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Praroop No. 11Detail of Claims Under Mukhyamantri Kisan and Sarvhit Bima Yojana

Insurance Company Name:- National Insurance Company Ltd. District Name:- BastiJun-17

Sr. No. Patient Name Name of Nominee Address Mobile No. Status of Claim Reason of Rejection

1 Pramod Kumar Ojha Pramod Kumar Ojha 9935405893 024-Jan-17 Cashles Denied

2 Seetapati Seetapati 8948057626 010-Apr-17 Cashles Denied

3 Sandeep Ram Saware 9721989618 8694 2-Feb-17 Cashless Paid

4 Atul Asharam 9161484356 12694 10-Mar-17 Cashless Paid

5 Ranjeet Jagnarayan 7081644485 14194 10-Mar-17 Cashless Paid

6 Sumitra Ram Milan 9838805347 9894 8-Mar-17 Reimburesement Paid

7 Kedar nath Ram Laut Badhni, savdih, basti 98393390736-Apr-17

Reimburesement Denied

8 Hanuman prasad Hanuman prasad 98396644652-May-17


9 Ramesh Chandra Ramesh Chandra 99192032472-May-17


10 Lavi Srivastav Dinesh Chandra2-May-17


11 Kusum Dinesh Chandra2-May-17


12 Dinesh Chandra Dinesh Chandra2-May-17


13 chhavi Dinesh Chandra2-May-17

Reimburesement Denied Deley Submission of Claim/ Claim Received after 4 month

Amount of Paid Claim

Date of Payment/Date of

RejectionCashless/

Reimburesement

S/O of Suresh Pal, Rajuali, Basti, Uttar Pradesh

Complete Hospitalisation Documents and eligibility document were not provided by Hospital hence Pre Authorization and PA

not given by TPAvillage-katiya noudiya post- gaur thana- Gaur basti 272163

Patient/HOF is not eligible under the scheme/ As per Policy term condition patient is not eligible under the schem . The

patient age is more then 70 years.

Dirahaw, Purani Basti, Basti

S/o of Banwari, Bahadurpur, Basti Nagar Bazar, Uttar Pradesh-272302S/o of Jagnarayan Pikaura Bari, Captain Ganj, Harraiyya Basti, Uttar Pradesh

Chandokhar, Ramnagar, Basti

Required documents for claim processing not provided /The claimant was presented his claim after 4 months of discharge

date. Therefore the claim is not acceptable.

Amari Bazar, Harraiya Basti

Hospitalization document not Received/Patient was Treated on OPD Basis/OPD Not Covered underthe scheme

agya bujurg, mahuva dabar, basti


Lalabad, Mahua, dabar, babhnan







14 Ram Janam Maurya Ram Janam Maurya5/23/2017


15 Hasim Ali Hasim Ali 96287153005/23/2017


16 Niraj Yadav Munnu Lal Yadav 9648468694 108686/19/2017

Reimburesement Paid

17 vakil ahmad vakil ahmad 9918762248 98946/27/2017

Reimburesement Paid

18 Lov Kush Lov Kush 7839745820 30006/27/2017

Reimburesement Paid

19 sachin(Raunak) santosh kumar 9935674648 Reimburesement In Process

20 ShivCharan Shiv Charan 9838546069 Reimburesement In Process

21 rama sudha devi 8948872401 Reimburesement In Process

22 manoj kumar manoj kumar 77540835057245 6/27/2017

Reimburesement Paid

23beena devi beena devi 7394015449 7245

Reimburesement Approved

24Chandrawati Babau Ram

Reimburesement In Process

25neeraj kumar verma raghoram verma


26vikash gautam santosh kumar 7800234374


27 Surya Prasad Pandey Baderi Prasad Pandey 7234801162 Reimburesement In Process

28hemant kumar rajkumar 7398816656


29dipika singh ramchandr singh 7206241261


30lalmati devi shivprasad 9478390464


Khatamsarai, Shankarpur, Basti

1. Copy of FIR/GD or SDM/ADM certificate2. Discharge Paper,X-Ray Report, Doctor prescription with

treatment detail 3. Mode of accident and Time of accident was not mention on

claim form 4. Original payment receipt

5. Original Final BillHaveli Khas, gandhinagar, marwa nagar, Basti-272001

head of Family age is more than 70 year (as per Adhaar Card) and as per SKSBY scheme guideline, head of family age

between 18 – 70 years. Due to overage of patient, claim can’t admissible

Bhagvanpur, sonaha,sonha,Basti- 272190

vill- aadampur post -shankarpur sonha basti

vill-ganeshpur daxin dwara basti

vill- atroura amoda harraiya basti00, Banrahi Jungle, Gram Panchayat Banrahi Jungle, Block Saltaua Gopalpur, Jilla Bastivill-aamkoil post- newari thana- lalganj basti

vill-bastinathu post-tusila thana-sonha basti

vill-kalimandir reilway stetion basti

Hasanpur Bargadawa Bhanpur Basti

vill-baghakadar post-sukrauli gaur basti

vill- chhapiya shukl post majhovababu harraiya basti

Gram - Marwatiya Babu , Sadar Basti

vill-pakardad post-gaura upadhya

vill-kudharai babu visheshargang

vill-jaguin post gobind pur jaguin

Praroop No. 11Detail of Claims Under Mukhyamantr iKisan and Sarvhit Bima Yojana

Insurance Company Name:- National Insurance Company Ltd. District Name:- Ambedkar NagarJun-17

Patient Name Name of Nominee Address Mobile No. Status of Claim Reason of Rejection

1 Hausila Hausila 7348366656###

019-Apr-17 Cashles Denied

2 Anita Rajitram 9554727902###


3 Ramkali Ramkali Sikhandarpur 9648759151###


4 Surendra Goutham Parashuram 9956572532###


5 Shiv Kumar Shiv Kumar Ludhiyana Panjab 9889101794###


6 Meraj Meraj 7800151793###

024-Jan-17 Cashles Denied

7 Sant Ram Sant Ram NA###


8 Noor Banu Noor Banu 98380004 ### 1140 10-Mar-17 Cashless Paid

9 Kariya Kariya Songoan Ambedkar Nagar NA ### 5500 18-Apr-17 Cashless Paid

10 Reshma Moin NA ### 3300 18-Apr-17 Cashless Paid

11 Dinesh kumar Bansh raj 7618907305###

07-Mar-17


12 Prem kumar Manoj Kumar Sharma 8052353296###

07-Mar-17


13 BASKALLI DEVI VISHAWNATH NA 26/04/17 ReimburesementUnder Query

14 RAMJI MISHRA RAMJI MISHRA 8853115675 28/04/1713041 6/19/2017

ReimburesementPaid

15mahendra mahendra 9811787408 ### 7245

ReimburesementApproved

16mewalal tripathi MEWALAL TRIPATHI 9415183273 ###

ReimburesementIn Process

17Nirmla Devi Ram Nayan 7237836003 ###


18Shri Ram Shri Ram 7237836003 ### 10867 6/19/2017

ReimburesementPaid

19mayank parashuram verma 7309486512 ###


20rupesh rajendra prasad 8577855991 ###


Sr. No.

Claim intimation date


Date of Payment/Date

of RejectionCashless/

Reimburesement

Mamrejpur,Haidrabad, Ambedkar Nagar

Complete Hospitalisation Documents and eligibility document were not provided by Hospital hence Pre Authorization and PA not given by TPAW/o of Ashok Kumar,

Mirjapur, Akbarpur, Ambedkar Nagar, Uttar Pradesh

Required Document for Claim Processing Not Received/ HOF Rajitran is father in low of Patient Anita Devi/Provide the Kisan Bahi, Income certificate with the name of Self or Mr. Ashok Kumar/ Copy of FIR /GD.Required Document for Claim Processing Not Received/ Complete Hospitalisation Documents and eligibility document were not provided by Hospital hence Pre Authorization and PA not given by TPA

Kadiyapur,Majha Hardaspur,Kathehari, Ambedkar Nagar

Complete Hospitalisation Documents and eligibility document were not provided by Hospital hence Pre Authorization and PA not given by TPARequired Document for Claim Processing Not Received/ BPL Rasan card with family details/ HOF detail with Kisan Bahi, Income certificate with the name of SHIV Kumar/ X RAY Report

Vill. Parsa Langra, Post. Sihari saradaha , Basti 272190

Complete Hospitalisation Documents and eligibility document were not provided by Hospital hence Pre Authorization and PA not given by TPA157, kumhi, kumhi, gram

panchait- kumhi, block- akhand nagar, dist. Sultanpur

Required Document for Claim Processing Not Received/ Original bill of implant with sticker / as per claim form date of accident is 2/01/2017 but patient was addimited 8 days of accident. Please provide an explanation.

Katriya, Yakubpur, Ambedkar Nagar

D/o Moin, Sikandarpur,Akbarpur,Ambedkar NagarSongav,Ashrapur,kidoha,ambedkarnagar

Required documents for claim processing not provided/ Original payment receipt Copy of FIR/GD X-ray report and blood report Medicine bill, Final Bill and original implant bill IPD record with detail

hidi, pakidiya, mithi ,Ambedkar nagar

Required documents for claim processing not provided /Original payment receipt /Copy of FIR/GD /X-ray report and blood report /Medicine bill, Final Bill and original implant bill /IPD record with detail

vill &post-GANDHI NAGAR,LORPUR,TAJAN

vill=PRAHLAD PATTI,PIYAREPUR

ramdihsarai shukla bajar,ambedkar nagar

sastri nagar akbarpur,ambedkarnagar

Uchegaon Gispur , Ambedakar Nagar

Peerpur Bubra Lorpur Tajan Ambedkar Nagar

vill=judawanpur,aria,surapur,ambedkar nagar,akbarpur

vill&post=songaon gaura,ambedkar nagar

21karan gena 7518232306 ###


22Ranjai Ranjai 9161548140 ### 8694


23mayank parashuram verma 7309486512 ###


24rupesh rajendra prasad 8577855991 ###


25karan gena 7518232306 ###


26RADHESHYAM HAUSILA PRASAD 9696089165 ###


27

RAMSAHAY TEBUL 8009181508 27/06/17


28BHIM TIWARI RAMDHAN TIWARI 9648293294 30/06/17


29 Pankaj kumarDwarika Prasad 9616515455 29/06/17 11935

Cashlees Approved

vill&post=marthua saraiya,katehari,ambedkar nagar

362, Saspana Ambedkar Ngar U.P. 224235

vill=judawanpur,aria,surapur,ambedkar nagar,akbarpur

vill&post=songaon gaura,ambedkar nagar

vill&post=marthua saraiya,katehari,ambedkar nagar

RAMPUR,MAGUDILA,SURAPUR,AMBEDKAR NAGAR

VILL=SAIYAD MAKHBOOLPUR,YAHIYA KAMALPUR,AMBEDKAR NAGAR

VILL=MAMRESHPUR,ALIGANG,AMBEDKAR NAGARMarhara ambedkar nagar marahara uttar pradesh 224139


