Personal Accident Claim Intimation Letter

(Preliminary Notice of claim should be sent to THE NEW INDIA ASSURANCE COMPANY within 30 days
from the date of death of the insured card member)

From                                                                                                                        Date :

Name :

Full address for
communication purpose.

Email ID

Phone No :

To

The Sr.Divisional Manager
The New India Assurance Company Limited
Allied Mount Casa Blanca Building, 2nd Floor
New No.260 Anna Salai (Old No.702, Near Anand Theatre)
CHENNAI-600 006.

Re :  Personal Accident - Claim intimation.

We give below the details of the Citibank Card member who died in an accident :-

a) FULL NAME OF THE CITIBANK CARD HOLDER :

b) CITIBANK CARD NUMBER(s)

c) DATE OF ACCIDENT

d) PLACE OF ACCIDENT

e) DATE OF DEATH

I have downloaded the claim form from your website.

Thanking you,
Yours faithfully,

SIGNATURE OF THE FIRST LEGAL HEIR WITH DATE

NAME IN BLOCK LETTERS