Tesco Pet Insurance Form PDF Details

When pets fall ill or suffer an injury, the stress on their owners can be significant. Navigating through insurance claims adds an additional layer of complexity during a challenging time. Tesco Pet Insurance aims to alleviate some of this stress through its comprehensive Pet Insurance Claim Form. The form requires detailed information about both the policyholder and the pet, including any changes in the policyholder's personal details, the pet's condition, and previous veterinary practices. Policyholders are advised to provide their mobile number and email address to facilitate communication and are reminded of the importance of submitting the pet's full medical history for new conditions or the medical history since the last claim date for ongoing conditions. The form outlines specific exclusions, such as conditions existing before the policy start date, and provides a helpline for assistance. It also includes sections for veterinary practices to fill out, detailing the pet's condition, treatment dates, and costs, ensuring a thorough review process. Submission of the form can be done via email or post, with instructions clearly outlined for swift processing. By ensuring all sections are completed and supporting documents are submitted, policyholders can avoid delays in their claims. This level of detail underscores Tesco Pet Insurance's commitment to providing a thorough and efficient claims process, helping pet owners focus on what matters most: the health and well-being of their pets.

QuestionAnswer
Form NameTesco Pet Insurance Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestesco pet insurance claim form download, tesco claims form, tesco pet form, bank pet insurance form

Form Preview Example

Pet Insurance

Claim Form

tesco.petclaims@uk.rsagroup.com

Once you and your vet have completed the form, the quickest way to get it to us is simply email it to the address above with the supporting documents. Alternatively you can send it by post to: Tesco Pet Insurance, Freepost - RSJG-ZJTB-GAGH, PO Box 1363, Peterborough, PE2 2QZ. Our Claims Helpline is 0345 078 3860.

A. About you (the Policyholder)

If your name or address has changed, please tick

(Please note that changes to your address may affect your premium)

Your name, address and postcode

Daytime tel

Mobile tel

Email

Please ensure you provide us with your mobile number and email address so that we can keep you informed of the progress of your claim.

Policy number (must be completed)

IMPORTANT INFORMATION – PLEASE READ

Is this claim for a:

New Condition

Please complete all sections

Continuation Condition

Please complete sections A, B & E

If this claim is for a new condition please ensure that the pet’s full medical history from all the vets that your pet has been registered with is submitted with the claim form.

If this claim is for continuation condition then please ensure that the medical history since the last claimed date of treatment is submitted with the claim form.

PLEASE NOTE THAT IF ANY SECTION OF THE CLAIM FORM IS NOT FILLED IN, OR THE SUPPORTING INFORMATION IS NOT SUBMITTED, THIS WILL DELAY YOUR CLAIM.

if you are claiming for continuation treatment you can batch your invoices up but you must submit your claims every 3-6 months.

Your policy does not cover:

•Any condition, illness or physical abnormality that exists before the policy started

•Any accident that happened within the first 5 days after the policy start date (ACCIDENT & INJURY COVER ONLY)

•Any condition that started within the first 14 days after the policy start date

B. About your pet

Pets Name*

How long have you owned the pet?

Cat

 

 

 

Dog

 

 

 

 

 

 

 

Male

 

 

 

Female

 

 

 

 

 

 

 

Breed

 

 

 

 

 

 

 

 

 

 

 

 

Date of birth

DD/MM/YYYY

 

 

Your pet’s microchip number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*If you have more than one pet insured with us, please ensure you enter the correct pet’s name and only one claim form per pet.

C. About your pet’s condition

Please tell us when you noticed your pet was unwell or injured. If your pet has had the same or similar changes in health we require the first date.

A description of the changes to your pet’s health that you noted.

Did you contact our 24 hour vetfone service for advice on your pet’s condition before seeing your vet? Please call 0800 1974949 if required in the future.

Condition 1

Time and date HH:MM DD/MM/YYYY

Yes

 

No

 

 

Date

DD/MM/YYYY

Condition 2

Time and date HH:MM DD/MM/YYYY

Yes

 

No

 

 

Date

DD/MM/YYYY

Was your pet under your care at the time of the illness/injury/incident? Yes

 

No

 

 

If no, please provide the name and address of any authorised

 

 

 

 

 

 

 

 

 

 

third party looking after your pet at the time of the incident

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

If your claim is for an injury, do you believe that another person was at fault? If so, please provide details separately

Yes

 

No

D. Your previous veterinary practices (Please tell us the vet(s) details where your pet was previously registered)

Practice name

Address

Postcode

Phone number

Date: from DD/MM/YYYY to DD/MM/YYYY

Practice name

Address

Postcode

Phone number

Date: from DD/MM/YYYY to DD/MM/YYYY

Please tell us your name and address at that time, if it was different to the name and address in Section A.

