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Grievance Entry Form
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Grievance Type
*
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Senior Citizen
IRDA Portal
I.C Grievance
Hospital Grievance
Others
Input Type
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Mail By Insured
Mail By I.C(R.O)
Mail By I.C(D.O)
Mail By I.C(B.O)
Mail By Agent
Mail By Hospital
Phone
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Subject
*
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Regarding Card
Regarding Claim
Regarding Hospital
Regarding Grivance
Delay In Settlement
Delay In Processing
Deduction
Reconsider
Others
Name
*
Card
Policy No
*
CCN
*
Contact Number
*
Email ID
*
Write Your Grievance/
Message/Feedback
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Priority
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