Pet insurance is an important topic for pet owners to consider. By taking out pet insurance, you can help protect your furry friend in the event that something happens and they need expensive veterinary care. In this blog post we will take a look at the Tesco Pet Insurance form, so that you can learn more about what is involved in taking out this type of insurance policy.
In the table, there is some good information regarding the tesco pet insurance form. It might be helpful to learn its length, the actual time to fill out the form, the blanks you'll need to fill in, and so on.
| Question | Answer |
|---|---|
| Form Name | Tesco Pet Insurance Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | tesco pet insurance claim form, tesco claim form, tesco pet form, tesco claims form |
Claim Form
Claims Helpline: 0845 078 3860 tesco.petclaims@uk.rsagroup.com
To be completed and returned to: Tesco Pet Insurance, Freepost -
A. About you (the Policyholder)
If your name or address has changed, please tick
Name, address and postcode
Daytime tel
Evening tel
Mobile tel
If you provide us with your mobile number and email address, we can let you know we have received your claim form.
Policy number
PLEASE NOTE that if any section of the form is not filled in, it may delay your claim – you MUST fill in sections A to E.
Please also read the following notes before submitting any claim and have your policywording to hand for full details:
Your policy does NOT COVER in whole or as part of a claim:
•Any condition that started before the policy start date
•Any condition that started within the qualifying period of the policy start date
•The excess specified in your policy schedule
•Food
•Flea treatment
•Wormers
•Vaccinations
If a claim for a new condition please ensure the full medical history is attached to the claim form.
B. About your pet
Your pet’s name (* multipet)
*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.
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Dog |
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Male |
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Female |
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Breed |
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Date of birth |
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Has your pet been |
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No |
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neutered/spayed? |
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kgs |
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What is the weight of your pet? |
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Note: If you are not sure about any of the above information, please ask your vet to complete this for you.
C. About your pet’s condition
Condition 1 |
Condition 2 |
Name of condition as advised by your vet
Please tell us when you first noticed your pet was unwell or injured, that led you to make an appointment with your vet.
Time and date
Time and date
Did you contact our vetfone service?
Was your pet under your care at the time of the illness/injury/incident?
If no, please provide the name and address of any authorised third party looking after your pet at the time of the incident
Yes
Yes
No
No
Date
If your claim is for an injury, do you believe that another person was at fault? |
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If so, please provide details separately |
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No
D. Your previous veterinary practices (Please tell us all vet(s) where your pet was previously registered)
Practice name
Address
Postcode
Phone number
Date: from |
to |
Practice name
Address
Postcode
Phone number
Date: from |
to |
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 signature (Policyholder – please complete one of the following boxes (a, b or c) 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 RSA 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 us or you in connection with managing and handling claims
i)Please pay my claim direct to me Printed name:
Policyholder’s signature:
ii)Please pay my claim direct to my vet Printed name:
Policyholder’s signature:
iii)Please pay my claim direct to the person named below:
Printed name: Policyholder’s signature:
Date:
Date:
Date:
Please note: if we decide we cannot pay some or all of your claim, it is your responsibility to pay your vet.
F. Your vet must fill in this section about each condition (We only accept claim forms from veterinary practices)
Please advise the date this pet was registered at your practice.
If this pet was referred to you, please advise the name and address of the registered vet
Postcode
Was this pet referred to a complementary |
If Yes, please advise the condition |
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treatment professional? |
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Yes |
No |
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If Yes, please also complete Sections G & H
Did any condition being claimed result in the death or euthanasia of the pet?
Yes |
No |
Date of death |
If your claim involves dental or gum treatment, was this caused by an injury? Yes |
No |
If a house call was made, you must confirm in writing why it was absolutely essential
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Condition 1 |
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What are the main clinical signs? |
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What is the diagnosis? (This must be completed) |
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Please tell us the treatment dates for this claim From |
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To |
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Have you filled in a claim for this condition |
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Yes |
No |
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Don’t know |
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before? |
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From |
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If yes, treatment dates from the previous claim |
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Condition 2
From |
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To |
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Yes |
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No |
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Don’t know |
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From |
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IF THIS IS A NEW CLAIM, PLEASE COMPLETE THE FOLLOWING QUESTIONS AND FORWARD THE FULL MEDICAL HISTORY. Please tell us the date or the number of days before the first date of treatment, that the clinical signs were first noticed.
Days |
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Has this pet had this condition or clinical signs before, |
Yes |
No |
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or any related condition or clinical signs before? |
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(If ‘Yes’ we will need the medical history to show the dates and full details)
Days
Date
Yes
No
G.Complementary treatment (N.B. If the claim involves complementary treatment this section of the claim form must be filled in by a vet and not the complementary treatment professional. Please ensure a copy of the referral letter and invoice(s) are attached.)
What complementary treatment did you refer this pet for?
What condition is the complementary treatment for?
If you have not attached a copy of the referral letter or the letter does not contain the following information, please tell us:
How many sessions have you recommended? Please tell us the cost of complementary treatment
What organisation does the complementary treatment professional belong to?
Please explain how this treats the condition.
H. The attending vet or a person authorised by the vet must fill in and sign 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.
Veterinary Surgeon’s Signature: |
Date: |
Printed Name:
Email address of the Veterinary Practice:
Practice Stamp
Postcode:
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. This must state fees for consultation, prescription charge, hospitalisation,
Tesco Pet Insurance is arranged, administered and underwritten byRoyal & Sun Alliance Insurance plc. Registered in England andWales (No. 93792) at St. Mark’s Court, ChartWay, Horsham,West Sussex, RH12 1XL. Authorised bythe Prudential Regulation Authorityand regulated bythe Financial Conduct Authorityand the Prudential Regulation Authority.
Tesco Personal Finance plc. Registered in Scotland, registration no. SC173199. Registered office: Interpoint Building, 22 HaymarketYards, Edinburgh EH12 5BH. |
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Authorised bythe Prudential Regulation Authorityand regulated bythe Financial Conduct Authorityand the Prudential Regulation Authority. |
Tesco Pet Claim Form 453340CU UNFOLDED |