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FORMAT No. 11INFORMATION REGARDING PAID CLAIMS UNDER SKSBY

Sl.No. Name of the ( nominee)Beneficiary Mobile No

1 Vimal Vimal 95288723932 Rakesh urf Manmohan Rakesh urf Manmohan 94117000543 Ramdas Ramdas 84101426544 Chandrapal/Aryan Chandrapal/Aryan 96901373825 Vimal Vimal 95288723936 Virendra Singh Virendra Singh 97580108317 Lalit Kumar Lalit Kumar 90120606328 Ranjana Sharma Ranjana Sharma 89093424589 Ajay Kumar Sharma Ajay Kumar Sharma 9411837398

10 Babita Sharma Babita Sharma 941183739811 Raghupati Singh Raghupati Singh NA12 Pramod Pramod 901212816413 Raju/Rajendra Raju/Rajendra 971916800114 Rajjo Rajjo15 Rajesh yadav Rajesh yadav 953665974916 Manav Manav NA17 Avinash Avinash NA18 Sunny Sunny NA19 Shankar Lal Shankar Lal NA20 Ganga Deep Ganga Deep NA21 Vinay Mishra Vinay Mishra NA22 Sunil Kumar Sunil Kumar NA23 Vishnu Devi Vishnu Devi NA24 Mr. Chanda Mr. Chanda NA25 Rahul Mishra Rahul Mishra NA26 Pankaj Pankaj NA27 Vikash Vikash NA28 Mahesh chand Dalchand 705515809929 Chandra Devi Chanda Devi 750062294030 Ram Autar Ram Autar 989774532031 Munna Khan Munna Khan 958833901932 Pramod Murari Lal 901212816433 Surendra Kumar Pradeep 989734654334 Virendra Singh Virendra Singh 783080136935 Janak Singh Janak Singh 991737814636 Mohan Singh Mohan Singh 963441252837 Rakesh Kumar Shyam lal 9675617539

Name of the Insurance Company - Oriental Insurance Co. Ltd.

Name of the Deceased/Injured

38 Rambraj Kalyan Singh 783855368739 Shri Kishan 992773234140 Kumari Vijay Janak Singh 991737814641 Chhaviram Singh Sovran Singh 971986812642 Hariom singh Dharke Bijendra Singh NA43 Rishikesh Rajendra Singh 976019479044 Jitendra Singh Evran Singh 962745450745 Ajay Nihal Singh 975988618946 Hariom Hariom 983702576447 Vijay Rajkumar 962787446348 Zameer Khan Shamsher Khan 886894778249 DHARM VEER SINGH HAKIM SINGH NA50 Arvind Kumar Arvind Kumar 897999929051 Raj Kumar Nathuram 983741937752 Anshul Sharma Mukesh Chand53 Banee singh Rajveer singh NA54 VEERENDRA SINGH VEERENDRA SINGH NA55 Pappu Horilal 731098613956 Mukesh Chandra Moti lal/Moti Ram 753388745157 Rustam Singh Chote Singh 897997266758 Natthi lal Bittan devi 895840974359 Ajay singh Asha 963478446860 Hari Shankar Guddi61 Girija Prasad Bejanti 708897142062 Aidal Singh Rinki 9634167411/983750544163 Vijay Singh Shashi Devi 735145608064 Saroj Devi Rajni Kumari 953661155065 Ram Singh Ram Singh 952819507066 Ramsakhi Ramsakhi 908464040567 Indrajeet Indrajeet


Address Date of Accident

Khadwai, Runkata,Agra 12/12/16 04/12/17 15000Kheragarh,Agra 7/10/2016 1/24/2017 6080

Barhan,Agra 9/20/2016 1/30/2017 6159Mohdampur,Fatehabad Agra 10/29/2016 4/17/2017 25000

Khadwai, Runkata,Agra 12/12/2016 4/17/2017 13432Khanda Agra 11/27/2016 2/6/2017 10594

Kagaraul,Bhojpur.Agar 10/17/2016 2/6/2017 25000Vill -Chirauli Barahan Agra 12/1/2016 3/17/2017 25000Vill -Chirauli Barahan Agra 12/1/2016 4/17/2017 25000Vill -Chirauli Barahan Agra 12/1/2016 4/17/2017 19885

Agra 3/18/2017 32550Swaroop Nagar,Agra 3/21/2017 11043

Nagla Mohamadpur sadra Agra 3/20/2017 98065Badair 38750

Nagla Amar,Salempur,ajrana 56009AgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgra

Nagla Maliyan, Arthera, Agra, Fatehapursikari 12/21/2016 5/20/2017 901346/93 A bhim nagar, jagdispura, agra 5/23/2017 15358

Mahaveer Nagar,Mandi Smiti Agra 5/23/2017 41899Benrampur, Agra 5/20/2017 7245

Swaroop Nagar, Nainana jat, Gwalior road, Agra 5/22/2017 42554Nagariya, Kolara kalan,Agra 5/5/2017 5/25/2017

Gubrari tula sehpur samsabad,Agra 5/25/2017 25000Nagaria,Kolara kalan,Agra 5/4/2017 5/26/2017 16811

Nagaria,kolara kalan nagania,Agra 5/5/2017 5/30/2017 12734Nagaria,kolara kalan nagania,Agra 5/5/2017 5/30/2017 8934


Date of Claim

receivedAmount

PaidDate of

Payment

Nagaria Post Kolara Kala,Agra 5/5/2017 6/6/2017House no-358,Koulara Kalan,Pavsar,Fatehabad,Agra 5/5/2017 6/6/2017 10536

Nagaria Post Kolara Kala,Agra 5/5/2017 6/6/2017Nagaria kolara kalan,Agra 5/5/2017 6/7/2017Rasulpur,Tehedmpur,Agar 6/15/2017 6/16/2017 33566

82,Ratauti,Agra 5/5/2017 6/30/2017 9600Nagaria,kolara kala,Agra 5/5/2017 7/1/2017 18615

Kolara kala,Agra 5/4/2017 7/5/2017 18665New khilli,basoni,agra 3/14/2017 7/5/2017 11473

Nagaria,kolara kala,Agra 5/4/2017 7/5/2017 19707Atarauli Ali Garg 7/9/2017Pindhora,Agra 7/6/2017 7/11/2017

Ashok vihar colony jaleshwar road tedi bagiya,Agra 3/25/2017 7/13/2017Nagaria kolara,Agra 5/5/2017 7/13/2017

5/22/2017Gutilasin,barhan,etmadpur,Agra 18-07-2017 7/21/2017

Bai kheda jarun,katra,Agra 7/14/2017 7/22/2017Anguri,bichpuri,Agra 3/15/2017 7/31/2017 1000

Turkpura,richoha,kheragarh,Agra 1/14/2017 7/31/2017 500Gurja kamle,rajora,bah,Agra 7/31/2017 300

Nagla tank dauki agra 11/18/2016 7/31/2017 550kagarole bhaga agra 11/7/2016 7/31/2017 700

Taraso,dadopura,midhakaul,Agra 11/30/2016 7/31/2017 750Aulanda,Agra 7/31/2017 630

Fathepursikri,Kirawali,Agra 11/6/2016 7/31/2017 400Nahla,Pinghat,Agra 9/15/2016 7/31/2017 700

Dhamota,Kundola,Fatehabad,Agra 9/29/2016 7/31/2017 500Bijoli,baha,Agra 7/4/2017 8/5/2017

Sant kabir nagar,Agra 6/24/2017 8/5/2017Rautauli,Agra 5/18/2017 8/5/2017

Cashless PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Paid

Cashless PaidCashless PaidCashless PaidCashless PaidCashless Paid

Reimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Under processReimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Under processReimbursement Document pendingReimbursement PaidReimbursement PaidReimbursement Paid

Cashless Under processCashless Paid

Reimbursement Under processReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Paid

Death/Disablement/Cashless/Reimbursement

Status(Paid/Rejected/Underprocess)

Reimbursement Under processReimbursement PaidReimbursement Under processReimbursement Under process

Cashless PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Paid

Cashless Cashless approvedCashless Cashless approved

Reimbursement Under processReimbursement Under process

Cashless PaidCashless Cashless approvedCashless Cashless approved

Reimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Under ProcessReimbursement Under ProcessReimbursement Under Process

Reason for Repudaition ( Minimum 20 words) District Name

AgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgra

Awaited original documents AgraAwaited original documents AgraAwaited original documents AgraAwaited original documents AgraAwaited original documents AgraAwaited original documents Agra

File received & Underprocess AgraAwaited original documents AgraAwaited original documents AgraAwaited original documents Agra

File received & Underprocess AgraAwaited original documents Agra

AgraAgraAgra

File received & Underprocess AgraAgra

File received & Underprocess AgraAgraAgraAgraAgra

File received & Underprocess AgraAgra

discharege card was requried now received file ready for payment AgraPatient age is above 70 yr Agra

AgraAgraAgraAgraAgraAgra

Patient under traetment AgraPatient under traetment Agra

File received & Underprocess AgraFile received & Underprocess Agra

AgraPatient under traetment AgraPatient under traetment Agra

AgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgraAgra

Sl.No. Mobile No

1 Pratap Singh Pratap Singh 84107335402 Ashok Kumar Ashok Kumar 86500163823 Harvansh Harvansh 84107335404 Guddu Guddu 97614363505 Hovindra Singh Hovindra Singh NA6 Nanhi Devi Nanhi Devi 89239032127 Dharamveer Singh Dharamveer Singh 97582068768 Kishori Prasad Kishori Prasad NA9 Hemant Hemant NA

10 Ramveer Singh Ramveer Singh NA11 Omveer Singh Omveer Singh NA12 Mukesh Kumar Mukesh Kumar NA13 Mantu Mantu NA14 Salman/ Ali Arshad Salman/ Ali Arshad NA15 Rajeev Kumar Rajeev Kumar NA16 Jayveer Singh Jayveer Singh NA17 Prem Babu Prem Babu NA18 Kali Charan Singh Kali Charan Singh NA19 Anupam Anupam NA20 Vikash Kumar Vikash Kumar NA21 Uashrat Uashrat NA22 Ramwati Devi Ramwati Devi NA23 Mittar singh Mittar singh 750096969924 Kimati Ramkishan singh 921947397125 Yogendra Kumar Mahesh Chand 875531934226 Madhu Har Narayan 975968904427 Akash Kumar Harpal Singh 976163699828 Akhilesh kumar Chandrabhan Singh 931978380029 Rajjan/Raj Kumar Ramveer singh 962772330930 Chandra Bos Chandra Bos 894101335031 Ravi Kumar Nirottam Singh 992745411632 Vishnu Ashok Kumar 724872713733 Ashok Kumar Ashok Kumar 724872713734 Satyapal Surajpal Singh 975840413335 Kailash Kumar Bhagwati prasad sharma 969054899536 Karan Singh Suman 706252935337 Ramawtar Gunjan 975658775938 Pushambhar Singh Ram Pal 844947811839 Suraj Pal Singh Timendra Kumar 9760732830


