| Policy Details |
| Policy Number / Certificate Number |
{{$response['policy_number']}} |
| Insured Name and Address |
{{$response['insured_name_address']}} |
| Period |
{{$response['policy_period']}} |
| Loss Details |
| Date & TIme of Incident |
{{ $response['incident_date_time']}} |
| Accident Location (Compelete Address with PIN Code) |
{{ $response['accident_location']}} |
| Cause Of Loss / Incident / Accident |
{{ $response['cause_off_loss']}} |
| Decription Of The Incident / Accident |
{{$response['incident_description']}} |
| Nature of Injury |
{{ $response['injury']}} |
| Estimated Loss in ₹ (Provisional) |
{{ $response['expense_amt']}} |
| Contact Person Name , Phone No. & Email ID |
{{$response['contact_person_detail']}} |
| Claim Reporting Person Name , Phone No. & Email ID |
{{$response['claim_reporting_person_detail']}} |
| Hospitalization Details , if any |
{{ $response['hospital_details']}} |
| Your Claim Reference number , if any |
{{ $response['claim_refrence_number']}} |
| Any Other Deatails |
{{$response['other_details'] = ''}} |
| Employee Details |
| Name , Gender & Birth Date of Employee |
{{$response['employee_detail'] }} |
| Full Postal Address of Employee |
{{$response['postal_address']}} |
| Date of joining Employment |
{{ $response['job_joining_on']}} |
| Employee Job Description |
{{$response['job_description']}} |
| Approximate Salary / Wages per Month |
{{ $response['approx_salary']}} |
| {{$response['ins_comp_name']}} Contact Details |
| Email ID |
{{$response['email_id'] }} |
| Toll Free Number |
{{$response['toll_free_number']}} |