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Tesco Pet Insurance Form PDF Details

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?	Yes
Fillable fields	91
Avg. time to fill out	18 min 46 sec
Other names	tesco claim form pet insurance, tesco claim claims, tesco claims form, tesco pet insurance form

12

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			No

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 recommended Yes		No


		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).	Date
were first noticed (as noted on your clinical records).
Has this pet had this condition or clinical signs before,				Yes		No
Has this pet had this condition or clinical signs before,
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 tesco claim claims 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 tesco claim claims. The multifunctional toolbar is available to you - insert, erase, change, highlight, and undertake several other commands with the text in the file.

Prepare the tesco claim claims PDF by entering the content necessary for each individual section.

step 1 to completing tesco claim form

Write the information in Condition, Time, and, date Yes, Date, Condition, Time, and, date Yes, Date, Yes, Yes, Practice, name, Address Postcode, Phone, number, Date, from, to Postcode, Phone, number, Date, from, to and Postcode.

Completing tesco claim form part 2

It's essential to identify the important information from the Iam, the, Policyholder Iam, the, Joint, policyholder Dated, b, WHO, WOULD, YOU, LIKE, US, TO, PAY, Policyholder Joint, policyholder and Vet, Organisation part.

stage 3 to filling out tesco claim form

The space From, Yes, Date, From, Yes, From, Yes Date, of, death Date, Postcode, Yes, Date, Condition, and Condition should be where one can put both sides, ' rights and responsibilities.

Filling out tesco claim form stage 4

End up by checking the following areas and preparing them as required: Yes, Date, Yes, Scale, pleaseadd, the, score, in, the, box Scale, pleaseadd, the, score, in, the, box Condition, Name, Practice, Address Email, Address Date, Position, in, the, Practice Postcode, and Phone, Number

Entering details in tesco claim 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

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