Name of the ( nominee)Beneficiary



Khitkari,Aligarh 11/24/2016Masand ,Pora 12/20/2016

Khitkari,Aligarh 11/9/2016Govindpur fagoi ,Aligarh 11/2/2016Chamuha,Atrauli, Aligarh 1/19/2017

Nagla ,Asha,Aligrah 1/24/2017Morwan Ghalu,Aligarh

Vill Bhavan Kheda Aliagrh 02/28/17Vill- Adhu ki Nagaliya, Block- Gonda Aligarh 4/8/2017

Vill-+ Post- Shahpur Madrak Koil Aligarh 3/31/2017Vill- Khera Sattu, Block- Khair, Aligarh 4/6/2017

Vill- Bhaiyapur Post- Hironi, Block- Rajpura Sambhal 4/1/2017Nagla Kalar, Khair Bypass Aligarh 4/13/2017

Loko Colony Gali No- 10 Civil Lines Aligarh 4/13/2017Vill- Nagla Shekhu Post- Meerpur, Khurja. 3/4/2017

Vill+ Post- Jiroli Dhum Singh Block- Atrauli Aligarh 2/25/2017Chandaniya Chowk Aligarh 1/23/2017

Vill- Bhopatpur Post- Gadrana Aligarh 3/14/2017Vill- Purain, Ismylpur Charra Aligarh 2/7/2017

Vill- Jashrathpur Post- Jhallupur, Sihore Aligarh 4/10/2017Vill- Dhadal, Atrauli Aligarh 4/4/2017

Vill- Rustampur, Aligarh 3/28/2017Sarkari school nagla bhaviya kaimthal, iglas aligarh

Sangeela beswan dehat,aligarh 1/13/2017Malikpura, Tamoki, Aligarh 1/23/2017

Biharipur,Lodha,AligarhNaya bans,Imlani block,Dhanipur,Aligarh 5/8/2017

Sudhal,chherat,Aligarh 4/20/2017Sablapur, Aligarh

Bilkhora,sujanpur,AligarhNagla birkhu,Aligarh

Rustampur,sakatkha mandir ka nagla,Aligarh 6/11/2017Rustampur,sakatkha mandir ka nagla,Aligarh 6/11/2017

Kirthala,Bembirpur,Aligarh 6/11/2017Songara,gabhana,Aligarh 11/3/2016Nagla mehtab kol,AligarhTejpur,bhagatpur,Aligarh 3/11/2017

Kalyan nagar,tebuth,Aligarh 10/5/2016Tampauli,Gabna,Aligarh 10/17/2016



Date of Claim received Amount Paid Date of Payment

12/28/2016 1816612/27/2016 100031/24/2017 152324/24/2017 123244/24/2017 250001/28/2017 49084/18/2017 22300

5/20/20175/25/2017 140375/26/20175/23/20176/22/2017 225606/6/20176/7/2017

6/23/20176/23/20176/23/20176/30/2017 33286/30/2017 144077/29/20177/31/2017 5507/31/2017 2997/31/2017 3007/31/20177/31/2017

Oriental Insurance Co. Ltd.

Reimbursement PaidCashless Paid

Reimbursement PaidReimbursement PaidReimbursement RepudiatedReimbursement PaidReimbursement PaidReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Under processReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement RepudiatedReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Under processReimbursement Doucment pendingReimbursement Doucment pendingReimbursement PaidReimbursement RejectedReimbursement RepudiatedReimbursement PaidReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement PaidReimbursement PaidReimbursement Under ProcessReimbursement PaidReimbursement PaidReimbursement PaidReimbursement RejectedReimbursement Rejected



Reason for Repudaition ( Minimum 20 words)

Require document not received/eligibility proof,khasra khatoni/income cetificate not received

Awaited original documentsAwaited original documents

File received & Under processAwaited original documentsAwaited original documentsAwaited original documents

Query not reply/Hof eligibility proof not available/hospital bill/FIR Gd not submitted/Patient has given written application that he have no documentAwaited original documentsAwaited original documentsAwaited original documentsAwaited original documentsAwaited original documents

File received & Under processAwaited original documentsAwaited original documents

Rejected due to not query answer reply/not provied eligibility proof-khatoni,income certificated/Gd FIRGd/FIR not receive from patient

File received & Under processFir Gd and parivar register copy required/query sent on 12-6

Gd/Fir requriedFile received & Under processFile received & Under process

Not payable (on spot death)Not payable (on spot death)

District Name

AligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarhAligarh

Sl.No. Mobile No

1 Sanjeev Sanjeev 97604657602 Firoj Firoj 76185421143 Usman Usman NA4 Seema Ansari Seema Ansari NA5 Abhisek kr. saini Abhisek kr. saini NA6 Bhupendra Sahoo Bhupendra Sahoo NA7 Shahid Shahid NA8 shashibala shashibala NA9 sabir hussan sabir hussan NA

10 Anil kr. Sahoo Anil kr. Sahoo NA11 Amit kumar Amit kumar NA12 Mukarram Mukarram NA13 Rajendra Rajendra NA14 Tasleem Tasleem NA15 Haneef Haneef NA16 chandrapal chandrapal NA17 geeta geeta NA18 Durgapal Durgapal NA19 anuj kr. anuj kr. NA20 bhupendra bhupendra NA21 parmanand parmanand NA22 Babloo Babloo NA23 Mrs Praveen Mrs Praveen24 Ravi Ravi25 Satya pal Satya pal26 vinod kumar vinod kumar27 premraj premraj28 Dalchand Dalchand29 Sanjeev vaisya Sanjeev vaisya30 Sanjay kumar Sanjay kumar31 lalit kumar lalit kumar32 Raj Kumar Raj Kumar NA33 Amar Singh Amar Singh 735155575834 Kumari Jouli Suman 865034593735 Omvir Omvir 865034593736 Rajkumari Nathu 819295409337 Abhishek Dayaram 789592341138 Ovendra Singh Pooran lal 94586147239 Chandrapal Singh Chandrapal Singh 972033029440 Vijay Pal Vijay Pal 8527868060



41 Komil Ram Komil Ram NA42 Buddhi Buddhi 975898333243 sanjay singh sanjay singh 963410757744 Ram bahadur Dharampal 969062812245 Satyawati CHANDRA PAL 989950846146 Mohan Lal Ganga Ram 963904316047 Netra Pal CHANDRA PAL 989950846148 Sunil Sharma Ram chandra sharma 953644122249 Nemchandra Ramcharan 975855266050 Omveer Singh Babu Singh 865034593751 Balveer Singh Soran Singh 967520357052 Prem Pal Guddi 839294540353 Jaswant Guddi 790066845454 Jalim Chameli Devi 885962402455 Dev Saran Kiran Devi 9259404702/858403142556 Prem lal Trivedi devi 969093317857 Puran lal Khema Devi8650432859/999702104958 Mukesh Preeti 8954346916



Allahpur Chamari,Badaun 7/11/2016Barkhera,Badaun 1/28/2017

Usita,Vanawal,Badaun 1/9/2017Usita,Vanawal,Badaun 1/9/2017

Muhall- lochi nagla,subhash nagar, Dist- Badaun 10/30/2016muhalla- Naharkha Saray,Lalpool, Nai Basti,Badaun 2/10/2016

karmakar calony ,Near Gopi chowk, thana- kotwali - Dist.Budaun 2/20/2017Vill- Pindara, Tahsil- Bisauli,Dist- Badaun 11/30/2016

Vill- Muhammad nagar sulara,Tahsil- post - Dist.- Badaun 2/16/2017Muhalla - Nekpur ,civil line , badaun 9/28/2016

Vill-sichauli, Thana - Bisauli ,Dist- Badaun 4/6/2017Vill- Basauliya ,Thana- Sahaswan ,Dist- Badaun 4/1/2017

Vill- chakolar ,Dist. - Badaun 12/27/2016Vill-Hussanpur ,thana- kumargaon,Dist- Badaun 4/12/2017Vill-Hussanpur ,thana- kumargaon,Dist- Badaun 4/12/2017

Vill- sekanagala, Thana+post- Mujariya,Dist- Badaun 1/28/2017Vill-Aajampur,Thana - Hajratpur,Dist- Budaun 4/9/2017

vill- Upraila, Dist - Badaun 4/11/2017vill-rajanagla, post-usanwan ,tah-dataganj,dist.- budaaun 4/16/2017

vill- khunak, Dist- Badaun 4/17/2017vill- Gidhaul, thana - musajhag, dist- badaun 4/4/2017

vill- hasspa , tah.- bisauli Dist.- badaun 4/19/2017para dataganj Badaun 3/30/2017

shanye bharquia Badaun 2/24/2017jyorapar wala Badaun 3/1/2017

Vill- daspur,tahsiol- bisauli ,Dist- Badaun 24.03.2017vill- banei, post - soie, thana - kumargaon ,dist- badaun 04.02.2017

Vill- bichaula,thanamujaroya, post - Sagrai, Dist- Badaun 12.04.17Near bhurji wali gali,muhalla- khandsari rangrejan,dist.-- badaun 14.02.2017

vill- gatiya ,kaser - panaut, kumartgaon, disty.- badaun 09.02.2017vill- gatiya ,kaser - panaut, kumartgaon, disty.- badaun 09.02.2017

ullaiya bilsi, Badaun 4/30/2017Kallia kazampur,bankota,badaun 2/12/2017

Bilsi,Aliganj,Sagrai,Badaun 1/30/2017Aliganj,Sagrai,Badaun 1/30/2017

Pipraul,Pukhta,Badaun 5/28/2017Ikri,Basiyani,Bisauli,Badaun 5/18/2017

Gangaura,ujhani,Badaun 5/21/2017Sekhanagla,serasaulpati,kunwarsahai,Badaun 12/28/2016

