Temporary disability due to an accident

Claim Request Form Л3-53 – an original
Accident Information Form ЛЗ 51 – an original
Medical documents for rendered first aid and treatment conducted:
- discharge summaries
- outpatient cards, medical referral with an Outpatient Card №
- interpretation of imaging/X-ray test results
- tests
- consultations with physicians-specialists* in the field of injuries, sustained by the Insuree prior to his/her being certified by the Insurance Medical Committee, etc.
* All of the above mentioned medical documents - a copy
School Certificate that the child has not attended school/kindergarten, if the non-attendance days (or part of them) are within the school year – an original with a signature and a stamp of the educational establishment/kindergarten
An official document, containing the bank account of one of the parents, if the Insuree does not have a personal bank account - a copy
A copy of the Birth Certificate of the insured child
A document certifying the right of guardianship over the insured child, if any
A copy of the insurance policy and a copy of the list of Insurees’ names

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.