Insurance Company Name:- National Insurance Company Ltd. District Name:- BalrampurJun-17

Sr. No. Patient Name Name of Nominee Address Mobile No. Amount of Paid Claim Reason of Rejection

1 Ramawati Ramawati 9161062673 010-Apr-17 Cashles Denied

2 Jumman Jan Mohammad 7317278761 010-Apr-17 Cashles Denied

3 Lalman Lalman 9161638325 019-Apr-17 Cashles Denied

4 Munna Devi Munna Devi 9161638325 010-Apr-17 Cashles Denied

5 Shalu Shalu 9161638325 010-Apr-17 Cashles Denied

6 Naim Ahamad Naim Ahamad 9628262280 010-Apr-17 Cashles Denied

7 010-Apr-17 Cashles Denied

8 Ramjan Ramjan 9198993710 019-Apr-17 Cashles Denied

9 Reshma Begham Reshma Begham 9838308453 019-Apr-17 Cashles Denied

10 Mahtab Alam Mahtab Alam 9838308453 019-Apr-17 Cashles Denied

11 Rafatulla Rafatulla 9838308453 019-Apr-17 Cashles Denied

12 Armanulla Armanulla 9838308453 019-Apr-17 Cashles Denied

13 Achal Achal 9839187304 2000 31-Jan-17 Cashless Paid


Rejection

Cashless/Reimbureseme

ntStatus of

Claim

Banjeria,Balrampur,Gaindas Bujurg,UP

Required Document for Claim Processing Not Received/1. As per document provided

by the hospital, patient was admitted in Khaliullah hospital laparoscopic & maternity

center, mankapur road, utraula. but the final bill has been prepared on letterhead

pad of Khaliullah hospital & jachcha bachcha kendra,chandauliya,madhpur,utraula

Sadulla Nagar, Balrampur,Uttar pradesh

Required Document for Claim Processing Not Received/Copy of FIR /GD /eligibility

document were not provided by Hospital/Clarification of Alcohal.

Complete Hospitalisation Documents and eligibility document were not provided by

Hospital hence Pre Authorization and PA not given by TPA

RAM VASIR DEEH ETI RAMPUR P,S. UTRAULA BALRAMPUR(271604)



RAM VASIR DEEH ETI RAMPUR P,S. UTRAULA BALRAMPUR(271604)



Daurahara, Balrampur,Uttar Pradesh



Jait unnisha Jait unnisha VILL. DHORA. POST DHORA P, S. .UTRAULA . BALRAMPUR.(271604)













Itairampur (a0) Utraula , Balrampur

14 Shama Jan Hommmad 7080845397 2000 31-Jan-17 Cashless Paid

15 Chotka Arjun 9918607487 3000 31-Jan-17 Cashless Paid

16 Rahima Abdul Salam 8953721525 5000 31-Jan-17 Cashless Paid

17 Murta Devi Ferai 9170850103 6000 31-Jan-17 Cashless Paid

18 Soharata Soharata 9918679520 7000 31-Jan-17 Cashless Paid

19 Mr Lalta Prasad Mr Lalta Prasad 9009740600 5000 31-Jan-17 Cashless Paid

20 Savari Ramprakash 9648530021 5000 10-Mar-17 Cashless Paid

21 Ram achal yadav Ram achal yadav Bazar dih,Prain pur, balrampur 9919814450 7245 18-Apr-17 Cashless Paid

22 jhagaru jhagaru Dudhra, utroulla, balrampur 7408789955 8694 22-Feb-17 Reimburesement Paid

23 Shivam Kinkan rahmarwa, gaisadi balrampur 8756637963 07-Mar-17


24 Raam Surat Yadav Raam Surat Yadav 99846101005/23/2017


25 Gulam Hussain Gulam Hussain 9839586408 Reimburesement Under query

26 Mukhtaar Rafatul vill.Nawa nagar post tulsipur bal, 7081526452 Reimburesement Under query

27 sethe sethe 9935893299 146946/19/2017

Reimburesement Paid

28 Raghavendra pratab Raghavendra pratab singh 9935882358 116446/19/2017

Reimburesement Paid

29 jamuna prasad jamuna prasad 8756806437 149946/19/2017

Reimburesement Paid

96 Mujhali Balrampur Gumari U.P.

W/O of Arjun, Balrampur, Uttar Pradesh

W/O of Abdul Salam, Rampur, Balrampur, Uttar Pradesh

W/O Of ferai, Balrampur,Uttar Pradesh

Kishunpur Grint, Balrampur, Rehra Bazar

Balrampur,Sadulla nagar,Uttar Pradesh

balrampur,Achalpur,Uttar pradesh

Required documents for claim processing not provided/Copy of FIR/GD or SDM/ADM

certificateDate of accident, place of accident and

mode of accident was not mention on claim form.

Provide the Kisan bahi/Khatauni/BPL ration card/Income certificate Bhawadajot, Chamrupur,

Utaurla

vill.SINGHI POST BHAMRI TULSIPUR BALRAMPUR

vill ,kohar gaddi kodar moti pur semri tulsipur balrampur

vill, baldev nagar post madhy nagar pachperwa balrampur

vill, hariharpur pachperwa balrampur

30 vimla devi bheekhi ram 8795968178 118676/19/2017

Reimburesement Paid

31 Holi kashyap Holi kashyap Purani bazar balrampur 9559691282 Reimburesement Under query

32 Vishnu Dev Kamla prasad n/a Reimburesement Under query

33 Deepak Ishar moti N/A Reimburesement Under query

34 PESHKAR HADAYARAM Reimburesement Under query

35DULARI DULARI BAIJPUR BALRAMPUR 8127600339


36SATISH CHANDRA SATISH CHANDRA 9651434383


37SITA DEVI SITA DEVI


38 Reena Reena Rahera Bajar, Balrampur 88085465685/23/2017 Cashless

Denied

39 Nawab Hasan Nawab Hasan Dahaurahara, Balrampur9792451281 5/23/2017 Cashless

Denied

40Abdul saleem Abdul saleem 9792451281 5/23/2017 Cashless

Denied

41 Jakirun Nisha Yunush 7897683168Reimburesement

In Process

42 Mangaldev Krishna Prasad 9888045632Reimburesement

In Process

43RAM SAMUJH PURENINA BALRAMPUR 7080444416 Reimburesement

In Process

44 smt, minka/ salala 7081355942Reimburesement

In Process

45 Ram sagar Ram sagar 9049024952Reimburesement

In Process

vill, dhandhra vikas khand gainsari distt balrampur

vill,Majgawan post , Bhajanwa Balrampur

W/O.let.kartar singh.mohalla dhusha balrampur

VILL MUJEHNI POKHARWA POST GUMRI .MAHADEIYA BALRAMPUR

S/O ,LT. MANIRAM . SHIVPURA BALRAMPUR

VILL, MATHURADEEH DHAWRIRI KALA DHARAMPUR BALRAMPUR



i) Date & time of accident on claim formii) Copy of FIR/GD or certificate of

SDM/ADMDate & time of accident on claim form ii) Id proof of patient and

HOF iii) Copy of FIR/GD or

certificate of SDM/ADM

Vill. Gaura mafi Gulhariya, Post Hishampur, Balrampur

Vill. Bhagawan pur , Post Mirjapur,Thana- Balrampur

vill , habibpur post rehra balrampur

vill,, jogiya kali nagar Griant balrampur

46 Vishal yadav Vishal yadav 7459845909Reimburesement

In Process

47 Chhedi lal Chhedi lal vill, bankashya balrampur 7380710739Reimburesement

In Process

48 PHOOLPATA PHOOLPATA 9454936219Reimburesement

In Process

49 Pramod kumar Mata prasad Bodhipur, Balrampur 88871088093726 Reimburesement

Approved

50PANKAJ HUSENI 7607343309 Reimburesement

In Process

51PINKY OJHA SHYAM NARAYAN OJHA VILL.PAHALWARA . BALRAMPUR 9616343064 Reimburesement

In Process

52RAM DULARE RAM DULARE 7317461852 Reimburesement

In Process

vill gara mafi gulriha mahrajganj balrampur

VILL, DHAM PUR,DEOPURA. BALRAMPUR

BELA BARGADHI TULSIPUR BALRAMPUR

VILL,LAKHNIPUR BHUSALLIA BALRAMPUR

Detail of Claims Under Mukhyamantr iKisan and Sarvhit Bima Yojana

Insurance Company Name:- National Insurance Company Ltd. District Name:- MaharajganjJun-17

Sr. No. Patient Name Name of Nominee Address Mobile No. Amount of Paid Claim Status of Claim Reason of Rejection

1MaharajganjSobha Ramakant 9161586418 ### 11194 16-Feb-17 Reimburesement Paid

2MaharajganjAjay Singh Ajay Singh 7565074028 ### 14694 16-Feb-17 Reimburesement Paid

3MaharajganjOm Gautam Ganga 8756091134 ### 9696 7-Feb-17 Reimburesement Paid

4Maharajganjsamiulla Khairunnisha 7235969369 ### 15694 7-Feb-17 Reimburesement Paid

5MaharajganjSona devi Sona devi 9565495052 ### 24694 16-Feb-17 Reimburesement Paid

6MaharajganjJokhani devi Harish Chand 7844909402 ### 17115 17-Feb-17 Reimburesement Paid

7MaharajganjRaju Tilak chand 9621928836 ### 15694 7-Feb-17 Reimburesement Paid

8MaharajganjNilu Lal muni sahu 887449141523/10/16 10694 10-Feb-17 Reimburesement Paid

9MaharajganjRaju Mewati 979372274224/10/16 24694 7-Feb-17 Reimburesement Paid

10MaharajganjNikhil Umesh 7348120124 ### 10894 7-Feb-17 Reimburesement Paid

11MaharajganjBhdhiram Budhiram 8052626346 ### 19989 7-Feb-17 Reimburesement Paid

12Maharajganjnavya Santosh Jaiswal 962139497727/10/16 17694 16-Feb-17 Reimburesement Paid

13MaharajganjShyam Yadav Vishnu Yadav 7379939458 ### 10894 17-Feb-17 Reimburesement Paid

