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(Insurance Regulatory and Development Authority Life Insurance Registration No. 117) Registered Office: Brigade Seshamahal,
5, Vani Vilas Road, Basavanagudi, Bangalore - 560 004, www.pnbmetlife.com, Fax: +91-80-4150 6969
Date:
To
PNB MetLife India Insurance Company Ltd, Bangalore.
Notification of Claim under Policy No.
Member ID/Certificate No.
Nature of Claim:
GPH
Details
_________________Date
_______________Place________ _____________
Customer Service Toll free: 1800-425-6969, OR Call on: +91 -80 -2650 -2244 (8:00 am to 8:00 pm)
Mail us at indiaservice@pnbmetlife.co.in
Version 1.0
Please do not leave any column blank. Please write N.A , if not applicable.
Signature of person receiving the intimation as mentioned in row # 3 above________________________________
Date____________________
Customer Service Toll free: 1800-425-6969, OR Call on: +91 -80 -2650 -2244 (8:00 am to 8:00 pm)
Mail us at indiaservice@pnbmetlife.co.in
Version 1.0