№ lp_1_33205
Administrative declaration used in health insurance reimbursement claim processing that records confirmation, conditions, and responsibilities for submitting scanned claim documents during the Government of India lockdown period.
Document type: Self-declaration
Claim type: Reimbursement claim
Insurance product: Group Mediclaim Policy
Submitting parties: Insured / Corporate
Third-party administrator: Heritage Health Insurance TPA Pvt. Ltd.
Address: 2, Hare Street, Nicco House, 5th Floor, Kolkata – 700001
Country: India
Submission mode: Scanned copies uploaded on TPA portal
Portal: www.heritagehealthtpa.com
Context: COVID-19 lockdown by Government of India
Authority reference: Ministry / DFS
File format requirement: PDF
Maximum file size: 30 MB
Attestation requirement: Self-attested on each page
Time limit for submission of originals: Within 15 days after lockdown is over or on request by TPA/insurer
Conditions: Subject to policy terms and insurer instructions
Declaration scope: Authenticity of documents and non-duplication of claims
Recovery clause: Applicable in case of misrepresentation or fraud
Signature requirements: Signature, name, designation, date
Corporate requirement: Company name and stamp for group policy
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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