District Name

Date of Accident


RejectionCashless/

Reimburesement

ramgarhba, dagroopur,Maharajganj

Khempipra,Khempipra, Maharajganj

khairawha jangal, harpur, Maharajganj

Nadua, nadhua, maharajganj

basdila, paniyara, maharajganj

vill. Khutaha Bazar,Post. Khutaha bazar sadar

Vill. Bhawanpur and Bhulwa, thana. Chauk bazar, maharajganj

sitlapur, khesarha,maharajganj

Dashrathpur,kajari, maharajganj

churaha wardno. 3 ambedkarnagar, maharajganj

Tenuahiya, paniyara,maharajganj

Bhagatar,mithaura bazar, nichlaul , maharajganj

Bhikham tola, Khutaha bazar, maharajganj

14MaharajganjNandlal Dharma Maupakad, maharajganj 9565707934 ### 24694 22-Feb-17 Reimburesement Paid

15MaharajganjSonu Ransaware 7607744708 ### 24694 16-Feb-17 Reimburesement Paid

16MaharajganjIshrawati Ishrawati 7318485995 ### 11814 10-Feb-17 Reimburesement Paid

17MaharajganjShivesh Baijnath 9919860057 ### 10894 16-Feb-17 Reimburesement Paid

18MaharajganjAbrun nisa Abrun nisa 28/10/16 5230 16-Feb-17 Reimburesement Paid

19MaharajganjParasnath Tiwari Parasnath Tiwari 723788822714/10/16 6210 7-Feb-17 Reimburesement Paid

20MaharajganjChotakan Chotakan 7860764665 ### 25000 22-Feb-17 Reimburesement Paid

21Maharajganjujra Ramlagan 7394004811 ### 18242 16-Feb-17 Reimburesement Paid

22MaharajganjAnurag Srawan kumar 739394190826/10/16 12194 16-Feb-17 Reimburesement Paid

23MaharajganjAryan raju kuamr Maupakad, maharajganj 723492646421/11/16 11694 8-Mar-17 Reimburesement Paid

24MaharajganjSadiya Jalisun 875639208229/11/16 11194 24-Mar-17 Reimburesement Paid

25MaharajganjManjesh Mohan 995682168728/11/16 9894 24-Mar-17 Reimburesement Paid

26MaharajganjDilmohhamed Dilmohhamed 8601306269 ### 11194 8-Mar-17 Reimburesement Paid

27MaharajganjRam dhwan Ram dhwan pipra babu 965113297020/11/16 10694 8-Mar-17 Reimburesement Paid

28MaharajganjDhiraj Gita sonbarsa pokhar bhinda 7755804711 ### 11194 8-Mar-17 Reimburesement Paid

29MaharajganjVidya Devi Vidya Devi 8953269800 ### 11694 17-Feb-17 Reimburesement Paid

30MaharajganjUjala Jiven Timohani 9026590788 ### 11194 8-Mar-17 Reimburesement Paid

Mujahana,Mujahana,Kodibhar,Maharajganj

Katahari bazar, Kothibar, maharajganj

Dhamau, regahiya bazar, nichlol , maharajganj

Mahadev , Khurda bazar, Maharajgang

Pipera munder, Pakadi visunpur, Maharajganj

113, Badaharamir, Mithaura, Maharajganj

nandana tola, belwa, dhudhuli, maharajganj

anarha,darhata kotawali, Maharaj Ganj

Nath nagar, kamhariya, maharajganj

pipra khadar, tarkulha tiwari,

Naksha- baksha, sekhuai, chauck bazar

Pipera tahsil ladar, Bargadwa, harya phrenda

31MaharajganjManour ali ayasha 9451685494 ### 12194 16-Feb-17 Reimburesement Paid

32MaharajganjRohit Guddu 9554288347 ### 10494 8-Mar-17 Reimburesement Paid

33MaharajganjRishu Verma Paras nath verma Bagapar 8052427307 ### 9894 24-Mar-17 Reimburesement Paid

34MaharajganjAmriun nisha Amriun nisha belwa, gadaura 7800908164 ### 15694 8-Mar-17 Reimburesement Paid

35MaharajganjGirja devi Ramanand 7388121649 ### 16694 8-Mar-17 Reimburesement Paid

36MaharajganjMun Devi Mahendra Singh Chayanpur, Maharjganj 9919442799 ### 13194 8-Mar-17 Reimburesement Paid

37MaharajganjRajesh Ram Milan 9554932378 ### 10194 8-Mar-17 Reimburesement Paid

38MaharajganjYogendra Kumar Yogendra Kumar 9956568282 ### 10694 8-Mar-17 Reimburesement Paid

39MaharajganjSubhawati Ramdeen 9794630462 ### 15694 24-Mar-17 Reimburesement Paid

40MaharajganjNaresh Naresh badhya, katahari, 9170518730 ### 15194 19-Apr-17 Reimburesement Paid

41MaharajganjMuni Gupta Paltu Gupta 9125161349 ### 12194 27-Apr-17 Reimburesement Paid

42MaharajganjSangita Ramesh Sharma Baithwailiya,nichauil 8858083738/97### 8745 19-Apr-17 Reimburesement Paid

43MaharajganjVisnu Chand Shkla Visnu Chand Shkla Nand bhar , Khjuria 8795021286 ### 10194 19-Apr-17 Reimburesement Paid

44MaharajganjUrmila Anil badahara vayidy khajuria 983881456520.01.2017 10694 18-Apr-17 Reimburesement Paid

45MaharajganjDeepak Sakindar 726786672102.01.2017 12194 27-Apr-17 Reimburesement Paid

46MaharajganjRam Pratap Ram Pratap 705422271509.02.2017 13694 27-Apr-17 Reimburesement Paid

47MaharajganjAmit Ramkaran 998416259013.02.2017 18541 19-Apr-17 Reimburesement Paid

Badhepurwa, barhaipurwa, nichlaul

Kamiya Kala, Darhata, Chauk

taun erya, ghughli, vard no. 7

Rudrapur Post- Mohua Mahrajganj

Laxmipur , Siwala , Mahrajganj

Pakardiha,Mahdeva Basdeela,Laxmipur,Mhaharajganj,

Bhagatar, Mithaura, Nichloul

vill-Rampurwan,Post-katahari Bazar,Police St.Kothibhar,

Vill-Jagdeeshpur, Post-Pakadi, Police St.Ghughuli

vill-Kaithvaliya, sarvjeet,Semara Maharaja,Laxmipur

48MaharajganjAngad Harita 706895771120.02.2017 10194 19-Apr-17 Reimburesement Paid

49Maharajganjnandlal Nandlal Gupta 980740636114.02.2017 9000 19-Apr-17 Reimburesement Paid

50MaharajganjRamdayal Harishchand 875694991527.12.2017 12194 18-Apr-17 Reimburesement Paid

51MaharajganjNavi Aalam Vajid Ali Parsa Gidhi 708093024311.02.2017 10194 19-Apr-17 Reimburesement Paid

52MaharajganjMahaveer Mahaveer Haraiya post-Bargadawan 840008091113.03.2017 13694 18-Apr-17 Reimburesement Paid

53MaharajganjManoj Kumar Ramugrah khajuria, post-baratgada 919845531101.03.2017 5000 18-Apr-17 Reimburesement Paid

54MaharajganjVinay Neeraj Singh Jamui Pandir post Nichlaul 800994797712.02.2017 7245 18-Apr-17 Reimburesement Paid

55MaharajganjSonmati Chhedi 885345451520.01.2017 11194 19-Apr-17 Reimburesement Paid

56MaharajganjVinod Kumar Shankar 887482055005.03.2017 10694 18-Apr-17 Reimburesement Paid

57MaharajganjAnil Dashrath Shahpur post-Samardheera 995619741124.02.2017 10494 18-Apr-17 Reimburesement Paid

58MaharajganjMintu Bundeelal Kathara, Kotwali 7571861774 ### 11694 18-Apr-17 Reimburesement Paid

59MaharajganjAmarjeet Kushuma 840047391115.03.2017 12194 27-Apr-17 Reimburesement Paid

60MaharajganjAarchi Rajkumar Baijnath kala Darhata 805247904507.03.2017 13694 27-Apr-17 Reimburesement Paid

61MaharajganjShamsher Aalam Shamsher Panewa Panei, 964834188410.02.2017 8245 27-Apr-17 Reimburesement Paid

62MaharajganjTairun Nisha kasim Madanpura, Nichlaul 991920677509.02.2017 7245 27-Apr-17 Reimburesement Paid

63MaharajganjRamsaware Ramsaware 9956228480 ### 07-Feb-17

Reimburesement Denied Not Eligible/ Hof age is above 70 Years

64MaharajganjChahat Indrawati parisia khurd, maharajganj 7525889823 ### 022-Feb-17


41 Pipariya post sohrauna tiwari

Vill-Bargadahi basant nath, post-darahata,

gaunariya raja post darahata

Gaunariya babu post.maharajganj

Pipariyan post-Sohrauna Tiwari

mahadewa Anandnagar Pharenda

amrutiya,pipra babu,maharajganj

Required documents for claim processing not provided/Patient was not provided the eligibility

document of HOF like that BPL ration card/Khatauni/Kisan bahi/Income certificate.

65MaharajganjSudama Sitaram 7317838279 010-Feb-17


66MaharajganjShyambali Shyambali 7379939458 ### 07-Feb-17


67MaharajganjHasina Sadrun 8795200421 ### 010-Feb-17


68MaharajganjParamhans Paramhansh 9793263521 ### 07-Feb-17


69MaharajganjNasima Khatun ishlam Zabar 800992339216/11/16 010-Feb-17

Reimburesement Denied Not Eligible Under the Scheme/ Not Admissible

70MaharajganjVishal Ramjag 951974418315/11/16 06-Apr-17


71MaharajganjPream Bihari 9118451028 07-Feb-17


72MaharajganjMariyam Basir gopala, maharaj ganj 745997562013/10/16 010-Feb-17


73MaharajganjSohrati Seshman 9838323541 ### 07-Feb-17


74MaharajganjRaju Ayodhya Bhutaha , Maharajganj 7565912307 ### 022-Feb-17


75MaharajganjAbhishek Parmila 840083990429/11/16 06-Apr-17


76MaharajganjMamta Soniya Mohanapur, Maharajganj 956571932323/10/16 022-Feb-17


77MaharajganjDhupai ram Dhupai ram Bnajarhin, maharajganj 9795141083 ### 07-Feb-17


78Maharajganjrisha Kishun Laxmipur, nabuiya , puraina 9793569362 ### 06-Apr-17


79MaharajganjVivek Sugriv Kumar sugauli, pipra bazar 995625308519/11/16 022-Feb-17


80Maharajganjrita Mahindra 739851045819/11/16 022-Feb-17


81MaharajganjAkash Shila 887482767030/11/16 06-Apr-17


pali and hanumanganj,Odwaliya, nichlowal,maharajganj

Patient not Eligible Under the Scheme /Patient is Grandson/ Not Admissible

Mundera kala, mithaura, maharaj ganj

Sihuli parsa, Parsoni, Chauk, Maharajganj

Not Eligible Under the Scheme/ Not Admissible /Patient was not provided BPL ration

card/Khatauni/Kisan bahi/Income certificate.