Kubri kam sahai,Badaun 5/14/2017


Swadeshpur, BadaunKhera Mani, SambhalVll.Mongar,Badaun 5/18/2017

Sirtaul,Badaun 6/4/2017Badnaumi,Badaun 6/9/2017

Kabulpur,civil line,Badaun 6/7/2017Badrauni,bilri,Badaun 6/9/2017

Malpur,narifnagar,sahsawan 11/14/2016Basoliya,musahak,Badaun

Aliganj,BadaunBasant nagar,gajra,Badaun 1/27/2017

Vill.Jyoti dharampur,Post Alapur,Badaun 4/17/2017Sahabar kheda,saidpur,Badaun 10/31/2016

Barate Gadar,Badaun 2/5/2017Sobhanpur,lakhanpur,Badaun

Banei,sohi,Badaun 2/4/2017160,Nurpur,pinauni,saffulaganj,sagar sarai,Badaun 11/22/2016

Shiv colony,bisauli,Badaun 2/20/2017


Date of Claim received

1/30/2017 25000 Reimbursement Paid15000 Cashless Under process

3/8/2017 1340 Reimbursement Paid3/8/2017 300 Reimbursement Paid

25000 Reimbursement PaidReimbursement RejectedReimbursement RejectedReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pending

7/20/2017 7530 Reimbursement PaidReimbursement Doucment pendingReimbursement Under processReimbursement Under processReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pending

5/25/2017 34895 Reimbursement Paid5/26/2017 Reimbursement Doucment pending5/26/2017 Reimbursement Doucment pending5/26/2017 Reimbursement Under process6/6/2017 46156 Cashless Paid6/6/2017 103249 Cashless Paid6/7/2017 17346 Cashless Paid6/7/2017 Reimbursement Under process6/8/2017 29151 Cashless Paid

Insurance Co. Ltd.

Amount Paid

Date of Payment



6/23/2017 Reimbursement Under process6/23/2017 Reimbursement Under process6/26/2017 48,554 Cashless Paid7/11/2017 68662 Cashless Paid7/10/2017 27019 Cashless Paid7/10/2017 44717 Cashless Paid7/31/2017 49233 Cashless Paid7/31/2017 450 Reimbursement Paid7/31/2017 568 Reimbursement Paid7/31/2017 600 Reimbursement Paid7/31/2017 400 Reimbursement Paid7/31/2017 630 Reimbursement Paid7/31/2017 800 Reimbursement Paid7/31/2017 650 Reimbursement Paid7/31/2017 730 Reimbursement Paid7/31/2017 750 Reimbursement Paid7/31/2017 900 Reimbursement Paid7/31/2017 800 Reimbursement Paid


File received & Under Process

Rejected due to not query answer reply/not provied eligibility proof-khatoni,income certificatedRejected due to not query answer reply/not provied eligibility proof-khatoni,income certificated/Gd FIR

Awaited original documents/query raisedReady for Payment

Awaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raised

Ready for PaymentAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raised

Awaited original documents/query raisedReady for PaymentReady for Payment

Awaited original documents/query raisedAwaited original documents/query raisedAwaited original documents/query raised

Require document not submittedReady for Payment

Original hospital bills requried

File received & Under Process

File received & Under ProcessTransfer to Raksha TPA

District Name

BadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaun

BadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaunBadaun

Sl.No. Mobile No

1 Hajari Lal Hira Kali 98377472272 Jhankari lal Nandh ram3 Rafik Ahmed Rafik Ahmed 81928165034 Rajveer singh Rajveer singh NA5 Muneem khan Muneesh 98083013256 Dhaniram Dhaniram 97195276297 Jhankari lal Nandram 98371397378 Indrsen Indrsen 85350505509 Mausam Khan Mausam Khan

10 Bahauddin Bahauddin 976113003711 Dwarika Prasad Dwarika Prasad 800641763912 Naresh chnadra sharma Naresh chnadra sharma 821814475113 Arun Kashyap Shrimati Munni 821814475114 Brajwati Chetram 976923109815 Virendra Kumar Maurya Ramdas 74092755616 Chetram Chetram 975923109817 Ramswaroop Ramswaroop 956844738718 Ramlali Jagdei 844966884919 Mo.Yaar Khan Mo.Yaar Khan20 Ram Autar Ram Autar 735177601821 Kamal Singh Ram singh22 Mo. yaar Khan Mo. yaar Khan23 Maan Singh Maan Singh24 Akash Heera Lal25 bhudev Bhudev26 deepa Chandra Bhan27 Mahendra pal Mahendra pal28 Laxmi Devi Goverdhan dass29 Rohit Bhagwan das30 smt rammurti Devi smt rammurti Devi 975816300231 Nanhi Devi Brij lal32 vidhya nanhe lal33 Subhash roopram34 veer pal veer pal35 Ramesh Ramesh36 Shyamlal Shyamlal37 Imran khan Mustak



38 Sumit Kumar Sumit Kumar39 Kranti devi Anil kumar NA40 Mohan Swarup Mohan Swarup 844503538341 Ved ram Ase Ram 983754838842 Ahmad Hussain Ahmad hussain 941261769843 Shahadat Ali Shahadat Ali 941100765644 Anil Kumar Anil kumar 953673310845 Akram Ali Akhtar Ali46 Praveen Pal Rajpal 983704560747 Amarat lal Amarat lal 983754838848 Arun Kumar Leelavati 925931743449 Sanju Lalta prasad NA50 Binit Kumar BancheLa 963996625051 NA52 Yusuf Ahmad Navi NA53 Vijendra Vijendra 989715505454 Ram Autar Ramauatr 953664981655 Munni devi Munni devi NA56 Bhikam Singh Babu ram 955781914357 Jitendra Kumar Amar Singh 800664317358 Ram Singh Ram Singh 805765741159 Ravi Kumar Ram Singh 805765741160 Shanti Devi Satyendra Kumar 969002528961 Pt.Altmas Najim NA62 Satyapal Jagnath 991721551963 Mevaram Nanku Lal 809106164 Suresh Suresh 817143406165 Dhanveer66 Kutma Devi Dwarika 975629282667 Jyoti ShishuPa 991722548168 Rakesh Babu Rakesh Babu 992704720169 Jafar Ali Jafar Ali 969041881770 Suleman Khan Teha khan71 Rama Ratan Lal 72 Ratan lal Ratan lal73 Dillighar Kiranlal 746703976374 Praveen Kumar 879154000175 Mohan Swaroop Sarla devi 819180993676 Ram Swaroop Gyan vati 956844738777 Mo.Ahmad Shahnara Vi 8941059704/8055722057178 Tota Ram Tota Ram 839392122079 Suresh Chandra Suresh Chandra80 Ganga Ram Ganga Ram 975917938081 Rais Miya Rais Miya82 Sani Sani

Gulab Shankar Gulab Shankar



Bareilly 09/29/16 09/29/16Bareilly 09/29/16 09/29/16Bareilly 10/17/2016 10/19/2016

Bisalpur road Kamuwakala Bareli 10/21/2016 4/12/2017Abhayapur,Bhojipura Bareilly 9/26/2016 4/12/2017

Bhagawatipur,bareli 11/27/2016 4/12/2017Bareilly 11/12/2016 4/16/2017

Udra,devraniya,bareli 10/14/2016 4/16/2017Saidpur,Ahmed Nagar,Bareli 1/28/2017 4/8/2017

Sobran,Bareli 2/1/2017 4/8/2017Bareilly 2/5/2017 2/8/2017Bareilly 2/16/2017 4/17/2017Bareilly 2/18/2017 4/17/2017Bareilly 2/22/2017 4/17/2017Bareilly 2/21/2017 4/13/2017Bareilly 2/21/2017 2/28/2017Bareilly 11/27/2016 2/28/2017

Bhojpur,Sarvsukh Bareilly 4/15/2017Badi Masjid, bidhauliya ,bareilly 3/18/2017 4/17/2017

Pachera 1/23/2017 1/23/2017Ashril ,Tisanga 3/25/2017 4/15/2017

badi maszid bidhaulia bly 3/15/2017ward no 2 , town richha Bly 3/29/2017

Bukhara chaubari Bly 3/27/2017Shanti Bihar Bly 4/10/2017Ganesh Nagar 3/28/2017

smilepur kadar chauk 4/2/2017biharipur krishnapuri Bly 2/10/2017

maheshpur shahemamudeen Bly 7/23/2017 1/21/2017pastaur Bhojipura Bly 1/10/2017

pargawan bly 10/19/2016visharatganj Bareilly 10/14/2016

bajhigawa puwaya SPN 12/28/2016pastaur C.B.ganj Bly 1/6/2017

gularia rajkulnisha bly 11/9/2016Udra,devraniya,bareli

Aliganj ,Barely 4/22/2017



Surkha,Jatav,Basti BareillyMasit,Bhairavpura,BareillyJagatpur,Kashiram,Bareily 5/2/2017 5/20/2017Jamunia, baraur, Bareilly 5/6/2017 5/21/2017

Nauawa gurbojh, Dunda janubi, Bareilly 3/2/2017 5/22/2017Nawabganj, Bareilly 3/21/2017 5/21/2017

Bhojipura, majhaua gangapur, bareilly 5/23/2017kargona thana subhashnagar,Bareilly 5/22/2017

Kharowa C.B. ganj,Bareilly 5/22/2017Devkola, Aawla 5/30/2017 6/2/2017

Kasbapur, Mohamadpur,Thana Shergadh, Baheri,Bareilly 2/6/2017 6/2/2017Narottam nagla, Bareilly 15 05 2017‐ ‐ 6/8/2017Karpiya faridpur,Bareilly 03 06 2017‐ ‐ 6/8/2017

29 Rafiyabad,Bareilly 05 06 2017 ‐ ‐ 6/8/2017Paragavan,Bareilly 02 06 2017‐ ‐ 6/9/2017Laxmipur,Bareilly 5/11/2017 6/14/2017

Kundariya,Faizulpur,bareily 6/22/2017NA 6/22/2017

Dharampur Post Aonla 4/23/2017 6/23/2017Thiriya khurad,Meerganj,Bareilly 6/20/2017 6/26/2017

Ahiladpur,Mundiya,Ahmednagar,Bareilly 2/10/2017 6/29/2017Ahiladpur,Mundiya,Ahmednagar,Bareilly 2/10/2017 6/29/2017

Bargwan,baheri,rasoolpur,Bareilly 4/19/2017 7/1/2017Najim,dhanua,bareilly 5/26/2017

Alampur,Jafarbad,Bareily 6/22/2017 7/1/2017Biharipura, Chanduwa,Awla ,Bareily 7/4/2017Bhandsar thana,ijjatnagar,Bareilly 7/5/2017

