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Critical Illness Claim Form (Hong Kong) Mobile App

Insurance claimants can use this digital form to file their Critical Illness Claims. Captures the following information: Claimant name and policy number, nature of claim, the nature of the critical illness, symptoms, and more.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Critical Illness Claim Form (Hong Kong) Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Policy Number

  • Ico textbox

    Name of Proposed Insured/Insured

  • Ico textbox

    I.

  • Ico textbox

    Area Code

  • Ico textbox

    Agency/Broker Name

  • Ico textbox

    Agent/Broker Code

  • Ico textbox

    Operations Team

  • Ico textbox

    Agent/Broker’s Name

  • Ico textbox

    Agent/Broker’s Tel.

  • Ico multiline

    Correspondence Address

  • Ico textbox

    Contact Phone No.

  • Ico statictext

    This is a:

  • Ico checkbox

    New Claim

  • Ico checkbox

    Further Claim

  • Ico checkbox

    Review/Appeal

  • Ico textbox

    1. Name the critical illness you are claiming for

  • Ico date

    2. Date of first consultation

  • Ico textbox

    3. Describe the symptoms from date of onset

  • Ico textbox

    The name, address and contact phone no.

  • Ico textbox

    How long have you been having thesesymptoms from the date of your firstconsultation?

  • Ico textbox

    The name, address and contact phone no.

  • Ico statictext

    Please give below the details of any doctor(s) who have been consulted in connection with this i...

  • Ico textbox

    a.

  • Ico date

    Date

  • Ico textbox

    b.

  • Ico date

    Date

  • Ico textbox

    c.

  • Ico date

    Date

  • ...and More!

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