Chokat rai , Fulwaria, maharajganj

Bhopal pur, Farenda Maharajganj

Moti tola, rasulpur, maharajganj

Required documents for claim processing not provided/Original Payment receipt

Original Payment Receipt with sticker Copy of FIR/GD or SDM/ADM certificate

bajaha & ahirauli, nichloul, Maharajganj

Patient is not Covered in the Scheme (Patient is Grandson)

Patient not Eligible Under the Scheme /Patient is Granddaughter of patient /Not Admissible

semrahini-chandanpur, Mudila Required documents for claim processing not

provided/Original Implant bill with sticker Copy of FIR/GD

Please provide the ID Proof of AYODHYA.Place of accident not mention on claim form

Pt. was hospitalised after 3 days of accident .please provide explanation.

Bashpar , baijoli tola, bhelhiya

Required documents for claim processing not provided/Copy of FIR/GD or SDM/ADM certificate

Original payment receiptOriginal implant bill

Kisan Bahi/Khatauni/BPL ration Card/Income certificate of HOF Miss Pramila Devi

HOF ID proof

Required documents for claim processing not provided /Original Payment receipt

Copy of FIR/GD As per IPD paper diagnosis is fracture in Rt. Side

chest Ribs but on discharge paper and doctor prescription mention is fracture Lt. Side chest Ribs.

Please provide explanation.

Required documents for claim processing not providedOriginal Payment receipt


Provide the Kisan bahi/Khatauni/BPL ration card/Income certificate of Mr. Kishun F/O Rishu

Required documents for claim processing not

provided/Original Payment receiptOriginal Implant bill with sticker

Copy of FIR/GD or SDM/ADM certificateX-ray report

Rudhauli, madam pur, Nichlaul

Required documents for claim processing not provided /Original Payment receiptOriginal Implant bill with sticker

Copy of FIR/GD As per claim form Sri Mahendra is HOF of Reeta

please provide the Kisan Bahi/Khatauni/BPL ration card/Income certificate .

tali, semara maharaj, puramder pur



Provide the Kisan bahi/Khatauni/BPL ration card/Income certificate of Miss Shila M/O Akash

ID proof of HOF

82MaharajganjBachchan Ansari Bachchan Ansari 991965725715/12/16 07-Feb-17


83MaharajganjAnmol Ramsankar 875652250219/11/16 022-Feb-17


84MaharajganjShivam Nandlal harmanjil khurd, mudila 7379851550 ### 06-Apr-17


85MaharajganjKismoti Kismoti 945069447429/11/16 07-Feb-17


86MaharajganjJadawati Sudama singh 979241834021/11/16 07-Feb-17


87MaharajganjRishu Ram prasad 912022711816/12/16 06-Apr-17


88MaharajganjAmit kumar Rauniyarsuredra prasad 9452188180 ### 022-Feb-17


89MaharajganjIrfan Ansari Mahamdin Kuiya, maharajganj 9935934508 ### 022-Feb-17


90MaharajganjSarvesh Lalji badhara, kamriya , chauk 9919707967 06-Apr-17


91MaharajganjRitika Chabdrawati Laxmipur, ekgada 9559662328 ### 022-Feb-17


92MaharajganjTribhuan Shiv puran padhari khurd, karmaha 9838532290 ### 022-Feb-17


93MaharajganjSangita singh Baderi nath Gopi kahe 8726721947 ### 06-Apr-17


94MaharajganjShristi Manorma devi Shyam devkha 7458859393 ### 06-Apr-17


95MaharajganjAdarsh yadav Ramagaya Kamasin khurd , paniyara 9580274913 ### 06-Apr-17


96MaharajganjChandra bhan Chandra bhan 7234894743 ### 06-Apr-17


97Maharajganjkolia devi Munib Harji, Barigao 9651210070 ### 07-Feb-17


98MaharajganjThagani Thagani Piprakajii, Nichlaul 9936470972 06-Apr-17


Paniyara, Maharajganj-273158, Uttar Pradesh

Shivnarayan, lokvidhyapith nagar


Copy of FIR/GD Please provide the ID Proof of Anil

As per claim form HOF is grandfather of the patient Anmol. Please provide the Kisan Bahi/Khatauni/BPL

ration card/Income certificate of Mr Anil F/O Anmol.

As per claim form date of accident is 19/11/2016 but patient was admitted in the hospital after 5

days of accident .please provide explanation.



Provide the Kisan bahi/Khatauni/BPL ration card/Income certificate of Mr. Upendra F/O Shivam

ID proof of HOFAs per Document date of accident is 08/12/2016

but X-ray has been done on date 03/12/2016 before

On Discharge paper,X-Ray report write Rt. side fracture but on Dr. prescription Lt. side fracture

Khutaha bazar, khudara bazar

Nichlauil ,wad no 3, marasay muhalla

Basant pur, Badhramir, maharaj ganj

Required documents for claim processing not provided /Original Payment receipt


Provide the Kisan bahi/Khatauni/BPL ration card/Income certificate of Mr. Ishwar Prasad F/O

RishuID proof and Bank detail of HOFbhagatar,mithaura,

maharajganj

Required documents for claim processing not provided/Original Payment receiptOriginal Implant bill with sticker

Copy of FIR/GD or SDM/ADM certificate


Copy of FIR/GD As per claim form HOF is grandfather of the patient

IRFAN ANSARI. Please provide the Kisan Bahi/Khatauni/BPL ration card/Income certificate of

Mr.Jainullah. f/o IRFAN ANSARIPlease provide the Bank Details of Jainullah.

Please provide the ID Proof of Jainullah.As per claim form Date of accident is 7/12/2016 but

patient was admitted in hospital after 4days of Accident, Please provide an explanation.



Provide the Kisan bahi/Khatauni/BPL ration card/Income certificate of Miss Shila M/O Akash

ID proof of HOF


Copy of FIR/GD As per claim form HOF is grandmother of the

patient RITIKA Please provide the Kisan Bahi/Khatauni/BPL ration card/Income certificate of

Mr.Vipin F/O Ritika.Please provide the Bank Details of VIPIN.

Please provide the Blood Report.


Copy of FIR/GD Please provide the Kisan Bahi/Khatauni/BPL ration

card/Income certificate of TRIBHUAN.Please provide the Bank Details of TRIBHUAN.Required documents for claim processing not

provided/Copy of FIR/GD or SDM/ADM certificateProvide the Kisan bahi/Khatauni/BPL ration

card/Income certificate of Mr. Ambika singh H/O Sangeeta .

Provide the Dr. Prescription.


Kisan Bahi/Khatauni/BPL ration Card/Income certificate of HOF Miss Manorma Devi

IPD record with treatment detail Investigation Report

Required documents for claim processing not

provided/Copy of FIR/GD or SDM/ADM certificateProvide the Kisan bahi/Khatauni/BPL ration

card/Income certificate of Rakesh F/O Adarsh .Bank detail of Rakesh.

Ganeshpur, sekhui, mithaura, chauk

Required documents for claim processing not provided /Copy of FIR/GD or SDM/ADM certificate

X-Ray film with reportOriginal Implant Bill with sticker

Dr. Prescription

As per Prescreption Date of accident prior start date of Policy


X-Ray film with reportOriginal Implant Bill with sticker

Dr. Prescription

99MaharajganjVishva nath Vishva nath 9, sastrinagar, farenda 8564083164 ### 07-Feb-17


100MaharajganjAditya Kumar Ganga Prasad Vargadhi, Darhata sadar, 9450280422 ### 06-Apr-17


101MaharajganjJaiprakash Kashi 9oo5969453 ### 06-Apr-17


102MaharajganjRamesh Kismati devi Pipra, Farenda 7897628160 06-Apr-17


103MaharajganjPrabhansh Prabhansh Ganeshpur, sekhui 9936148871 ### 06-Apr-17


104MaharajganjSatish Sharma Rama Shankar 9838557195 ### 06-Apr-17


105MaharajganjMoti Prasad Ram Kamal 893396577913.12.2017 02-May-17


106MahrajganjAashik Chandrika 979508246017/09/2016 010-Jan-17 Cashles

Denied

107MahrajganjVipin Kammal Ahairauli, Maharaj ganj 887445386417/09/2016 010-Jan-17 Cashles

Denied

108MahrajganjAnil Daya Ram Dasharthpur Maharajganj 979250463823/09/2016 010-Jan-17 Cashles

Denied

109MahrajganjJiyna Banwari Mahuhna, Maharajganj 991923470423/09/2016 010-Jan-17 Cashles

Denied

110MahrajganjAbdullah Gufran Ahamad 817703375623/09/2016 010-Jan-17 Cashles

Denied

111MahrajganjRam Sewak Dasrath Govindpur , Mahrajganj 752302753625/09/2016 010-Jan-17 Cashles

Denied

112MahrajganjSubhash Ghaneshree Sinduria , Mahrajganj 9519922708 ### 013-Feb-17 Cashles

Denied

113MahrajganjVinod Sanichara 723507651826/09/2016 010-Jan-17 Cashles

Denied

114MahrajganjRisabh Pardesi 840096749128/09/2016 010-Jan-17 Cashles

Denied

115MahrajganjSubash Nar Singh 979452483329/09/2016 010-Jan-17 Cashles

Denied

Required documents for claim processing not provided/Provide the Kisan bahi/Khatauni/BPL

ration card/Income certificate of Mr. Shailesh F/O Aditya

Naksa- baksa, sekhui bazar , chauk


Kisan Bahi/Khatauni/BPL ration Card/Income certificate of HOF Mr. Sanjay

HOF ID proofAs per ID proof , pt. name is jai pratap but in IPD record everywhere mention is jai prakash ,kindly clear the correct name of the pt. with affidavit.

Required documents for claim processing not provided/Copy of FIR/GD or SDM/ADM certificateDate of accident, place of accident and mode of

accident was not mention on claim form.Provide the Kisan bahi/Khatauni/BPL ration

card/Income certificate of Ramesh .