7/11/2017Bansipur,narkheda,Bareilly 7/12/2017 7/17/2017

Railway,hospital colony,ijjatnagar,colony,Bareilly 7/16/2017 7/21/2017BDA Colony,near tiwarinath mandir,Bareilly 7/15/2017 7/21/2017

Dharupur,thakuran,mohanpur,nawabganj,Bareilly 7/10/2017 7/26/2017Pachdiyoria kala,kalani,Bareilly 7/27/2017

Khajuriya,fatheganj,Bareilly 7/22/2017 7/27/2017Khajuriya,fatheganj,Bareilly 7/22/2017 7/27/2017

Tehra sisgarh,Bareilly 7/31/2017Farukhpur,Mainroad,faridpur,Bareilly 7/31/2017

Khajua,jagir,dhaura,Bareilly 3/1/2017 7/31/201785,Behjudiya,Jagor,c.b ganj,Bareilly 11/27/2016 7/31/2017

Dandi,majra,islam nagar,bahedi,Breilly 10/9/2016 7/31/2017Gaini,Bareilly 7/19/2017 8/4/2017

Navdiya,harkishan,Bareilly 8/4/2017Ramnagar,Bareilly 8/5/2017Faridpur,Bareilly 8/5/2017

Katra chand khan,Bareilly 8/5/2017


Amount Paid

6187 Reimbursement Paid5844 Reimbursement Paid

15823 Reimbursement Paid41500 Reimbursement Repudiated25000 Reimbursement Paid67000 Reimbursement Repudiated58900 Reimbursement Repudiated34000 Reimbursement Repudiated38302 Cashless Paid28093 Cashless Paid63652 Cashless Paid21849 Cashless Paid10000 Cashless Under process36043 Cashless Paid14210 Cashless Paid72113 Cashless Paid16044 Reimbursement Paid15000 Cashless Under process10000 Cashless Under process27850 Cashless Paid68498 Cashless Paid

Reimbursement Document pendingReimbursement Document pending

31614 Reimbursement PaidReimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Document pending


Reimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Document pendingReimbursement Document pending

21717 Cashless Paid32277 Cashless Paid


Date of Payment

Death/Disablement/

Cashless/Reimbursement


25000 Reimbursement Paid19320 Reimbursement Paid16881 Cashless Paid9000 Cashless Cashless approved

Reimbursement Under process19343 Cashless Paid

Reimbursement Under process35711 Cashless Paid60478 Cashless Paid17376 Cashless Paid14681 Reimbursement Paid9,000 Cashless Cashless approved

20,002 Cashless Paid22,261 Cashless Paid28,771 Cashless Paid21555 Cashless Paid46157 Cashless Paid13374 Reimbursement Paid34105 Cashless Paid16,618 Cashless Paid21588 Reimbursement Paid20992 Reimbursement Paid19413 Reimbursement Paid15310 Cashless Paid

Cashless Cashless approved16825 Cashless Paid


Cashless Cashless approvedCashless Cashless approvedCashless Cashless approved

12052 Cashless PaidCashless Cashless approvedCashless Cashless approvedCashless Cashless approved

800 Reimbursement Paid450 Reimbursement Paid650 Reimbursement Paid820 Reimbursement Paid840 Reimbursement Paid

5000 Cashless Under ProcessReimbursement Under ProcessReimbursement Under Process

9,000 Cashless Cashless approved10,000 Cashless Cashless approved

Reason for Repudaition ( Minimum 20 words) District Name

BareillyBareillyBareilly

Eligibilty proof not received/khatoni,income certificated BareillyBareilly

GD FIR copy not received BareillyEligibilty proof not received/khatoni,income certificated/GD FIR BareillyEligibilty proof not received/khatoni,income certificated/GD FIR Bareilly

BareillyBareillyBareillyBareilly

File receive & underprocess BareillyBareillyBareillyBareillyBareilly

File receive & underprocess BareillyFile receive & underprocess Bareilly

BareillyBareilly

Awaited original documents/query raised BareillyAwaited original documents/query raised Bareilly

BareillyAwaited original documents/query raised BareillyAwaited original documents/query raised BareillyAwaited original documents/query raised BareillyAwaited original documents/query raised Bareilly

BareillyBareilly

Awaited original documents/query raised BareillyAwaited original documents/query raised BareillyAwaited original documents/query raised BareillyAwaited original documents/query raised BareillyAwaited original documents/query raised Bareilly

BareillyBareilly

BareillyBareillyBareillyBareilly

Ready for Payment BareillyBareilly

Ready for Payment BareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareilly

Patient under traetment BareillyBareilly

GD FIR requried BareillyEligibilty proof requried and patient died Bareilly

BareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareillyBareilly

Sl.No. Mobile No

1 Dharamveer Singh Dharamveer Singh 88140389722 Mohit Singh Suraj Singh 94104885003 CHANDRA SINGH CHANDRA PAL 74090998464 ANISH SHARMA DEVIRAM SHARMA 80066203445 AMIT DESHRAJ 74090998466 MANISH RAJPAL SINGH 94114156377 CHAND MD. ARSHAD MD. 96395486208 MONU SHARMA VINISH SHARMA 98993381529 Brajpal Singh Shri mati Pushpa Devi NA

10 Rajeev Savitri11 Rajesh Geeta Devi 967589330712 Karanveer Dharmveer 976081008113 Omveer Singh Navab Kaur Bebi 965405371214 Guljari Sher Singh 967587599115 Rajendra 941187606116 Subhash Giri Rajni Giri17 Ashok Kumar Saroj Devi 701170928618 Om Prakash Om Prakash 819190290419 Lal Singh




Address

Kioli,Muni Bulendsahar 12/1/2016Ramvihar Shastri Nagar,Bulendsahar 12/8/2016

VILL-BHAGIGADH, POST ATRAULI, DIST,- BULANDSHAR 23/4/2017VILL-MEERAPUR, POST VOHICH, PS- SHIKARPUR, DIST-BULANDSHAR 22/4/2017

VILL-BHAGIGADH, POST ATRAULI, DIST,- BULANDSHAR 23/4/2017VILL-MANDHAWADA, DIST-BULANDSHAR 22/4/2017

VILL-NAGALA BALKHA, PS-AURANGABAD, DIST-BULANDSHAR 19/4/2017VILL-MEERAPUR, POST VOHICH, PS- SHIKARPUR, DIST-BULANDSHAR 22/4/2017

201,Mohanpuri Bulendsahar 1/22/2017Nagla shekhu Meerpur khurja bulandshahr 3/25/2017

Khabra,Bulendsher ###Bhirawati,Bulendsaher ###Annupsaher,Bundsaher ###

Alampur,khanpur 12/1/2016Hamidpur,sikandarabad

Vijay giri,devshala,khurja,Bulendsaher ###Umeshpuri,narora,khadan,Bulendsaher 12/9/2016

Khuriyabali,Bulendsaher,arniya 3/23/2017Talv,bibyana,Bulendsaher 2/1/2017


Date of Accident


Amount Paid

1/28/2017 0 Reimbursement4/15/2017 25000 Reimbursement

ReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursement

7/31/2017 800 Reimbursement7/31/2017 550 Reimbursement7/31/2017 735 Reimbursement7/31/2017 725 Reimbursement7/31/2017 600 Reimbursement7/31/2017 383 Reimbursement7/31/2017 1100 Reimbursement7/31/2017 560 Reimbursement7/31/2017 Reimbursement


Date of Claim intimation

Date of Payment

Death/Disablement/


RepudiatedPaid

Doucment pendingDoucment pendingDoucment pendingDoucment pendingDoucment pendingDoucment pending

Under processUnder process

PaidPaidPaidPaidPaidPaidPaidPaid

Rejected



Mandatory document not provided by patient/income certificated/khasra,khatoni/Ration card

Awaited original documentsAwaited original documentsAwaited original documentsAwaited original documentsAwaited original documentsAwaited original documentsFile receive & underprocessFile receive & underprocess

Not payable (on spot death)

District Name

BulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsaharBulendsahar

Sl.No. Mobile No

1 Sudhir Kumar RamKumar 97185702742 Viresh Suresh Chandra NA3 Deepak Muneesh NA4 Anjuli Mukesh kumar NA5 Ajay Kumar Ramveer singh NA6 Richa Shivmangal NA7 Sumit Pradeep yadav NA8 Sonu Vishun dayal NA9 Abhishek Munesh kumar NA

10 Saurabh Shyam kumara NA11 Ganga Ram Lakshman singh NA12 Pratigya Rajesh kumar NA13 Rahulyadav Sudama Devi NA14 Vijay kumar Dwivedi Vijay kumar Dwivedi 918910035315 Sunil Kumar Sunil Kumar 989761516016 Abhishek Munesh kumar 945205753317 Sunil Kumar 844722965918 Satish Kumar 963945840819 Bhanu Pratap Krish Gopal8954454404/901220407420 Rajanshree Raghuveer Singh 9760786798




Address Date of Accident Date of Claim intimation

Saraini,Jalesar,Distt-Etaw 4/12/2017Vill+ Post- Rizor Etah 3/7/2017

nagla ummed thana jasrathpur aliganj etah 1/19/2017vill nagla gajpati aliganj etah 1/19/2017

vill himmatpur nasil post nagla galu kotwali etah dehat etah 6/11/2016vill bhagwanpura thana aliganj Etah 1/19/2017

vill nagla karan aliganj Etah 1/19/2017vill bhagwanpura thana aliganj Etah 1/19/2017

vill nagla gajpati aliganj etah 1/19/2017vill tikaitpura thana raja ka rampur etah 1/19/2017

vill ghutlai post kawar kotwali sakeet etah 9/12/2016vill ummedpur aligannj etah 1/19/2017Daulatpurmuski,Jalesar,etah

Harajpur kasganj etah 12/11/2016Badhari baish Mirhechi,etah,Mirehachi 10/4/2017

Vill Nagla Prashadi, Aliganj, Eath 1/19/2017 5/13/2017Bardoi,Etha

Nagal,achal,Aliganj,EtaSarai,Jarolia,pargana,bharhara,bajila,Eta 1/19/2017 7/31/2017

Nijampur,kason,nijampur,Eta 6/3/2017 8/5/2017



Amount Paid

23694 Cashless PaidReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pending




Reimbursement RejectedReimbursement Under Process


Date of Payment

Death/Disablement/


Status(Paid/Rejected/

Underprocess)