Postcode

E. Your Declaration, who to pay and Data Protection notice (Please complete boxes a & b below to tell us who to pay)

I declare, to the best of my knowledge and belief, that all the information provided in this form is true and complete. I agree that Tesco Bank Pet Insurance may seek any information it requires from any vet. I accept that the information provided may be released to other companies who provide a service to Tesco Bank Pet Insurance in connection with managing and handling claims. Please ensure you provide us with your mobile number and email address so that we can keep you informed of the progress of your claim.

a. YOUR DECLARATION. By ticking the following box, I confirm that I agree with the above statement:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am the Policyholder:

 

 

I am the Joint policyholder:

 

 

 

 

 

 

My name is

 

 

 

 

 

 

 

Dated

DD/MM/YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. WHO WOULD YOU LIKE US TO PAY: Policyholder:

 

Joint policyholder:

 

 

 

Vet/Organisation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. PAYMENT METHOD: If you pay your premium by Direct Debit we will automatically pay any settlement into that account by electronic transfer. If Direct Debit is not used please ensure that you provide us with your contact details in Section A above, in the event we have to contact you to agree an alternative payment method.

Please note: If we decide we cannot pay some or all of your claim, it is your responsibility to pay your vet.

IF ANY REQUIRED INFORMATION IS NOT RECEIVED THEN THERE WILL BE A DELAY TO YOUR CLAIM.

If the condition being claimed for is new please enclose a full medical history for the pet. If the condition is ongoing please enclose the medical history since the last claim.

F. The vet must fill in this section about each condition

Please advise when the pet was registered at your practice Date DD/MM/YYYY

If this pet was referred to you, please advise the name and address of the registered vet which referred it, and submit the referral letter/report with this claim.

Postcode

 

 

 

 

 

 

Please advise if you are a member of the RSA preferred

 

 

 

No

 

 

referral network

Yes

 

 

 

 

 

 

 

 

 

 

If any part of this claim is for dental treatments please tell us the date prior to the claimed problem being noted that the pet had its teeth checked, and if treatment was recommended at this check up was this carried out?

 

 

Treatment recommended Yes

 

No

 

Date

DD/MM/YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatment was carried out Yes

 

No

 

 

 

 

 

 

 

If a house call was made, you must confirm below why it was absolutely essential.

If the pet was seen out of hours please confirm why this was and whether the treatment could have waited until normal surgery hours.

Condition 1

Condition 2

What is the diagnosis of the condition (if no diagnosis has been made please provide the main clinical signs).

Please tell us the treatment dates for this claim

Is this claim for a continuation of treatment?

If yes, please advise the previous dates of treatment.

Did the condition being claimed for result in the death or euthanasia of the pet?

From

DD/MM/YYYY

 

 

 

Yes

 

 

 

 

From

DD/MM/YYYY

 

 

 

Yes

 

 

 

 

 

Date of death

To

DD/MM/YYYY

 

 

 

No

 

 

 

 

To

DD/MM/YYYY

No

DD/MM/YYYY

From

DD/MM/YYYY

 

 

 

Yes

 

 

 

 

From

DD/MM/YYYY

 

 

 

Yes

 

 

 

 

 

Date of death

To

DD/MM/YYYY

 

 

 

 

 

No

 

 

 

 

 

 

To

DD/MM/YYYY

 

No

DD/MM/YYYY

Please tell us the date that the clinical signs

Date

DD/MM/YYYY

 

 

were first noticed (as noted on your clinical records).

 

 

 

 

 

 

 

 

 

Has this pet had this condition or clinical signs before,

 

 

 

Yes

 

No

 

 

 

 

or any related condition or clinical signs before?

 

 

 

 

 

 

 

 

 

 

 

(If ‘Yes’ we will need the medical history to show the dates and full details.)

The body condition score for the pet.

Scale 1-5 please add the score in the box

 

 

 

 

Date DD/MM/YYYY

 

Yes

 

No

 

 

 

 

Scale 1-9 please add the score in the box

If this claim is for a cruciate rupture, is this solely the result of a trauma

 

or is there any breed predisposition, underlying disease or conformational issue?