Required documents for claim processing not provided/Copy of FIR/GD or SDM/ADM certificateAs per ID proof, pt. name is Prabhansh but in IPD

record everywhere mention is Paramhansh, kindly clear the correct name of the pt. with affidavit.

As per prescription patient was admitted in hospital on date 7-12-2016 but treatment start on date 13-

12-2016. Please clarify the reason for this.On X-ray film patient age was mention 90 years and

date is 06-12-2016 but on report patient age was mention 70 years and date is 07-12-2016. Please

clarify the reason for this.

Bazar Dihtola, Tenuhiya Post Lokvidyapith Nagar

Required documents for claim processing not provided /Kisan Bahi/Khatauni/BPL ration

Card/Income certificate of HOF Mr. Satish SharmaBank A/C detail of satish sharma

Dr. prescription Post-operative X-Ray

khanpur tola, Viraicha, Ghughuli

Patient not eligible under the scheme/HOF Age is above 70 Years.

vill. Sonari kahs, tahsil. Sadar , Dist. Maharaj gankj

Based on Invetigation/ Hospital Has Charged the amount from the patient/ Hospital Has not

Provided any documents and bill to beneficiary.







Dhanewa Dhanehi , Mahrajganj





Complete Hospitalisation Documents and eligibility document were not provided by Hospital hence Pre

Authorization and PA not given by TPA

Barwar,Paniyara, Maharajganj



Khajuria, Baratgarha, Mahrajganj

Based on Invetigation/ Hospital Has not Provided any documents and bill to beneficiary / Hospital has

not provide discharge summary document

Karmha, Bhaisari, Mahrajganj



116MahrajganjSudama Sudama 879523011729/09/2016 010-Jan-17 Cashles

Denied

117MahrajganjSalma Khatun Ruvab Ali 7393861433 ### 013-Feb-17 Cashles

Denied

118MahrajganjVijaya lakshmi Vijaya lakshmi 9198082359 ### 024-Jan-17 Cashles

Denied

119MahrajganjIsrawathi Devi Israwathi Devi 8090105356 024-Jan-17 Cashles

Denied

120MahrajganjNarvada Pandey Narvada Pandey Kamsin Khurd , Mahrajganj 912974950617/09/2016 27694 17-Nov-16 Cashless Paid

121MahrajganjSahid Sahid Pakri Maharjganj 900533938218/09/2016 25745 17-Nov-16 Cashless Paid

122MahrajganjSaddam Khusaru Pipra Sonari Mahrajganj 955466836821/09/2016 12155 17-Nov-16 Cashless Paid

123MahrajganjAyodhya Ayodhya Narayanpur , Mahrajganj 962155667625/09/2016 28600 2-Feb-17 Cashless Paid

124MahrajganjAbhay Baliraji Jahda, Mahrajganj 917040059225/09/2016 13907 17-Nov-16 Cashless Paid

125MahrajganjRamawati Devi Ramawati Devi 983891470225/09/2016 60305 17-Nov-16 Cashless Paid

126MahrajganjSaiyad Ali Saiyad Ali 738829567227/09/2016 34873 17-Nov-16 Cashless Paid

127MahrajganjRimjhim Param Hans Singh 991981149929/09/2016 13872 17-Nov-16 Cashless Paid

128MahrajganjKawalpati Radhey Shyam 965120496428/09/2016 12194 2-Feb-17 Cashless Paid

129MahrajganjBhaagwati Jugut 788056450528/09/2016 11694 2-Feb-17 Cashless Paid

130MahrajganjJahid Ali Jahid Ali 993571628029/09/2016 29385 17-Nov-16 Cashless Paid

131MahrajganjMunnar Munnar 9984217859 ### 58534 17-Nov-16 Cashless Paid

132MahrajganjRamsevak Ram Sewak Jamui 9621234790 ### 28600 2-Feb-17 Cashless Paid

Kathwalia, Singhpur , Mahrajganj



Lejar Mahadev, Leela inapar, Mahrajganj

Required Document for Claim Processing Not Received/ HOF is Grand father of Patient /Provide the Kisan Bahi, Income certificate with the name of

Ruvab Ali.Vill. Belawa Tikar, Nautanwa , Maharajganj UP 273302



W/O of Suraj Prasad, Maharajganj,Uttar Pradesh



Dharmauli, Sokari,Maharajganj

Mojari, Bhariya , Mahrajganj

Vishun pur, Gabrua, Mahrajganj

Murila Chaudhari, Mahrajganj

Rampurmir, Mithaura, Mahrajganj

Ganeshpur, Pachrukhia, Mahrajganj

Pipra, Munderi , Mahrajganj

Simrhna, Tilpur, Mahrajganj

133MahrajganjBikau Bikau 8601256685 ### 36252 17-Nov-16 Cashless Paid

134MahrajganjPadhohi Padhohi 9616861259 ### 13194 2-Feb-17 Cashless Paid

135MahrajganjSabina Motavi Baratpur, Mahrajganj 7317050829 ### 13452 17-Nov-16 Cashless Paid

136MahrajganjRamagya Birval 9918564321 ### 32037 17-Nov-16 Cashless Paid

137MahrajganjAayush Sunil Patel Darhta, Sadar, Mahrajganj 9721234903 ### 12850 17-Nov-16 Cashless Paid

138MahrajganjRamkishun Ramkishun Dhuthibari , Maharajganj 9723688723 ### 7700 16-Feb-17 Cashless Paid

139MahrajganjPramod Sharma Pramod Bhagwanpur, Mahrajganj 7068424018 ### 6600 16-Feb-17 Cashless Paid

140MahrajganjRambharos Vimlawato 8127185491 ### 16374 17-Nov-16 Cashless Paid

141MahrajganjUmesh Kumar Umesh Kumar 9125550640 ### 0 16-Nov-16Cashles Denied

142MaharajganjAdalat Adalat 8736865688 ### ReimburesementDenied GD with No.Not Received

143MaharajganjDropati Rikhai banspar baijauli 8739089467 ###14245 6/27/2017

ReimburesementPaid

144MaharajganjJaykesh AnirudDha 9565850085 ### 13245 5/16/2017

ReimburesementPaid

145MaharajganjMeera Subash 8423159945 ### 8745 5/16/2017

ReimburesementPaid

146MaharajgnajNitesh Usha Devi 8726371099 ###10745 5/10/2017

ReimburesementPaid

147MaharajgnajAli Husain Ali Husain Vill-Parsauni Tikar, 9794064510 ###8745 5/10/2017

ReimburesementPaid

148MaharajgnajSanjay Sanjay 8933981113/97###8745 6/12/2017

ReimburesementPaid

149MaharajgnajPradeep Suvash 7704959581 ###10745 5/10/2017

ReimburesementPaid

Bargadahi, Basant Nath, Mahrajganj

Ahirauli, Vishunpurdhar, Mahrajganj

Banaspur Bijauli, Mahrajganj

Darhata , Baragadahi, Basant Nath, Maharjganj

Jila udyog road, Shastri Nagar,Maharajganj - 273303, Uttar Pradesh PA Denied By Hospital / Patient Not Eligible Under

the Scheme

Pipra rasul pur, tola katkahiya, chehari

Vill & Post- Khalikgarh,Tola-Jinigihawa

Vill-Pipara Narayan,Post-Mujahana Bujurga

Vill-khalikgarh Araji Subain, post-Khalikgarh

Vill-Kewalapur,Post- Darahata

Vill-Piparaich,Pachrukhia,Post-Puraina Khandi

150MaharajgnajDeepak Yadav Jagdish 9118029457###10245 6/12/2017

ReimburesementPaid

151MaharajgnajKhdija Habbibur Rahman vill-ganshpur 760783750204.03.2017 8745 6/27/2017

ReimburesementPaid

152MaharajgnajHariSankar Hari Shnkar Vill-Khajuriya 900555087301.04.2017


153MaharajgnajRavindra Ravindra 972187374117.03.2017 10194 6/27/2017

ReimburesementPaid

154MaharajgnajBarsati Ramchandra 911893160913.05.2017


155MaharajgnajBechu Bechu 962835843327.04.2017


156MaharajgnajVishnu Rishikesh 9833197983 ### 13867 6/19/2017

Reimburesement Paid

157MaharajgnajDharmendra Aarti 916135112512194 6/27/2017

Reimburesement Paid

158MaharajgnajGovind Basanti 900590825813.03.20178745 6/27/2017

Reimburesement Paid

159MaharajgnajGulson Sukhdeo 9621512580 Reimburesement In Process

160MaharajgnajJagdish Jagdish 800929975405.04.2017 Reimburesement In Process

161MaharajgnajJagjeevan Jagjeevan 812708433408.04.2017 Reimburesement In Process

162MaharajgnajJadawati Jadawati 737639706018.04.2017 Reimburesement In Process

163MaharajgnajPrashant Ravi Maharajganj 983981763804.04.2017 Reimburesement In Process

164MaharajgnajRajaram Hira Karmaha tola 900508907823.04.2017 Reimburesement In Process

165MaharajgnajRidhhi Sanjay 979414062922.04.2017 Reimburesement In Process

166MaharajgnajAbhay Abhay 945000337424.04.2017 Reimburesement In Process

obari,chauck bazar, maharajganj-273303

Vill-Gopala, Post -nautanawa, MRJ

Vill & Post-Chowk Bazar MRJ

Vill-Piparihiya,Karan jaha, Post-Narayanpur MRJ

Vill- Darhata , Post- Darhata , Dist- Mahrajganj

Vill-Parsiya Bujurg,Post- Pokharbhinda, MRJ

12.03.2017

Vill-Parsa Gidahi, Post Shikarpur,MRJ

Vill-Karmahi, Post- Laxmipur Shivala, MRJ

04.04.2017

Vill-Belbhariya, Post- Karmahi,MRJ

Vill-Phatakdauna,Post-Nichlaul,MRJ

Vill-Sitalapur, post-Lediform, MRJ

Vill-Jogiya,Post-Ghughuli bujurg, MRJ

Vill & Post-Belwa Tikar, ghughuli, MRJ

167MaharajgnajPardeshi Pardeshi 708431911411.05.2017 Reimburesement In ProcessVill-Kishunpur,Post-Dagarupur,MRJ


District Name:-ShravastiJun-17

Sr. No Patient Name Name of Nominee Address Mobile No. Status of Claim Reason of Rejection