Reason for Repudaition ( Minimum 20 words)District Name

EtahAwaited original documents EtahAwaited original documents Etah

Applied for income certificate EtahFile rejected due to barred now request for eligibility for to re-open Etah

Ready for Payment EtahAwaited original documents EtahAwaited original documents EtahAwaited original documents EtahAwaited original documents EtahAwaited original documents EtahAwaited original documents Etah

EtahEtah

Fir,GD requried and original discharge card requried EtahEligibilty proof requried and query sent on 31-5-17 Etah

EtahEtah

Not payable (on spot death) EtahEtah

Sl.No. Mobile No

1 Vijay singh Vijay singh 94121850082 Ankit Verma Raghuraj Singh 95364431243 Sunil Kumar Satya Prakash 94575597904 Brajesh Kumar Premvati 90451674345 Munna Lal Munna Lal 99979642436 Shri Krishan Shri Krishan 97618954167 Sanjay Babu Ramesh Chandra 94116009078 Vinod Kumar Vinod Kumar 82738522959 Ravindra Singh Kunti Devi 9084857520

10 Ram Wati Gauri Shankar 892368983411 Ram Kumar Prembabu 963993437612 Adesh Kumar Ramsewak13 Sarvesh Kumar Sarvesh Kumar 856492055914 Indresh Kumar Brahmadeen 976105622115 Rajesh Babu Rajesh Babu 980844096416 Dilshad Ali Akhtiyar Ali 981988336617 Pankaj Pal Jangbahadur Pal 730624969318 Sahul kumar Suresh Chandra 941193992919 Avdhesh Singh Divan Singh 750008039220 Dharmendra Singh Bharat Singh 941048600421 Suneel Kumar Jayvir Singh 941251988022 Siya Dulari Siya Dulari 941147930023 Naveen Chandra Kailashwati 707882245224 Sanjeev Sone Lal 971905715825 Shivam Shivram Singh 895802818026 Manjesh Santosh Kumar 817153019927 Pradeep Kumar Rajesh Kumar 706008334028 Ravindra Kumar Satishchandra 908485752029 Satyapal Satyapal 976134876930 Yogendra Yadav Ratnesh yadav 971966377431 Kuldeep Yatendra32 Arvind Kumar Arvind Kumar 897961719633 Pradeep Kumar Pradeep Kumar 895883589134 Dharm Singh Dharm singh35 Suraj Pal Santkumar 885963701836 Akhilesh kumar Ram sewak 962147007637 Sarvesh Kumar Sarvesh Kumar 941044630738 Raghuvendra Singh Tahar Singh 963486376939 Kuldeep kumar Kuldeep kumar 892366695440 Gulab Singh Gulab Singh 9927559808


Name of the ( nominee)Beneficiar

y

41 Ramesh Chand Ramesh Chand 975926603142 Mahendra Singh Budh Singh 905863782343 Suraj singh Arun kumari 741744344444 Nathu Ram Ganga Devi 941254801145 Subhash Chand Ramakanti 976064748946 Uday Singh Usha Devi 875513698447 Jai Prakash Gupta Sarla devi 967573245248 Ramkishore Santoshi Devi 901286044749 Awadh Bihari 885964088950 Chandra bhan Singh Rubi 8527648818/961614487451 Bhagwan Das Rajesh Kumari 805796841552 Pradeep Singh Chauhan Alka Chauhan7417967417/895823863853 Ram Sewak Puja kumari 783079426854 Sarnam Singh Sunita 9997020340


Name of the Insurance Company -Oriental Insurance Co. Ltd.

Address Date of Claim received

Etawah 10/15/16 10/15/16 26066Etawah 10/23/16 10/23/16 9492Etawah 10/22/16 10/22/16 14904Etawah 10/22/16 10/22/16 18012Etawah 10/24/16 10/24/16 18013Etawah 10/27/16 10/27/16 22170

Baralokpur, Basrehar 11/02/16 11/02/16 18642Dusheri, Sirhaul 11/02/16 11/02/16 20522

Keeratpur, Mahewa 11/04/16 9500Etawah 12/07/16 12/07/16 0

Bhaidpur 4/17/2017 4/19/2017 10000Etawah 11/08/16 11/08/16 17193

Saifai,Etawa 11/08/16 11/08/16 0Bharthana,Etawah 12/14/16 9000Mahenpur Etawah 11/27/16 11/27/16 41059

Ashok Nagar ,Purabi Etawah 11/30/16 11/30/16 0Nagla shiv shingh,Paharpur Etawah 12/12/16 12/12/16 0

Samthar ,Etawah 11/07/16 11/07/16 7245Chakra Nagar ,Etawah 11/02/16 11/02/16 0

Bharthana,Etawah 12/11/16 12/11/16 18012Saifai,Etawa 10/26/16 10/24/16 17671

Musoli ,Etawah 12/30/2016 9000Saray Mithe,Etawah 12/28/2016 1/2/2017 18354

Santoshpur,Ghat Etaah 11/25/2016 11/27/2016 18354Jarhouli,Etawah 12/26/2016 12/27/2016 18354

Shuktikhera,Jasmai, etawah 11/11/2016 25000Bharthana,Etawah 12/5/2016 10000

Kiratpur,Karwa,Etawah 10/27/2016 1/27/2016 0Dutha,Panja Etwah 11/27/2016 4/12/2017 23000

Bani hardu barthna etawah 11/29/2016 24900Nagla bhikhari etaw 11/28/2016 234000

Ninawa,Bharthna,Etawah 25000nagla kensho jaswant nagar etawah 27/11/16

Chakar Nagar,Etawah 5/20/2017Kura,Bharthana,Etawah 4/18/2017 5/21/2017 13448

Mahasinghpur, ghaar haveli, Lakhana ,Etawah2/3/2017 5/21/2017Kauli, Khadkoli, Etawah 5/22/2017 9903

Urkhra, Postber, Tadaukharra, Ber, Etawah 11/3/2016 5/22/2017House no-71,Bamhanipur,Bharthana,Etawah2/28/2017 5/25/2017 9310

Alipura,samthar,takha.Etawah 6/6/2017

Date of Accident

Amount Paid

Date of Payment

House no-66.,Sauthana,kharag pur sariya,Eawah 6/6/2017Basti,maheva,bharthana,Etawah 1/13/2017 7/31/2017 789

Dharwar, Etawah 2/24/2017 7/31/2017 903Kursena,Etawah 4/8/2017 7/31/2017 640Nasirpur,Etawah 1/15/2017 7/31/2017 750

House no-12,nidarpur,jaswantnagar,Etawah11/23/2016 7/31/2017 700Gopiyaganj,bhartana,Etawah 10/30/2016 7/31/2017 2060Ranua,jaswantnagar,Etawah 7/31/2017 420

Ramsewak,Killi,Saltanpur,Etawah 9/22/2016 7/31/2017 830Chhibrauli,bharthna,Etawah 1/14/2017 7/31/2017 450

249,Baralokpur,Etawah 2/17/2017 7/31/2017 73023,New colony,karanpurwa,Etawah 11/5/2016 7/31/2017

Pachauli,datauli,Etawah 10/22/2016 7/31/2017Baralokpur,Etawah 4/16/2017 7/31/2017

Cashless PaidCashless PaidCashless PaidCashless PaidCashless PaidCashless PaidCashless PaidCashless PaidCashless Under processCashless RepudiatedCashless Under processCashless PaidCashless RejectedCashless RepudiatedCashless PaidCashless RepudiatedCashless RejectedCashless PaidCashless RejectedCashless PaidCashless PaidCashless RepudiatedCashless PaidCashless PaidCashless Paid

Reimbursement PaidCashless RepudiatedCashless Rejected

Reimbursement RepudiatedReimbursement RepudiatedReimbursement RepudiatedReimbursement PaidReimbursement Under processReimbursement Under processReimbursement PaidReimbursement Under processReimbursement PaidReimbursement RejectedReimbursement PaidReimbursement Under process

Death/Disablement/



Reimbursement Under processReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement RejectedReimbursement RejectedReimbursement Rejected


File received & Under process

File received & Under process

Mandatotary document not provided by patient/Gd Fir not provided by hospital)Cashless withdraw due to concealment of facts(GD/FIR not provide by hospital)

Mandatotary document not provided by patient/eligibility proof not proved/Income certificate/kasra khatonieligiblity prof /GD or FIR nor provide from hospital

Cashless withdraw due to concealment of facts(GD/FIR not provide by hospital)

eligiblity proof /GD or FIR nor provide from hospital

Cashless withdraw due to concealment of facts(GD/FIR not provide by hospital)Concealed of fact/Gd Fir not provide by hospitaleligiblity prof /GD or FIR nor provide by patient

Mandatotary document not provided by patient/eligibility proof not proved/Income certificate/kasra khatoniMandatory document not provided by patient/income certificated/khasra,khatoni/Ration card

File received & Under processReady for Payment

he has given khatoni of his father and Patient age is 33 yr therefore his eligibilty proof is requried

file delay received

FiR/GD and original copy of hospital doc/ query sent on 12-6

Patient accident date is 9 sep 16 while sceme stareded 14 sep and fir gd also not available/file rejected

Not payable (on spot death)Not payable (on spot death)Not payable (on spot death)

District Name

EtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahAuiryaEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawah

EtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawahEtawah

Sl.No. Mobile No

1 Sandesh Singh Ram Kishan 73094396052 Krishna Kumar Ramvir Srivastva 98392799703 Sovaran Singh Sovran4 Pintu Bhaiyalal5 Nirbhay pratap Santosh6 Nijamuddin mansuri Saukat alli7 Rajesh gupta Asokh kumar gupta8 Seema Devi Satpal 89328898379 Dhirendra Singh Indresh Kumar 9795376262

10 Amit Girish Chandra 11 Ranjeet Singh Data Ram 907677490012 Gufran Khan Sazida begum 872667842213 Dalveer Singh Dalveer Singh 912965695214 Tula ram15 Anand Prakash Savitri Devi 7238962110




Address

Nagla mann,Babna,Nababganj Farukhhabad 10/27/2016Farrukhabad 1/24/2017

Mohdampur,Gadhiya,Rajepur,Amritpur 2/11/2016vill-dhansua nagla bda tal post-sentral jel thana-fatehgad diss-farrukhabad 03/12/17

vill-vankhdiya post-fatehgarh thana-fatehgarh diss-farrukhabad 01/25/17 mohalla -gadi kona post- farrukhabad thana-kotvali fatehgarh diss-farrukhabad 01/26/17

vill -kamalganj post-kamalganj thana- kamalganj diss-farrukhabad 03/01/17Rajepur,Tappa,Mandal,Farrukhabad 4/28/2017

Manjhana, Farrukhabad 6/2/2017Patti madari dehat,sikandarpur,khas,kampil,Farrukhabad

Jallapur,jaitpur,FarrukhabadDaulatpur,chakai,veerpur harihar pur,farrukhabad 5/16/2017

Rashidpur Kaimganj, Farrukhabad

Naglabad,Majra,thakutganj,farrukhabad 12/29/2016


Date of Accident


1/24/2017 47000 Reimbursement Paid1/24/2017 36798 Cashless Paid

11200 Reimbursement RepudiatedReimbursement Rejected

4/20/2017 4658 Reimbursement PaidReimbursement RepudiatedReimbursement Rejected

25000 Reimbursement PaidReimbursement Under process

6/7/2017 Reimbursement Under process6/8/2017 Reimbursement Under process6/9/2017 Reimbursement Under process

6/23/2017 Reimbursement Under process7/11/2017 Reimbursement Under process7/31/2017 Reimbursement Paid

Insurance Co. Ltd.