 

 

 

 

 

G. The attending vet or a person authorised by the vet must fill in this section

Please advise the cost of treatment incl. VAT Condition 1 £

Condition 2 £

I declare to the best of my knowledge and belief that all information provided in this claim form is true and complete. The fees I have charged are no more than the fees I would normally charge my clients.

Name:

Position in the Practice:

Practice Address:

Postcode:

Email Address:

Phone Number:

Date: DD/MM/YYYY

 

IMPORTANT: Please ensure that a dated and itemised breakdown of all treatment costs is attached to the claim form before you send it to us.

IF ANY REQUIRED INFORMATION IS NOT RECEIVED THEN THERE WILL BE A DELAY IN PROCESSING THE CLAIM.

Tesco Bank Pet Insurance is arranged, administered and underwritten by Royal & Sun Alliance Insurance Ltd. Registered in England and Wales (No. 93792) at St. Mark’s Court, Chart Way, Horsham, West Sussex, RH12 1XL. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Tesco Personal Finance plc. Registered in Scotland, registration no. SC173199. Registered office: 2 South Gyle Crescent, Edinburgh EH12 9FQ. Authorised by the Prudential Regulation Authority

and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

453340N (06-21)

Please note there can always be a risk in sending personal information via email.

 

How to Edit Tesco Pet Insurance Form Online for Free

You can easily create the bank pet insurance form form using this PDF editor. The following steps will help you quickly prepare your document.

Step 1: Select the orange "Get Form Now" button on the web page.

Step 2: At this point, you can start editing your bank pet insurance form. The multifunctional toolbar is available to you - insert, erase, change, highlight, and undertake several other commands with the text in the file.

Prepare the bank pet insurance form PDF by entering the content necessary for each individual section.

step 1 to completing tesco pet insurance form

Write the information in Please tell us when you noticed, A description of the changes to, Did you contact our hour vetfone, Time and date, Time and date, Yes, Date, Yes, Date, Was your pet under your care at, Yes, If your claim is for an injury do, Yes, D Your previous veterinary, and Practice name.

Completing tesco pet insurance form part 2

It's essential to identify the important information from the b WHO WOULD YOU LIKE US TO PAY, Joint policyholder, VetOrganisation, c PAYMENT METHOD If you pay your, and Please note If we decide we cannot part.

stage 3 to filling out tesco pet insurance form

The space F The vet must fill in this, Please advise when the pet was, If this pet was referred to you, If a house call was made you must, Postcode, Please advise if you are a member, Yes, If any part of this claim is for, Date, Treatment recommended Yes, Treatment was carried out Yes, If the pet was seen out of hours, What is the diagnosis of the, Condition, and Condition should be where one can put both sides' rights and responsibilities.

Filling out tesco pet insurance form stage 4

End up by checking the following areas and preparing them as required: If yes please advise the previous, Yes, Please tell us the date that the, Date, Date of death, From, Yes, Date of death, Date, Has this pet had this condition or, Yes, Yes, If Yes we will need the medical, The body condition score for the, and Scale please add the score in the.

Entering details in tesco pet insurance form step 5

Step 3: Hit the Done button to save your form. Then it is accessible for upload to your electronic device.

Step 4: It's going to be more convenient to have copies of your form. You can rest assured that we are not going to share or see your data.

Watch Tesco Pet Insurance Form Video Instruction

Tesco Pet Insurance Form isn’t the one you’re looking for?

Related Documents

  • Pet Insurance Form

    "... pet healthcare plan claim form ph 866 725 2747 fax 919 859 8193 section this claim form must be filled out completely and you must attach your itemized in voice incomplete forms will be returned ..."

  • Pet Sitting Contract

    "... pet sitting service contract owner information name please list all parents address city zip cell phone work cell mail address emergency contact name number how did you hear about us pet information pet name age ..."

  • Samba Insurance Claim Form

    "... health insurance claim form instructions are shown on reverse side mail samba claims to ign box 188007 chattanooga tn 37422 301 984 1440 800 638 65891 medicare medicaid champ us champ va group fec other ..."

  • Standardized Department Insurance

    "... product regulation 50 town st rd fl suite 300 columbus oh 43215 614 644 2661 fax 614 728 5238 www insurance ohio gov ohio department of insurance governor standardized credential ing form part agency program ..."

Please rate Tesco Pet Insurance Form

1 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .