COVERING LETTER

Dear Sir/Madam,

Please find the list of documents attached towards reimbursement of Hospital Expenses in the name
of Jhanvi Dinesh, D/o Dinesh Karunakaran

Card Number: BLR-OI-Q0074-008-0001372-C

JHANVI D

Policy Holder: Dinesh Karunakaran- BLR-OI-Q0074-008-0001372-A

Yours Sincerely

Dinesh Karunakaran
 Documents Enclosed

1 Original Signed Claim Form Yes

2 Original Hospital Bill Yes

3 Original Pharmacy Bill Yes

4 Original Discharge Summary Yes

5 Medical Investigation Reports -Original Yes

6 Original OPD Bills Yes

7 Photo ID Proof -Policy Holder Yes

8 Address Proof -Policy Holder Yes

9 AADHAR- Patient Yes

10 Bank Account Proof- Statement copy Yes

11 Copy of Mediclaim Card Yes