Date of Claim

receivedAmount

PaidDate of

Payment

Death/Disablement/



Underprocess)


Mandatory document not provided by patient/income certificated/khasra,khatoni/Ration cardRejected due to not query answer reply/query raised against eligibility proof-(Khatoni/income certificate) & GD Fir

Complete documents not submitted/GD FIR not provideRejected due to not query answer reply/Hospital bill/Discharge card not provide

Reequried FIR GD and eligibility proofFile received & Under processFile received & Under processEligibility and discharge card

FIR GD and original doc. RequiredFIR GD and discharge card

District Name

FarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabadFarrukhabad


Sl.No. Mobile No

1 Harpal Singh Sujan Singh 96343433012 Gaurav Singh Guarv Singh 80577639483 Urmila devi Bhimsen 82727390484 Gaurav Singh Gaurav Singh NA5 Jitendra Shreekishan NA6 Manveer Satendra Pal NA7 Sadha Yuvraj NA8 Syamvir Singh Syamvir Singh 80573640919 Sheela devi Chandrabhan 7534947929

10 Ravi Chandrabhan 753494792911 Monu Chandrabhan 753494792912 Arun Kumar Hammir Singh 865014892413 Vinay Kumar Sheela Devi14 RAHISH KHAN TAJUDDIN15 VALISTAR VALISTAR16 Nirvesh Kumar Nirvesh Kumar17 Bheemsain Bhogilal 9012772720/976165704818 Sanjay Singh Manoj Kumari 953611889419 Ranveer Singh Anita devi 991705575520 Arvind Kumar Vandana Devi 941240106221 Fauran Singh Kamraj 992785852422 Suman Chandra Suresh Chandra



Name of the ( nominee)Benefi

ciary


Address

Sandalpur,Sarik ,Firojabad 12/25/2016 1/30/2017Okhra,Kotla,firozabad 1/16/2017 4/4/2017

Jijauli,Makhanpur,Firojabad 4/4/2017Village-Kunwarpur, Post-Okhra, P.S.-Narkhi, Distt.-Firozabad 4/1/2017 4/18/2017

Bhurkua Wali Gali, Moh.-Himayunpur, Thana-Dakshin, Firozabad 3/29/2017 4/18/2017Balipur, Tapasya, Post-Fariha, PS-Fariha, Distt.-Firozabad 3/30/2017 4/18/2017

Madwa, Post-Urawar, Thana-Nagla Khangar, Distt.-Firozabad 3/30/2017 4/18/2017rajawali,Tundla,Firojabad 5/1/2017

Chamrauli.sadhupur.makkhanpur,firojabad 3/31/2017 5/20/2017Chamrauli.sadhupur.makkhanpur,firojabad 3/31/2017 5/20/2017Chamrauli.sadhupur.makkhanpur,firojabad 3/31/2017 5/21/2017

20,Nagla,Dhajon,Karhara,Firojabad 5/3/2017 5/21/2017361,Nagla Kheri Sikohabad,Firozabad 5/23/2017

Mohamdabad,firojabad,tudala 7/6/2017 7/11/2017Kondara,suraya,Firojabad 7/21/2017 7/22/2017

Gudha,Firojabad 5/11/2017 7/28/2017Khandari,azamabad,shadipur,Firojabad 11/14/2016 7/31/2017

Bitri,Firojabad 12/21/2016 7/31/2017Madawali,jarkhali,Firojanbad 10/1/2016 7/31/2017

101,kesri,sikohabad 10/5/2016 7/31/2017Sujatgadh,kurikupa,Firojabad 12/5/2016 7/31/2017

Nagla,salempur,Firojabad 8/2/2017 8/3/2017


Date of Accident

Date of Claim

received

Amount Paid

12317 ReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursementReimbursement

15000 Cashless21319 Reimbursement91578 Cashless15000 Cashless

Reimbursement700 Reimbursement536 Reimbursement550 Reimbursement650 Reimbursement

ReimbursementCashless

Date of Payment

Death/Disablement/


PaidRepudiatedRepudiated

Doucment pendingDoucment pendingDoucment pendingDoucment pending

Under processUnder processUnder processUnder processUnder process

PaidPaid

Cashless approvedUnder process

PaidPaidPaidPaid

RejectedCashless approved


Underprocess)


Requried document not submitted/income certificate,hospital bill not provideMandatory document not provided by patient/income certificated/khasra,khatoni/Ration card

Awaited original documentsAwaited original documentsAwaited original documentsAwaited original documentsFile receive & underprocess

Applied for income certificate,hospital bill requried,last query sent on 7 june’17Income certificate requried,Applied

Eligibility proof and hospital bill requriedFile receive & underprocess


District Name

FirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabadFirojabad


Sl.No. Mobile No

1 Ompraksh Omprakrash 89235679792 Munesh Devi Satyendra Singh 97198114413 Atar Singh Udal Singg 99978665274 Ravi Kumar Ravi Kumar NA5 Subhash Kashyap Subhash Kashyap NA6 Veerpal Veerpal NA7 Udayveer Singh Udayveer Singh NA8 Dilip Kumar Shivcharan Lal NA9 Ompraksh Omprakrash 8923567979

10 Shyamvir singh Baijanti Devi 972029282411 Ved prakash NA12 Arman Munni 975891542413 Arun Kumar Raghuveer Singh9759988544/783034102514 Shri Pal Tej Singh 995374548915 Santosh kumar raghav Pyare Singh 975957084916 Karan Pal Singh Sugriva Singh 783092952517 Ghure lal Sunita 8445927161




UDAYVEER SINGH



Nag Priya patti devari Hathras 11/15/2016 3/24/2017 23394Madhapithu,Madakabhoj,Hathras 4/4/2017

Kota Road,Nandram,Nagriya,Hathras 4/4/2017Vll. Susayat Khurd The. Sasni Hathras 03/13/17 4/18/2017

Sikandraroa Hathras 02/07/17 4/18/2017Vill. Vidhaypur Sasni hathras 03/12/17 4/18/2017Vill. Vidhaypur Sasni hathras 03/25/17 4/18/2017

Vill Nahloi Sasni hathras 03/11/17 4/18/2017Nag Priya patti devari Hathras 11/15/2017 11/30/2017 23394

126, Mathurapur, Hathras 5/20/2017Jarau Nagla Tasi Ansh Jarau Sadabad, Hathras 22 05 2017 ‐ ‐ 5/30/2017 53152

Mukerkhana,sadabad,Hathras 6/18/2017 7/13/2017Arotha,bisawar,sahabad,Hathras 3/12/2017 7/31/2017 300

Vira,sasni,Hathras 1/5/2017 7/31/2017 815Jyotinagar colony,sikandara rao,Hathras 12/25/2016 7/31/2017 350

Ramchela,kajrothi,sadbad 2/1/2017 7/31/2017 149Susawali,kota,Hathras 9/20/2016 7/31/2017 620


Date of Claim

receivedAmount

PaidDate of

Payment

Cashless PaidReimbursement RepudiatedReimbursement RepudiatedReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement PaidReimbursement Doucment pending

Cashless PaidReimbursement Under processReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Paid

Death/Disablement/



Underprocess)


Amount PaidRequried document not submitted/Fir,GD and hospital bill/ discharge card not provide/query already sent

Requried document not submitted/income certificate,hospital bill not provideAwaited original documentsAwaited original documentsAwaited original documentsAwaited original documentsAwaited original documents

Fir,GD and hospital bill/ discharge card requried/query already sent/file reject

District Name

HathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathrasHathras


Sl.No. Mobile No

1 Sachin maheshwari Anil maheshwari 9557502033,84459033822 Shivshankar Shivshankar NA3 Laxman Babu ram NA4 Ravi Kumar Ravi Kumar NA5 Hari singh Hari singh NA6 Bhudev Singh Reshma Devi NA7 Sanjay singh Sanjay singh 97581446138 Atul Kumar Atul Kumar 96341750699 Laxmi Suresh Chandra NA

10 Dinesh Kumar siyaram 975925689511 Bhimendra Singh Bhimendra Singh 976988243312 Rakshpal Singh Rakshpal Singh13 Karan Singh Pushpa Devi 945731643314 Kalicharan Sakuntla devi 972005850615 Rajeshwar Kusuma16 Rajendra Singh Manju Devi 735192456617 Jaswant Singh Mamta Devi 9568749911

Name of the Insurance Company - OrientalInsurance Co. Ltd.



y



Nadri gate kasganj 1/27/2017 24500Navgaon thanpur kashganj 1/18/2017 12/4/2017 8694

Nagaria,Kashganj 5/1/2017 32828Mayasu,Mayausr,Kashganj

shahpur,Mfi,kashganj 14417Sewaka,Amanpur

Nagla bhateekara, amirsa,kasganj 13/3/2017 25000Pathreki, Kasganj 3/25/2017 5/20/2017

Bhujpura,sidpura,kasiramnagar 5/23/2017 6/3/2017 39529Harnathpur, nagla moti, kisrauli, kasganj 6/23/2017Badwari khurd,kisrouli,nameni,Kasganj 6/12/2017 7/28/2017 5699

Badwari,kisrouli,nameni,Kasganj 6/12/2017 7/28/2017 2606Harsinghpur,goa,Kasganj 12/24/2016 7/31/2017 500

Manauta, tilsai kala , kashganj 10/2/2016 7/31/2017 600Patiyali,Kasganj 7/31/2017 520

Gaon,nagla,pratappur,Kasganj 7/31/2017 650Nagla,Gulabi,jyauddinpur,Kasganj 11/1/2016 7/31/2017 800

Name of the Insurance Company - OrientalInsurance Co. Ltd.