1 Maniram Maniram 9695344323

###

0

7-Mar-17


2 Shiv Narayan Shiv Narayan Pure adhra, Harihar pur 7408707849

###

0

7-Mar-17


3 dileep kumar malik ram 805269067117/3/2017

5/23/2017


4 NASEEM AHMAD SHJUVER AHAMAD 9519353611 ### Reimburesement Under Query

5 Raju Raju 9454611509 ###7245 6/19/2017

Reimburesement Paid

6 mohd arif asiya 9616263693 ### Reimburesement Under Query

7 zahida laddan 9621374743 ### Reimburesement Under Query

8 amirca 7408968640 ### Reimburesement Under Query

9 Surasata Devi Tirath ram Yadav 9918212420 ###

13245 5/16/2017

Reimburesement Paid

10 Amit Kumar Pathak Manohar Lal Pathak 7800365332 ###8694


11 ravi pathak ravi pathak 9125502509 ### Reimburesement In Process

12 Kayyum Kayyum khan 9415970172 ### Reimburesement In Process

13 brijesh kumar ram kishor 8052167745###


14 ram banaras ram banaras 8953454569 ### Reimburesement In Process

15Ram Gopal Ram Gopal 05252-234008 ###7245


16 ashok kumar ashok kumar 9721155072 ### Reimburesement In Process



Date of Payment/Date of Rejection

Cashless/Reimburesement

ramawapur, pariyara, ekauna, shrawasti

Required documents for claim processing not provided /Original payment receipt /Copy of

FIR/GD /X-ray report and blood report /Medicine bill, Final Bill and original implant bill /IPD record

with detail

Required documents for claim processing not provided/Copy of FIR/GD or SDM/ADM certificateDate of accident, place of accident and mode of

accident was not mention on claim form.Provide the Kisan bahi/Khatauni/BPL ration

card/Income certificate

vill-bhandepara ps-ikauna district-shravasti

Unable to Provide required documents for Claim Processing/ FIR/GD , Eligibility documement , IPD

Reocrds and Hospital Records not rececied

SADHI PURWA, PURE WALE, SHRAWASTI

Lal Bojha darvesh ganv, jamunaha, bhinga

h no 112 nai bazar uttari ps bhinga teh bhinga dist shravasti

rajapur rani bhinga shravastirajapur rani bhinga shravasti

Vill. Chai purwa, virpur khaurhaniya, , belha raghav, belha radha, ekauna, shrawasti-271845

401, Hadatt Nagar, Girant Ashik , Shravasti 271875

vill harnamar ps gilaula shravastivill kanibaujhi ps malhipurshravastivill bechua katkuiya bhinga shravasti

vill dakahi post katra ps ikauna shrawasti

Sahiyapur Kathara Mafi Shravastivill hitainagar chaugai shrawasti

17 noor mohd noor mohammed 983814912021/6/2017 Reimburesement In Process

18 vishvnath vishvnath gupta 993555754827/6/2017 Reimburesement In Process

19 nibbar nibbar 8858483545 ### Reimburesement In Process

20 saddam munsharef 9919563693 ### Reimburesement In Process

vill chakarbhandar ps ikaunavill chaubeyjot ps ikauna shrawastimangal bhatta ps bhinga

vill lahorkala bhagwanpur ps Malhipur


Insurance Company Name:- National Insurance Company Ltd. District Name:- SiddhrathnagarJun-17

Sr. No Patient Name Name of Nominee Address Mobile No. Cashless/Reimburesement Reason of Rejection

1SiddhrathnagarRamai Tirath 7379576373 10/9/2016 8-Mar-17 45200 10-Mar-17 Cashless

2SiddhrathnagarGudda Gudda 7800272814 12/28/2016 8-Mar-17 10194 10-Mar-17 Cashless

3Sidharth NagarRAJ KUMAR YADAV NISHA DEVI 9670306011 11/19/20161-May-17

01-May-17

Reimburesement

4Sidharth NagarAJAY PASHWAN GOVIND PASHWAN 7379277806 6-Apr-17 Reimburesement

5Sidharth NagarDHIRENDRA SUKHRAM SAHANI 9721841315 5-Apr-17 26-Apr-17

7245 6/12/2017

Reimburesement

6Sidharth NagarAAMAR VERMA KAPPUR VERMA 8795295904 16-Dec-17 26-Apr-17

5/23/2017

Reimburesement Deley Submission of Claim/ Claim Received after 4 month

7Sidharth NagarASHIF ALI BHADAU KURASHI 7379240213 23-Mar-17 Reimburesement

8Sidharth NagarAmit Kumar Anjeet Singh 9838787462 5-Apr-17 6-Apr-17 Reimburesement

9Sidharth NagarPoonam Chaudhary Rajesh kuamr 7565820521 6-Apr-17 Reimburesement

10Sidharth Nagarganpat ganpat `9565780977 14/10/2016 5-May-17 Reimburesement

11Sidharth NagarVijay kumar chaudhari Lal Bahadur 9794314922 20/04/2017 20-may-17

9000 6/12/2017

Reimburesement

District Name

Date of Accident




Rejection

Padria Parasa, Sidharthnagar

W/o of Ramsukh,bhavaniganj,Uttar Pradesh,272195

HARANAKHURI,BHANWAPUR,SIDDHARTNAGAR,(U.P.)


VILL-DANIYA SUR,PARSSHA,SOHARTGHAR,SIDDHARTNAGAR

VILL-SONBARSHA,PO-MADHUKARPUR,P.S.-BANSHI,SIDDHARTNAGAR

VILL-ITWA,ITWA,P.S.-ITWA,SIDDHARTNAGAR

VILL-ITWA,ITWA,P.S.-ITWA,SIDDHARTNAGAR

Vill- Bhagel singh, 1, chechraf khurd, Siddharth Nagar Kathela -272192

Vill- Patana, Kathela garvi, Siddharth Nagar Kathela, -272192

vill- khoriya post raghubeer singh District -sidharthnagar

babhani,Birdpur no. 8 Siddhartnagar, Birdpur

12Sidharth NagarAnita Devi Raghuveer 9161235625 8-May-17 22-May-16 Reimburesement

13Sidharth NagarKrishnawati Ram Achal 9792879426 17-May-17 Reimburesement

14Sidharth NagarMantosh Ram Sevak Gupta 9919485454 3/5/3017 5/26/2017 Reimburesement

15Sidharth Nagarniyaj ahamad meanudin 8874772475 27.5.2017 5/31/2017

Reimburesement

16Sidharth NagarSaurabh Gupta Ramsevak Gupta 9919485454 27/5/2017 8-Jun-17 Reimburesement

17Sidharth Nagaranil kumar ramdas 14.05.2017 12.06.2017

Reimburesement

18Sidharth NagarDASHARTHA DASHARTHA 9005809228 28.5.2017 14.6.2017

Reimburesement

19Sidharth NagarMr. Maniah Mrs. Manju Devi 9129445539 3/12/2017 6/19/20178745

Reimburesement

20Sidharth NagarMr. Ramakant Mrs. Ramnaresh 9554375532 31/05/2017 6/27/2017 Reimburesement

21Sidharth NagarKamla Wati Devi Krisna Chand NA 5/30/2017 6/28/2017

Reimburesement

22Sidharth Nagar Jeetman Jeetman 9695475158 16-Jun-17 7/3/2017 Reimburesement

23Sidharth Nagardharmendr subhai 9565841369 9.6.2017 28.06.2017

Reimburesement

Vill. Santora-sontori, Block -sohratgarh, siddharthnagar-272204

Vill. Mahadeva, Siddharth Nagar , Uday raj Ganj, 272204

Biskohar, Biskohar , Siddhrath Nagar U.P. 272192

vill-pachmohani post pachmohaniBiscohar bazar, siddharthnagar

vill-ujjaniya post-trilokpur sitharthnagar

W/O. RAJESHWARI BISKOHAR vill- Baherva post - uska bazar, Siddharth Nagar

vill- Kapiya mitra, post- Dhensanaankar, Disst- Sidd. Nagar

Vill- Jagargathia, Santora Sidhrath Nagar

S/O - Lalit 26, Gajrahwa, Sisawa Disst- Siddharthnagar

vill-rampur bhaiya post-pthara bazar si


Insurance Company Name:- National Insurance Company Ltd.Detail of Claims Under Samakwadi Kisan and Sarvhit Bima Yojana

District Name:- SultanpurJun-17

Sr. No Patient Name Name of Nominee Address Mobile No. Status Reason of Rejection

1 Chhottan Chhottan ###

10-Apr-17

0


2 Sagardin Sagardin ###

19-Apr-17

0


3 Sukhdei Ram dayal pal belhari, Sultanpur 9936034385 ### 17-Feb-17 8694 22-Feb-17 Reimburesement Paid

4 Jaiprakash Jaiprakash Basupur, sultanpur 7388668756 ### 17-Feb-17 8694 22-Feb-17 Reimburesement Paid

5 Ashish Jaishwal Sumitra devi 8573943788 ###

4-Apr-17

0

6-Apr-17


6 Vipin Mishra Vipin Mishra 9721693325 ### 15-Apr-17 Reimburesement Under Query

7 Ram Dulare Ram Dulare 8874713720 ### 8-Apr-17

5/23/2017


8 Shakuntla pal Ram Kumar Pal 9198817970 ### 5/25/2017 Reimburesement In Process

9 Shiv mohan Shiv mohan 7706969677 05.05.2017

5/30/2017


10 Vinod sharma Vinod sharma 7618925292 29.04.20175/30/2017


Date of Accident

Claim intimation

dateAmount of Paid

ClaimDate of

Payment/Date of Rejection

Cashless/Reimburesement

Dostpur, Sulthanpur

Required Document for Claim Processing Not Received/ 1. Kisan bahi/Khatauni/BPL ration card/Income certificate of Chottan/2. As per claim form date of accident is 22/12/2016 but

patient was admitted in the hospital after 7 days of accident. Please provide an explanation/5. X-ray film without name and date

S/o Of kushiyal, Kathgara Patti Sulthanpur, Uttar Pradesh- 228145 Complete Hospitalisation Documents and eligibility document were not provided by Hospital

hence Pre Authorization and PA not given by TPA

Mahilow ashapur, kanouli, sultanpur

Required documents for claim processing not provided/The claimant was presented his claim after 4 months of discharge date. Therefore the claim is not acceptable.

Mohammadabad Kadipur Sultanpur

Askhan, Ramganj, lambuha

1. Copy of FIR /GD no. or SDM/ADM certificate2. Discharge Paper,X-Ray Report & film (pre op & post op), Doctor prescription , ot notes &

order sheets with treatment detail.3. Original Implant bill with sticker if done.

