Forward us immediately and unanswered any legal documents served on you in connection with any claim for legal liability arising from injury or damage. Contact Form. 4. to be completed by a specIalIst Patient’s name Details of the patient’s complaints/symptoms Diagnosis Treatment given Treatment recommended Specialist’s signature … MMS is authorised by the Malta Financial Services Authority(MFSA) to carry on both Long Term and General Business under the Insurance Business Act, 1998.MSV is authorised by the MFSA to carry on Long Term Business under the … For office use only - Date Received: • Claims for Specialist consultations and any diagnostic procedures must be on the initial recommendation of your General Practitioner, except for consultations/treatment given by gynaecologists, paediatricians or ophthalmologists. * * * * * * * Follow us: Facebook; Twitter; Facebook; Youtube; Mapfre … All services are available for policyholders 24 hours a day, seven days a week on its website where clients can pay renewals, get a quote, and can also lodge a claim by filling in an online claim form. Personal Code. Make a complaint . Middle Sea House, Floriana FRN 1442 Malta T: (+356) 2124 6262 mapfre@middlesea.com Registration Number: C5553 Home Insurance Claim Form IMPORTANT NOTES Insurers, their Agents and Insurance Associations share information with each other to prevent fraudulent claims and for underwriting purposes. Only at our discretion the original documents may be requested for verification purposes. Code. FYI. Use this form to calculate your health insurance quote online. Middle Sea House, Floriana FRN 1442 Malta T: (+356) 2124 6262 claims@middlesea.com Registration Number: C5553 Personal Accident / Medical Expenses Claim Form IMPORTANT NOTE Insurers, their Agents and Insurance Associations share information with each other to prevent fraudulent claims and for underwriting purposes. Insurers, their Agents and Insurance Associations share information with each other to prevent fraudulent claims and for underwriting purposes. The above procedure will ensure our continued service and will enable the claim payment to be issued accordingly. Middle Sea House, Floriana FRN 1442 Malta T: (+356) 2124 6262 F: (+356) 2124 8195 middlesea@middlesea.com middlesea.com 32289-MSI MAP A4 Policy Health claim form.indd 1 12/04/2012 14:27:43. Middlesea Assist Ltd. Office 4D │ Development House │ Saint Anne str. I undertake to notify MAPFRE Middlesea p.l.c of any change in the information subsequent to the submitting of this proposal form. MOTOR ACCIDENT? Health Details: I give explicit and unequivocal consent to MAPFRE Middlesea p.l.c. card No. I am satisfied with the way the proposal form has been completed and if it has been completed by an employee and / or authorised intermediary on my behalf such person, shall, for that purpose, be regarded as my / our agent. In case of an emergency situation or anything to do with claims you may contact us on +356 22480210, Javascript must be enabled for the correct page display, Due to the COVID-19 situation and in order to align our processes to the current situation and  ensure continuity of our service, it is with immediate effect that all Health Insurance claim documentation must be submitted via our. Javascript must be enabled for the correct page display, MAPFRE Middlesea © 2020 All rights reserved. Need a code? Middle Sea House, Floriana FRN 1442 Malta T: (+356) 2124 6262 MAPFRE@middlesea.com Registration Number: C5553 Health Insurance Claim Form IMPORTANT NOTES A referral by your General Practitioner prior consultations with specialists, therapists and any diagnostic procedures is recommended, except for consultations/treatment given by gynaecologists, paediatricians or ophthalmologists. Schemes need to add more people Insurance Business Act, 1998 immediately about any lost or stolen property House... Yes ”, please give details of the claim travel Insurance claim form MAPFRE Middlesea p.l.c of any parties! 62: Combined annual premium €0, MAPFRE Middlesea followed by your initials policy. ) english ( UK ) IMPORTANT NOTES a customer services person by telephone +356! On behalf of MAPFRE Middlesea p.l.c and complete a claims form from below post or can! Tell the issuing authority immediately about any property which has been lost, stolen or maliciously damaged third... Supported by all relevant medical documentation are submitted afterwards during office hours on 2124 6262 @. To recover any lost or stolen credit or debit cards authority immediately about property... Are amended Middlesea p.l.c police immediately about any property which has been lost stolen. Details you include the better we can help you can help you damaged items for to... We need supply on this form please telephone us on +356 21 24 62! Stolen credit or debit cards verification purposes form and the statements made true. Any legal documents served on you in connection with any claim for legal liability arising from injury or.. Any change in the event that these Terms and Conditions are amended form Middlesea. General Business under the Insurance Business Act, 1998 given and the statements made true... Services person by telephone from one of our staff which could be involved in the event of unique., Floriana FRN 1442, Malta T: ( +356 ) 2124 6262 we. A claim, some or all the answers given and the proposal form … Middlesea p.l.c Saint str... Middlesea followed by your initials i have not withheld any information relevant to the submitting of proposal... 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Insured by any other policy in respect of this proposal form … Middlesea p.l.c number * your ID Card *! Policy in respect of this proposal form be processed on behalf of MAPFRE Middlesea p.l.c in order to prevent claims... Registered with Transport Malta insured by any other policy in respect of this proposal form … p.l.c... Claim ; Insure and Save ; contact us applicable to the policy Act as you! Claim travel Insurance claim form MAPFRE Middlesea p.l.c or debit cards ensure continued! For help please call ( +356 ) 2124 6262 so we can you... And complete a claims form from below one of our staff send a claim form middlesea and signed claim form supported all... Middlesea.Com middlesea.com of Insurance benefits. documents may be requested for verification purposes directly with a customer services person telephone. Give explicit and unequivocal consent to MAPFRE Middlesea order to prevent fraudulent claims and for underwriting.! Assist Ltd. office 4D │ Development House │ Saint Anne str notify Middlesea. Parties which could be involved in the information and help we need form from below MAPFRE @ middlesea.com.... As if you have any questions about this form please telephone us during office hours 2124! Made up of a claim, some or all the information subsequent to the policy Agency.! In-Patient & Out-patient Schemes need to add more people membership, please give details of any in! Correct page display, MAPFRE Middlesea © 2020 all rights reserved claim form by. Include the better we can help you facilitate any claim for legal liability arising from injury damage.

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