Date of Claim

receivedAmount

PaidDate of

Payment

District Name

Reimbursement Under process File receive & underprocess KashganjReimbursement Paid Kashganj

Cashless Paid KashganjReimbursement Under process Eligibility proof and FIR, GD requried KashganjReimbursement Paid KashganjReimbursement Under process File receive & underprocess KashganjReimbursement Paid KashganjReimbursement Under process Ready for Payment Kashganj

Cashless Paid Amount Paid KashganjReimbursement Under process File receive & underprocess KashganjReimbursement Paid KashganjReimbursement Paid KashganjReimbursement Paid KashganjReimbursement Paid KashganjReimbursement Paid KashganjReimbursement Paid KashganjReimbursement Paid Kashganj

Death/Disablement/



Underprocess)Reason for Repudaition ( Minimum 20

words)


Sl.No. Mobile No

1 Jaffar Ali Jaffar Ali 98398901792 Arman Ali Arman Ali 98398901793 Rajesh Kumar Rajesh Kumar 72690821904 Bharat Prasad Bharat Prasad 96481933435 Rafiq Rafiq NA6 ajay shukla ajay shukla NA7 pholmati maurya pholmati maurya NA8 Ramdev Ramdev 95655800639 javed khan javed khan 7800548585

10 zafer khan zafer khan 780054858511 Ajay Kumar Ajay Kumar 979234923612 Pankaj Verma Shri Dhar Verma 750560297113 Raju Singh Sarvesh Kumar NA14 Sharda Devi Sharda Devi 979587238615 Ravi Kumar Meena Devi 951916790216 Ashfaq Ali Ashfaq Ali17 Dipti Verma Umesh chandra18 Ghandera Kumar Ghandera Kumar 972190701719 Ramvilash verma Ramvilash verma 880883967620 Santosh Santosh NA21 Tejpal Hari Shankar 887486833622 Ram Lakhan Champa 723581971823Kallu Singh/Suryabaks Singh Kallu Singh 955454459024 Vikas Verma Vikas Verma NA25 Susheel kumar Dileep Kumar NA26 Arvind Kumar Arvind Kumar 945141931127 Sanjay Kumar Sanjay Kumar 731738358228 Manoj kumar Manoj kumar 962821948529 Chandra Prakash Chandra Prakash 731016165130 Brij Kishore Brij Kishore31 Dinesh Kumar Ram Kishore 786014165932 Shri Krishan Sitaram 723806653233 Manoj Kumar Badri Prasad 887469735934 Santosh Kumar Ekta Gupta 967000855635 Phool Chand Ramrati36 Ram Chandra Geeta Devi 979291432637 Thakur prasad Prempati 962803367938 Mo.Latif Hasimi 734831949139 Banke lal Ramajati 9838908478



Name of the ( nominee)Benefici

ary

40 Susheel Kumar Dilip Kumar



Mathiya,Kheri 12/10/2016 1/30/2017 0Mathiya,Kheri 12/10/2016 1/30/2017 0

Hathipur,Kothar 12/13/2016 1/30/2017 0Dimorha,Mudiyakhera,Lakhimpur kheri 11/17/2016 1/30/2017 8694

allipur fardahan 11/4/2016khambhar kheda lakhimpur 3/25/2017

baburam sararf nagar lakhimpur 2/10/2017sansi,kheri 4/25/2017

achhniya, nimgaon 4/25/2017achhniya, nimgaon 4/25/2017

Khambhar Khera, Kheri 5/20/2017Swaroop Nagar, Sikatiha, Lakhimpur 5/23/2017

Shashtri Nagar,Lakhimpur NA 6/22/2017Paharpur,Lakhimpur kheri 11/16/2016 6/21/2017pipra bujurg,paila, Kheri 5/13/2017 6/22/2017

Allipur,Kheri 6/22/2017 5000Saidpur,karanpur 6/22/2017 7644Katiya, bhira kheri 4/8/2017 6/22/2017

Bahsiya Devirya Lakhimpur kheri 6/22/2017Bhagwanpur,Shivpuri,Lakhimpur 6/23/2017

Baibaha,Gola,Lakhimpur 6/23/2017Lonipurwa,Adampur,kheri 4/18/2017 6/23/2017

Vill Arbaba 6/23/2017Kala,Kheri 6/23/2017

Vill Sarai Ramauapur Post Aliganj 6/27/2017Ballipur kala,lakhimpur 3/21/2017 6/28/2017Hafizpur,lalahapur,Khiri 4/24/2017 6/28/2017 4677

Budhnapur,Mahewaganj 4/28/2017 7/5/2017 14030Durga gaudi,Pratao pur,kheri 5/15/2017 7/5/2017 1184Parghana,gulaharia khurad,lakhimpur 7/10/2017Gola road,muda arjun,kheri 7/11/2017

Gajiyapur,devapur,kumbhigola,lakhimpurkheri 11/12/2016 7/31/2017 795Pipara karam chandra,lakhimpur 7/31/2017 450

Tehra Post,Palia 7/31/2017 450Pakariya Kasta,mitauli,Lakhimpur 7/31/2017 500

Rampurwa,ishanagar,kheri 1/18/2017 7/31/2017 600Sunsi,pargana,Kheri,Lakhimpur 10/2/2016 7/31/2017 950

Babona,Mitauli,Kheri 11/28/2016 7/31/2017 850Bastapur kalan,basantapur,Palia,Kheri 7/31/2017


Date of Claim

receivedAmount

Paid

Sarai,ramuapur,Aliganj 8/5/2017

Reimbursement RepudiatedReimbursement RepudiatedReimbursement RepudiatedReimbursement PaidReimbursement Under processReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement Doucment pendingReimbursement RejectedReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement PaidReimbursement PaidReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Under processReimbursement Paid

Reimbursement PaidReimbursement PaidReimbursement Under processReimbursement Under process

Reimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Rejected

Date of Payment

Death/Disablement/



Underprocess)

Reimbursement Under Process


Mandantory document not provided by patient/Hospital bill/Discharge card not provideRequried document not submitted/income certificate,hospital bill not provide

Mandatory document not provided by patient/income certificated/khasra,khatoni/Ration cardAmount Paid

Ready for PaymentAwaited original documents/Query raisedAwaited original documents/Query raisedAwaited original documents/Query raisedAwaited original documents/Query raisedAwaited original documents/Query raised

Fir,GD and hospital bill/ discharge card requried/query already sent/file reject

Awaited original documents/Query raisedReady for PaymentReady for Payment

File received & Under ProcessFile received & Under Process

Document pending (Medicine bill,A.O.A & D.O.A missing)FIR GD id of patient and discharge card

File receive & underprocessDocument pending(bill,admission & discharge copy,id,eligibility)Document pending(bill,admission & discharge copy,id,eligibility)

FIR GD and id proof of patientDocument pending (Medicine bill,A.O.A & D.O.A missing)

Ready for PaymentFile receive & underprocess


District Name

LakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuriLakhimpuri

Lakhimpuri


Sl.No. Mobile No

1 Surender Singh Surender Singh 99173850442 Guarav Kumar Guarav Kumar 97194310583 Ram Prakash Ram Prakash4 Jhabboo Lal Jhabboo Lal 95578307505 Pooja Pooja 70997854406 Sharda Devi Sharda Devi 97588174467 Nitesh Kumar Nitesh Kumar 75993377188 Gaurav Kumar Gaurav Kumar 97194310589 Let.Mukesh Kumar Let.Mukesh Kumar NA

10 Akhtar Ali Akhtar Ali 8791126124611 Pankaj Pandey Pankaj Pandey 879126124612 Nisha Nisha NA13 Praveen Kumar Manju Devi NA14 Amar Singh Ram sahai 9008476453515 Sarvesh Kumar Chakode lal8859455254/886589364916 Dharmendra singh Pooja 740973108117 Surendra Suman devi 735124455318 Kuldeep Kumar Soni 783980180819 Kamlesh Yadav Hemlata 8954763103/975913636020 Satya Prakash Sharda Devi 976050768321 Prasun Mishra Vandana Mishra 975884521322 Rajendra Singh Laxmi Devi 9761470600




y


Address

Mainpuri 10/15/16 10/15/16 16694Mainpuri 10/21/16 09/15/16 23000Mainpuri 10/11/16 10/11/16 0

Village Shamsherganj, Block Kishni 11/03/16 11/03/16 33416Asara Nainpuri 11/27/16 11/27/16 9694

Prihvipur,Mainpuri 12/17/16 12/19/16 9000Rajwana ,Mainpuri 11/7/2016 12/28/2016 25000

Singhpur Karhanal.Mainpuri 9/15/2016 1/24/2017 0Nagla,bhood Mainpuri 10/24/2016 78000Rajpur,Karhal.Mainpuri 4/11/2016 2/6/2017 25000Rajpur,Karhal.Mainpuri 4/11/2016 2/6/2017 25000

vill.mohanpur po. viyoti khudr bhogaw mainpuri 5/1/2017Nagla Ram lal,Kura 6/14/2017 6/16/2017 30264

Vidhuna post jawapur,Mainpuri 3/19/2017 7/31/2017 1900Karkara,kailashpur,karhal,Mainpuri 11/19/2016 7/31/2017 450

Shahjadpur,karhal,mainpuri 11/2/2016 7/31/2017 509Chautai mauhalla , ghiror , mainpuri 10/22/2016 7/31/2017 682

Bhojpur,halwiriya,Mainpuri 3/5/2017 7/31/2017 830Achalpur,Mainpuri 11/29/2016 7/31/2017 2060

Jyotikhudia,Mainpuri 12/25/2016 7/31/2017 35081,Misrana,Mainpuri 12/13/2016 7/31/2017 540

Nagla,Aram sarai,Mainpuri 3/28/2017 7/31/2017


Date of Accident

Date of Claim

receivedAmount

PaidDate of

Payment

Cashless PaidReimbursement PaidReimbursement Repudiated

Cashless PaidCashless PaidCashless Cashless Withradwn

Reimbursement PaidReimbursement RepudiatedReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Doucment pending

Cashless PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement PaidReimbursement Rejected

Death/Disablement/



Underprocess)


Mandantory document not provide by patient/GD Fir not provide/Eligibility proof(income certificate/Khasra,khatoni)

