, even though declaring the event should be made within 72 hours after the accident has occurred. This declaration could be made either by telephone or by fax to make it quick, but it is still necessary to fill in a Claim Declaration Form. For this reason, we are providing you with this form just to put you in the mood of what could we ask you about in terms of declaration thus relieving you from the move. You may fill this form by yourself or have somebody fill it for you in order to let the claims department handle your request the fastest possible.

Necessary Documents that should be submitted to the Claims Department
  • Original
  • Policy
  • Treating Physician Report
  • Forensic Report for Disability Percentage
Maashak Claim Form
PS: Fields marked with a (*) are required.
Policy Holder *
Insured Name*
Address
E-mail *
Phone Number
Policy Number *
Name of Person Filling this Claim *
Relationship With Insured
Time and Date of Accident HH:MM dd/MM/yy
Name of Hospital
Name of Treating Physician
Was There any Expert Report
Forensic / Expert Name
Brief Description / Cause of Accident
Bodily Injury Description