Faizabad Road Kaudiyavan karebhar sultanpur

Hasanpur gabhariya nai basti anath ashram sultanpur

Imamganj hasanpur sultanpur

11 Ram jatan Ram jatan 9559686510 14.04.20175/31/2017


12 Foola devi Foola devi 7607409303 20.05.20175/31/2017


13

Kamlesh Kumari Rama Shankar 9695813552 21.05.201709.06.2017


14 Krishna kumar Krishna kumar 8922833823 10.10.201616.06.2017 Reimburesement In Process

15 Kushla devi Kushla devi 7236812420 17.05.201717.06.2017 Reimburesement In Process

16

Sher Bahaudur Sher Bahaudur 7068351561 ### 6/22/2017


17

Kamlesh Kumari Rama Shankar 9695813552 21.05.201709.06.2017


18Ravi Shankar Ram Rudra Kashyap 7408652423 13.03.201720.06.2017


19Mahendra Kumar Kamla Prasad 7348276877 11.06.201723.06.2017


20Saloni Indrawati 9889629232 08.05.201722.06.2017


21 Ram surat Ram surat 9628482170 04.06.201730. 06.2017 Reimburesement In Process

22Mo Jafar Mo Ishhak 7897768588 10.06.201728.06.2017


23

Shripal Shripal 8726507585 20.06.201701.07.2017


24

Chandrawati Chandrawati NA 22.06.201703.07.2017


Narayanpur (bisane)bhada sultanpur

meharam post paliya sultanpur 7607409303

Gaura Bauramau Baldirai SultanpurDhammaur(rasvada)sultanpur

Jaitapur dhammaur sultanpur

Vill-Buniyad singh Uchgaon Sultanpur U.P. 227805

Gaura Bauramau Baldirai Sultanpur

Vill & Post Baijapur Dist Sultanpur

Vill jaitapur Post Dhammaur Dist sultanpur

Vill jaitapur Post Dhammaur Dist sultanpurAgresar semari pursotampur

Vill & Post Judupur Dist Sultanpur

Vill & post Chandipur Dist Sultanpur

Vill & Post Chandapur Dist Sultanpur


Insurance Company Name:- National Insurance Company Ltd. District Name:-Gorakhpur

Jun-17

Sl.No. Mobile No Address Date of Accident Amount Paid Date of Payment

1 9129631506 Rafeek Nagar, Gochandi 30/10/16 NA NA Cashless

2 Laldhar 9621281045 Titanpar, Bhiti Rawat, 03/11/16 NA NA Cashless

3 9198578923 17/11/16 ### 16891 21/03/17 Cashless paid

4 Rajendra Rajendra 9838358110 03/12/16 16447 02/02/17 Cashless paid

5 8853987945 03/01/17 35413 02/02/17 Cashless paid

6 Tejai Tejai 8009440351 24/12/2016 15535 02/02/17 Cashless paid

7 Devmani 7388283692 10/02/2017 ### 18847 21/03/17 Cashless paid

8 7080293146 20/03/17 24878 26/04/17 Cashless Paid

9 7068202950 12/09/16 Reimbursement compliance awaited

10 Lalchandra Lalchandra 9792982096 06/11/16 Reimbursement compliance awaited

Name of Injured

Name of Beneficiary

Date of Claim intimation/Complete Documents Received

Death / Disablement/

Cashless/ Reimbursement

Status as on date (Paid/ rejected/ under process )

Meraj Ahmed

Abdul Gaffar

16/01/17

No Claim, No beneficiary proof & Hospital did not submit claim form/ cashless request form & medical discharge/bills before discharge of patient from hospital despite repeated mails

Shaktiman

27/03/17

No Claim, copy of FIR GD not submitted despite mails dated 29.12.16, 07.01.17, 14.01.17, 27.02.17 and last / final notice dated 16.03.17

Mumtaj Ahmed

Mumtaj Ahmed

Vill-Majhora, Sahjanwan, Gorakhpur

123, Dhuriapar, Pali, Gorakhpur

31/01/17Chootelal

SinghChootelal

SinghParshurampur bada tola, Parshurampur, Gorakhpur

20/01/17Vill- & Post- Bhabua,Ghoshauli,

Gorakhpur

31/01/17Rajendra

PrasadVill- & Post-Ganauri, Sahjanwa, Gorakhpur

Subhawati Devi

Subhawati Devi

Vill-Ramnagar, Post-Mahta, Sahjnwa

25/04/17Premlata

SinghRajkumar

SinghHatwa, Gagaha, Gorakhpur-273411

27/04/17Shoharat, Ujikhore, Sahajanwa,

Gorakhpur

11 Shreemati Shreemati 7068468376 04/03/17 Reimbursement compliance awaited

12 Dhannu Sravan 27/04/17 Cashless in process

13 Jhallu 7238862391 08/05/2017 ### Cashless in process

14 Tara Devi Tara Devi 9005739072 Vill & Po-Gorakhpur 10/05/2017 ###Cashless

Original documents awaited

Aligarh, Campierganj, Gorakhpur-273155

28/04/17Katahariya Jungle Rasoolpur,

no.2, Chauri Chaura, Gorakhpur

Shyam Gaud

Vill & Po- Mehadraw, Gorakhpur-273408


Jun-17 Insurance Company Name:- National Insurance Company Ltd. District Name:-DEORIA

Sl.No. Name of Injured Mobile No Address Date of Accident Amount Paid

1 Rama Devi Rama Devi 29/9/16 NA 29/11/16 Cashless

2 Vibha Ramashray 7398173873 03/10/16 NA 29/11/16 Cashless

3 Yashi Tiwari Raghvendra Tiwari 8948151864 07/10/16 NA 29/11/16 Cashless

4 Chandrama Yadav Chandrama Yadav 9129172249 Bhartoli, Rudrapur 18/10/16 11345 07/11/16 Cashless Paid

5 Om Namah Shivay Arti Devi 7897098697 Masjid Ward, Rudrapur 18/10/16 NA NA Cashless

6 Laxman Kushwaha Laxman Kushwaha 20/10/16 5406 07/11/16 Cashless paid

7 Nagendra Nagendra 7081141491 Gahila, Satraon, Barhaj 21/10/16 NA NA Cashless

8 Sanjay Nishad Gorakh Nishad 21/10/16 NA 29/11/16 Cashless

9 Upendra Upendra 9838390100 Chordha, Salempur 21/10/16 NA NA Cashless

10 Vimla Devi Vimla Devi 7849822930 Bakhari, Salempur 23/10/16 6883 18/11/16 Cashless paid

11 Munni Lal Munni Lal 9795688019 Jot Khajuha, Rudrapur 26/10/16 7356 18/11/16 Cashless paid

12 Guddu Sonkar Guddu Sonkar 8953179350 Nathe Sonkar, Rudrapur 28/10/16 8926 27/12/16 Cashless paid

13 Lalmati Ram Pravesh 7379456625 Batulahi, Rudrapur 28/10/16 9659 18/11/16 Cashless paid

14 Manju Devi Harendra Prajapati 9984631314 Sanjhwan, Deoria 29/10/16 NA NA Cashless

15 Dhanu Geeri Markandey Geeri 9721149775 Mahua Khurd, Baghara 31/10/16 6517 18/11/16 Cashless paid

Name of Beneficiary

Date of Payment




Case withdrawn by hospital

Gaura Barhaj, Tahsil-Barhaj (Deoria)

No Claim, As per documents submitted, accident is not proved, hence Hospital has withdrawn claim.3/325, Nath Nagar,

Deoria

No Claim, hospital discharged patient before submission of documents & not responded despite repeated mails.Raghav Nagar, Dubolli,

Deoria

No Claim, Hospital has not submitted complete documents for cashless as per deficiency details, moreover patient already discharged before cashless requestNo Claim, Claim rejected due to manipulation of documents

Near Shivraji Devi School, New Colony

No Claim due to non compliance of documents by hospital

Case withdrawn by hospital

Vill-Ramchak, Post-Rudrapur

No Claim, Patient not admitted, hence hospital has withdrawn claim.No Claim due to non compliance of documents by hospital

No Claim, due to cause and nature of accident could not be proved by hospital.

16 Ram Adhar Ram Adhar 8252867475 Konhaveliya, Deoria 19/10/16 17135 18/11/16 Cashless paid

17 Tantan Giri Dilip Giri 7270853973 Mahuwawa, Khurd 05/11/16 6359 18/11/16 Cashless paid

18 Vidya Sagar Mishra 956506605 05/11/16 7142 09/03/17 Cashless paid

19 Nandini Subedar Yadav 9628764251 05/11/16 19275 01/12/16 Cashless paid

20 Rajkumari Devi Rajkumari Devi 9044811109 09/11/16 6946 09/03/17 Cashless paid

21 Gaurav Mishra Umesh Mishra 9453485162 12/11/16 NA NA Cashless

22 Raghvendra Singh Raghvendra Singh 7839123918 12/11/16 7346 01/12/16 Cashless paid

23 Gunaraji Devi 9565853383 12/11/16 NA NA Cashless

24 Vibha Ramashray 7398173873 03/10/16 NA NA Cashless

25 Nandini Mishra Bechai Mishra 9984876811 15/11/16 15826 27/12/16 Cashless paid

26 Munna Yadav Munna Yadav 9554242797 Jiraso, Bhatni, Deoria 16/11/16 NA NA Cashless

27 7786863211 16/11/16 8600 01/03/17 Cashless paid

28 Awadhesh Prasad Awadhesh Prasad 7800861636 Sahopar, Uska, Deoria 18/11/16 9098 09/03/17 Cashless paid

29 Jyoti Prabhunath 8052423454 Chapala Jaidev, Bhatni, 17/11/16 7778 28/03/17 Cashless paid

30 Mahendra Singh Mahendra Singh 7268807165 22/11/16 NA NA Cashless

31 Vishnu kant Mishra Vishnu kant Mishra 8736910991 23/11/16 6614 09/03/17 Cashless paid

32 Dharmendra Yadav 8858673024 24/11/16 NA NA Cashless

33 Deena Nath Deena Nath 9670368809 Purana Chappar, Bhatni 26/11/16 8349 09/03/17 Cashless paid

34 Virendra 7041455095 , Purna Chhapar, Bhatni 28/11/16 11150 28/03/17 Cashless paid

35 Chandrakesh Yadav Vinod Yadav 9559281744 Post-Korva, Radrapur 27/11/16 14215 01/03/17 Cashless paid

36 Mahadev Prasad Mahadev Prasad 7052000904 28/11/16 NA NA Cashless

Ravish Kumar Mishra

Chapia, Jaidev Bhatani, SalempurBharauli, Tola Munder Bujurg, DeoriaMishraulia, batulahi, DeoriaChapia, Jaidev Bhatani, Salempur

No Claim, Filled as “No Claim due to non-complicance of documents despite repeated mailsMathura Chappar,

DeoriaRambharosa Chauhan

Gangi, Noonkhar,Deoria

No Claim, Hospital has withdrawn the case as HOF of patient is over aged (80 Years). File sent to IC for “No Claim” on 13-12-16.3/325, Nath Nagar,

DeoriaNo Claim, Claim rejected due to manipulation in date of accident

Bhaidava, Barhaj, Deoria

No Claim, due to tempering of documents by hospital

Madanmohan Upadhyay

Madanmohan Upadhyay

Shivala ward, Ward No.-5, Rudrapur

Vill-Mathura Chappar, Bhatpur Rani

No Claim due to no reply of clearification in respect of DOA and DOD despite mail dated 15.01.17, 04.02.17 and 27.02.17Purnachapar,

Salempur, Majholi, Bhatni

Ramkeshwawr Yadav

H.No.-70, Purna Chhapar, Bhatni

No Claim, NO proof of accident & discrepancy in x-ray film. Filed as “No Claim” 15.01.17 in absence of proof of accident.