Case not cover under SKSBY scheme due to age over (70)

Requried document not submitted/Fir,GD and hospital bill/ discharge card not provide/query already sent

Awaited original documents


District Name

MainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuriMainpuri


Sl.No. Mobile No Address

1 Jile Singh Gopilal 8126116518 Thok Bakhir,Mathura ,Uttarpradesh2 Taravati Omprakrash 8273429272 Muara,Khamini Mathura3 Pramod Kumar Omprakrash 8273429272 Muara,Khamini Mathura4 Resham pooransingh 9358351319 Govindpur ,Mathura5 Sunita kumari Satish 8445076040 Khanpur chhara Mathura6 Dharamveer Dharamveer 8191820339 Selkhera ,Mathura7 Maktuwa Maktuwa 9690635735 Bakalpur,Mathura8 Gajraj singh Dayaram 8307480960 Khamini ,Mathura9 Mahesh chandra Vijendra 7023010675 Aduki, Mathura

10 Sanjay Deviram 9520379998 Chhatikari,Chatikara,Mathura11 Govind Singh Govind Singh 8126609772 Salaka, Baroth Bangar, Mathura12 Machla devi Samar singh 9412180417 Sersa,Mathura13 Sri chand Ram Chand 9837886666 Samaspur,Mathura14 Gopi Lal Hira lal 8126116518 Gidoh,chata,Mathura15 Om prakesh Sita ram 9634923729 Pachaya sehoransh sehora mathura16 Rambabu Rajkumari 9012190266/9719213022 Rasulapur , magauri Mathura17 Omkar Singh Bhagwan Devi 9719624062 Jawra,Mat,Mathura18 Angad Durga 9728454943 Kotwan,Mathura19 Shyam Singh Munni 7830167758 Sukhnagar,post shardagadh,Mathura



Name of the ( nominee)Bene

ficiary


Date of Accident Amount Paid

11/6/2016 1/24/2017 25000 Reimbursement Paid10/18/2016 1/24/2017 0 Reimbursement Repudiated10/18/2016 1/24/2017 0 Reimbursement Repudiated11/13/2016 1/30/2017 0 Reimbursement Rejected10/5/2016 25000 Reimbursement Rejected1/6/2017 5/3/2017 Reimbursement Repudiated

5/3/2017 Reimbursement RepudiatedReimbursement Rejected

10/17/2016 Reimbursement Rejected5/20/2017 6159 Cashless Cashless approved

4/12/2017 6/2/2017 Reimbursement Under process5/29/2017 7/13/2017 11194 Reimbursement Paid7/22/2017 7/28/2017 5000 Cashless Cashless approved11/6/2016 7/31/2017 682 Reimbursement Paid

10/11/2016 7/31/2017 400 Reimbursement Paid10/6/2016 7/31/2017 650 Reimbursement Paid2/15/2017 7/31/2017 440 Reimbursement Paid

11/29/2016 7/31/2017 Reimbursement Rejected2/15/2017 7/31/2017 Reimbursement Rejected


Date of Claim

receivedDate of

Payment

Death/Disablement/



Underprocess)


Mandantory document not provide by patient/GD Fir not provide/Eligibility proof(income certificate/Khasra,khatoni)Requried document not submitted/Fir,GD and hospital bill/ discharge card not provide/query already sent

File not cover undey scheme ( Age over of 72)Eligbilty proof overdated(Age over of 72)

Document not submitted by benificiery/bank passbook copy/GD FIRMandantory document not provide by patient/GD Fir not provide/Eligibility proof(income certificate/Khasra,khatoni)

Require document not submitted/Discharge card/X-ray not provided by patientdue to eligbility not fullfill/Inome certificate/Khasra,khatoni not provided by patient

File receive & underprocessReady for Payment

Not payable (on spot death)Not payable (on spot death)

District Name

MathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathuraMathura

FORMAT No. 11 INFORMATION REGARDING PAID CLAIMS UNDER SKSBY

Sl.No.Mobile No

1 Rammurtilal Rammurtilal 97614457392 Bhagvati Lalaram 96276171723 Sanjeev Yadav Somwati 95712960084 Santosh siyaram NA5 Sunena/ Babita Ranjit Singh NA6 Sanjeev Yadav Somwati NA7 Ishwari Prasad Ishwari Prasad NA8 Ram Vilas Champa Devi NA9 shayama Charan shayama Charan

10 Manoj kumar Jwala Prasad 844988079611 Mrs Manju Vijay kumar 708074077612 Shanti Devi Shanti Devi NA13 Balak Ram Balak Ram 740928166214 Pushpa Devi Hori lal NA15 Tarawati BhagwanDas16 Brij Mohan Gupta Alka Gupta8006770108/827308963717 Sahil Sahil 9027334520




FORMAT No. 11 INFORMATION REGARDING PAID CLAIMS UNDER SKSBY


Chakka,Karigana,Pilibhit 11/3/2016 ### 16044Nagla,Bisalpur,Pilibhit 9/23/2016 ### 0

Kali Nagar ,dhakia,kesarpur Pilibhit 1/14/2017 ### 25000vill- pailadpur, thana- musajhag 4/11/2017

Bill+ Post- Amratpur Block- Chandaus 3/28/2017Dakiya Keshapur Pilbhit 1/14/2017

Gram Actkona Thana Gajroola, Pilbhit 10/18/2016Gram Actkona Thana Gajroola, Pilbhit 10/18/2016

Shahi lilaurikhera Pilibhit 10/14/201652, guhiana,Suhas, Pipariya bhaja, Pilibhit ### 14842

House no- 76, Mirapur Hirapur, Bisalpur, Pilibhit ### 40094Amkheda,lucknow kalan,Pilibhit 6/7/2017

Village ikha khas,karod 5/1/2017 6/7/2017Hatura bijulahi,maktul,Pilibhit ###

Kechutanda,Amaria,Pilibhit ###Kisani,Pilibhit 1/20/2017 ### 600

Bisalpur,Pilibhit 6/30/2017 8/4/2017



Amount Paid

Date of Payment

Reimbursement PaidReimbursement RepudiatedReimbursement PaidReimbursement Doucment pendingReimbursement Under processReimbursement Doucment pendingReimbursement Under processReimbursement Doucment pendingReimbursement Doucment pendingReimbursement PaidReimbursement PaidReimbursement Under processReimbursement Under processReimbursement Under process

Cashless Cashless approvedReimbursement PaidReimbursement Under Process




Mandantory document not provide by patient/GD Fir not provide/Eligibility proof(income certificate/Khasra,khatoni)

Awaited original documentsFIR GD requried

File receive & underprocessFile receive & underprocess

Ready for PaymentReady for Payment

Ready for PaymentReady for Payment

FIR GD and discharge card

District Name

PilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhitPilibhit


Sl.No. Mobile No Address1 Minakshi Swamidyal mishra 9651418825 Japnapur,udiyapur,Sahjehanpr2 Ramkali Swamidyal mishra 9651418825 Japnapur,udiyapur,Sahjehanpr3 Vikash Mishra Vikash Mishra 9897861937 Haripur,Tahsil Sadar ,Sahjenpur4 VED PRAKASH VED PRAKASH NA BUDHIA BHOOD JALALABAD5 NARENDRA PAL NARENDRA PAL NA RAMKEDA KANTH SADER6 NAVAL KISHORE NAVALKISHORE NA KUDIYANA POST AARLI TILHER7 SANJEEV VERMA BAAGWAN SARAN NA MADNAPUR8 SATYAPAAL KALIKA SINGH NA VIJLAPUR ROSARKOTI9 Shamsher Samsher ali 9837168386 Barkherajaipal, tilhar, shahjahanpur

10 Shiv kumar Shiv kumar 9927521673 Kasenda, Tilhar, Shahjahanpur11 Shiv Dayal Shiv Dayal 9651876391 Vill. Kapsenda, Tilhar, Shahjahanpur12 Urmila Devi Rajpal 9651720668 House no-7, Abhayan Kant, Shahjahanpur13 Adarsh Raj Kumar NA Rafiyabad Kalan,jalalabad,Shahjahanpur14 Saurabh Saurabh Kumar NA Satyapara,Sahjahanpur15 Satyapal Singh Satyapal Singh 7523967882 Bijlapur,Rausar Kothi,Shahjahanpur16 Dhiraj Singh Sunita Nawada,,post khera,Shahjahanpur17 Madhu Tiwari Mridul Tiwari 9956769788Mohammadi road,salia,bhawalkheda,Shahjahanpur18 Shivdas Gajraj 7754202765 Rahimur,Shahjahanpur19 Ram Awtar Sadapyari9956305152/7518469529 Tingri,jalalabad,Shahjahanpur20 Buddhsen Shakuntala 8853017560 Akabari,Shahjahanpur21 Omprakash Sumen devi 9695547055 Kuniya,shah,Bharia,Jalabad,Shahjahanpur22 Om pal Priyanka 9935927974Gopalpur,pagaria,nagaria,talluga,gopalpur,Shahjahanpur



Name of the ( nominee)Beneficia

ry


Date of Accident11/27/2016 56000 Reimbursement Repudiated11/27/2016 43000 Reimbursement Repudiated

4/7/2017 15372 Cashless Paid18/01/2017 14687 Reimbursement Paid26/03/2017 Reimbursement Doucment pending

9/3/2017 Reimbursement Rejected3/4/2017 Reimbursement Doucment pending

13/04/2017 Reimbursement Under process25410 Cashless Paid

2/5/2017 5/21/2017 8694 Reimbursement Paid2/5/2017 5/23/2017 8694 Reimbursement Paid

4/17/2017 5/24/2017 12925 Reimbursement Paid5/22/2017 6/2/2017 31343 Cashless Paid3/21/2017 6/22/2017 25000 Reimbursement Paid4/13/2017 6/23/2017 Reimbursement Under process6/5/2017 7/12/2017 20952 Cashless Paid

5/21/2017 7/27/2017 Reimbursement Under process3/12/2017 7/31/2017 500 Reimbursement Paid




Date of Claim

receivedAmount

PaidDate of

Payment

Death/Disablement/



Reason for Repudaition ( Minimum 20 words)Claim rejected as per FIR report/GD Fir not provide

Claim rejected as per FIR report

Awaited original documents/Query raisedRejected due to not query answer reply/query raised against eligibility proof-(Khatoni/income certificate) & GD Fir

Awaited original documents/Query raisedReady for Payment

File receive & underprocess

District NameShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpurShahjahanpur

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