Grievance redressal portal

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Enter OTP

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Grievance To Be Lodged Against

Details of Complainant

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Communication Details

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Complaint Details

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Brief details of the Complaint


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Documents

You are requested to upload the following documents. Kindly note that each document size must not exceed 10 MB. Supported file types are *.pdf and *.jpg

(*) - Mandatory fields
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Please Review & Confirm the details filled by you

1 Complaint Details
Approached your Insurance Company?: Date of complaint lodged with the Insurance Company:
Insurance Broker:
Insurance type:
Insurance Company:
Policy No.:
Compensation Sought (Rs.):
Date of Occurrence:
2 Details of Complainant
Complainant name:
Relation with Insured:
Gender:
Email Id:
Mobile number:
Date of birth:
Address:
State:
City:
Pincode:
Insured name:
Ombudsman centre:
Brief details of the complaint:
3 Documents submitted
Copy of complaint submitted to Insurance Company:
KYC particulars,Aadhar card, Pan Card,Driving License, etc:
Letter from Insurance Company rejecting the representation/repudiating the claim:
Photograph:
Copy of Insurance policy:
Other document(s):
I hereby declare that the information given by me is correct to the best of my knowledge.
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Consent

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Complaint Submitted

Thank you for submitting your complaint. Complaint details would be verified by us and post successful verification, your complaint would be registered.

Kindly note that this complaint will not be registered if it is found to be incorrect/invalid.



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