For payment of sums for surgical treatment, resulting from an accident or illness, the Insuree should provide the following documents:

1. Claim Request Form Л3-53 - an original, containing all particulars
2. Copy of the identity card of the eligible person for Life insurance and Group Risk Life insurance
3. Discharge summary of a hospital stay - a copy
4. An official document, containing the Insuree’s bank account, if it has not been indicated in Form ЛЗ 53 – a copy
5. Upon individual insurance: Insurance policy
6. Upon group insurance at the Employer’s expense: A copy of the insurance policy and the list of Insurees’ names

Upon an ACCIDENT, the Insuree should provide the following additional documents:

1. ACCIDENT Information Form ЛЗ 51
2. Upon an Accident at Work– a Declaration Statement to NSSI about an Accident at Work – a copy
3. NSSI order about an acknowledged Accident at Work – a copy

In case the sums will not be received by the eligible person:

Notarized power of attorney from the entitled person, if the sums will be received by another person. The power of attorney must contain a statement (text) that the eligible person has been notified that he is entitled to receive the sums in person.

Print list