Saurabh Kumar Mishra

171, Devkali Jayram, Madanpur

No Claim, filed as “No Claim” 15.01.17 in absence of proof of accident.

37 Nisha Dinesh Gupta 9506440820 Nakail, Rudrapur 26/11/16 9080 23/03/17 Cashless paid

38 Surendra Surendra Not provided 29/11/16 11471 28/03/17 Cashless paid

39 Rajaram Prasad Rajaram Prasad 9554589947 29/11/16 18200 27.12.16 Cashless paid

40 Ram Chandra Ram Chandra 9919861285 Purana Chappar, Bhatni 29/11/16 7570 09/03/17 Cashless paid

41 Sandeep Tiwari Pradeep Tiwari 9559242014 Piprahia, Deoria 03/12/16 NA NA Cashless

42 Rajesh Paswan Jaikaran Paswan 7388580262 Jogia Buzurg, Rudrapur 02/12/16 9315 23/03/17 Cashless paid

43 7379539925 04/12/16 NA NA Cashless

44 Manish Gond Rajkumar Gonde 9984618088 03/12/16 NA NA Cashless

45 Rajan Baijhnath 9170597820 05/12/16 4785 28/03/17 Cashless paid

46 Durgesh Gupta Ghanshyam Gupta 9918962231 05/12/16 5936 28/03/17 Cashless paid

47 Suresh Yadav Suresh Yadav 9721533884 05/12/16 5762 27.12.16 Cashless paid

48 Ram Shankar Ram Shankar 9565054240 23/11/16 26724 29/03/17 Cashless paid

49 Menika Singh Vijay Kumar Singh 9170765320 06/12/16 5744 13/02/17 Cashless paid

50 Tara Devi Shriprakash 7860612461 66, rudrapur, Fatehpur 05/12/16 8320 17/03/17 Cashless paid

51 Deepak Pal Satyram Pal 8953613091 Dala, Rupdrapur 07/12/16 NA NA Cashless

52 Mannu Prasad Mannu Prasad 9918771641 Bhaluani, Deoria 15/12/16 NA NA Cashless

53 Kishmati Sharma Shubash Sharma 7408176669 18/12/16 17697 13/02/17 Cashless paid

54 Harendra Rajbhar Harendra Rajbhar 7317355396 26/12/2016 7769 02/02/17 Cashless paid

55 Dulari Devi Kanta Pal 9125499638 Khukhundu,Deoria 26/12/2016 43874 13/02/17 Cashless paid

56 Sarasvati Akhilesh 8052077792 Parsiya Mishra, Deoria 08/01/17 7606 09/03/17 Cashless paid

57 Kadira Riyajudin 9984481459 12//01/17 15434 13/02/17 Cashless paid

Vill-Tedha Sthan, Ward-RudrapurBanacat Bahadurpur, Rampur Khas,

No Claim, original claim file along with copy of FIR GD & documents of family proof not received despite laps of more than 3 months.

Hridya Nand Mishra

Hridya Nand Mishra

Purana Chappar, Salempur, Deoria

No Claim (HOF is 78 years old- Over Age)

Badhapurwa, Dumwalia, Deoria

No Claim, copy of FIR GD not submitted despite mail dated 29.12.16, 07.01.17, 14.01.17, 27.02.17 and final notice dated 16.03.17Purana Chappar,

Majholi, Salempur87, Purana Chappar, BhatniBariyarpur Banaraha Dubey Tola, DeoriaBhainsa Mafi, Mehdawal, Sant Kabir NagarMathura Chappar, Deoria

No Claim, Claim withdrawn by hospital (OPD), filed as “No Claim”,No Claim, due to manipulation of documents

Bindahi, block- Pathardewa, DeoriaKaraundi, chaubariya palti, Bhatpar Rani Deoria

Harfoda, Rampur Mahuari, Deoria

58 9838384502 16/01/2017 9880 13/02/17 Cashless paid

59 Priyanshu Tripathi Ramashray Tripathi 9889411593 12/01/17 5038 13/02/17 Cashless paid

60 Majeed Alam Majeed Alam 7753833758 Inguri Sarai, Deoria 17/01/2017 7102 13/02/17 Cashless paid

61 Nabirasul Ansari Nabirasul Ansari 7459988659 Inguri Sarai, Deoria 17/01/2017 7260 13/02/17 Cashless paid

62 Nitil Manju 8127823016 20/01/2017 7454 01/03/17 Cashless paid

63 Satyam Anju 9919919660 Vill-Sakatui, Deoria 26/01/2017 5830 01/03/17 Cashless paid

64 Baijanath Baijanath 9935412318 29/01/2017 8566 13/02/17 Cashless paid

65 Aarti Devi Prabhunath Singh 8052037160 29/01/2017 6903 28/02/17 Cashless paid

66 Nirmala Devi Lakshmi Prasad 9838660906 07/02/17 10266 09/03/17 Cashless paid

67 Mahatam Gupta Mahatam Gupta 9451416410 20/12/16 19750 01/03/17 paid

68 Durgawati Devi Bhukhal Yadav 8052961546 ,04/02/2017 42078 09/03/17 Cashless paid

69 Brijesh Paswan Ram Hajoor 8756302947 23/01/17 6887 28/03/17 Cashless paid

70 Malati Devi Parshuram 9532294791 08/02/17 7008 21/03/17 Cashless paid

71 Peaveen Kumar Tap Narayan 8948036455 09/02/17 16408 09/03/17 Cashless paid

72 Laxmi Devi Umesh Parwar Not provided 15/02/2017 NA NA Cashless

73 Pushpa Ram Bharosha Not provided 17/02/17 8373 23/03/17 Cashless paid

74 Devanti Devi Devanti Devi 8382972432 13/02/2017 21880 28/03/17 Cashless paid

75 Faiz Khan Mukhtar 7071695749 24/02/17 5585 28/03/17 Cashless paid

76 Savitri devi Sheshnath Not provided 25/02/2017 7637 17/03/17 Cashless paid

77 Sumit Rajkapoor 7524973331 28/02/2017 Cashless Original Documents awaited

78 Manish Kumar Gauri Shankar 8795149764 Karmel, Deoria 05/03/17 8557 28/03/17 Cashless paid

Ram Prakash Prajapati

Ram Prakash Prajapati

217, Ramnath Deoria North, Ward No. 5, DeoriaNath Nagar, Bhatwalia, Deoria

64, Mishralauliya, Batlahi, Rudrapur, Deoria

Vill-Purana Chappar, Bhatani, DeoriaVill- & Post-Barari, Baitalpur, DeoriaVill-Mathura, Chappar, DeoriaBishunpura, Baitalpur, Deoria

Re-imbursement

Vill- & Post-Saraiya, Kausar, Pindi, DeoriaSrinagar, Kalhuan, Rudrapur, DeoriaVill-Mathura, Chappar, DeoriaVille- Telia Afgan, DeoriaRudrapur ward no. 4, Rudrapur, Deoria

No Claim, documents of beneficiary proof and copy of FIR/GD not submitted despite mail dated 09.03.17, and 25.03.17Vill & Post- Deenapur,

Rudrapur, DeoriaVill-Mahuava Khurd, Baghara, Deoria450, Madanpur, Rudrapur, DeoriaVill. Mahuwawa Khurd, Patherdewa, Bhatpar Rani, DeoriaDeenapaar, Rudrapur, Deoria

79 Anup Mishra Anil Mishra 9918470112 ,07/03/17 6373 28/03/17 Cashless paid

80 Lalmati Devi Ram Parvesh 19./03/17 11150 14/04/17 Cashless paid

81 Pradeep Kumar Pradeep Kumar 9565623416 26/03/17 5195 14/04/17 Cashless paid

82 Praduman Prajapati Shriram Prajapati 8127823016 29/03/17 5695 14/04/17 Cashless Paid

83 Manju Prajapati Manju Prajapati 8127823016 29/03/17 7188 02/05/17 Cashless Paid

84 Saif Ali Sirajuddin Ansari 7388216833 27/03/17 7235 02/05/17 Cashless Paid

85 Meena Devi Meena Devi 9565732945 31/03/17 9095 14/04/17 Cashless Paid

86 Hareram Prajapati Hareram Prajapati 9795582061 ,03/04/17 4849 14/04/17 Cashless Paid

87 Basanti Devi Basanti Devi ,03/04/17 6619 14/04/17 Cashless Paid

88 7379456625 ,08/04/17 8110 02/05/17 Cashless Paid

89 Pawan Rampal 14/04/17 Cashless in process

90 Matiya Devi Nepal 8934904023 16/04/17 Cashless in process

91 Ashraf Ansari Ashraf Ansari 8004471252 15/04/17 Cashless in process

92 Subhagi Devi Nandu Nishad 7394942868 18/04/17 Cashless in process

93 Piyush Reena Devi 8601989734 14/04/17 Cashless in process

94 Kalavati Devi Ravindra 7526015896 20/04/17 Cashless in process

95 Laxmi Bharti Ishwari Prasad 8564055886 21/04/17 Cashless in process

96 Gopal Ji 9839782855 16/04/17 Cashless in process

97 Anari Devi Chandrma 9616843255 25/04/17 Cashless in process

98 Ram Ishwar Yadav Ram Ishwar Yadav 7705868231 Uska, Deoria, U. P. - 274701 25/04/17 Cashless in process

99 Sheshnath Sheshnath 7880896060 24/04/17 Cashless in process

83, Purana Chappar, Purnac Chappar, Bhatni,Vill- Mishrolliya, Babhana, Deoria-27400145, Purana Chappar, SalempurKumbhar Tola, Misraullia, BatulahiKumbhar Tola, Misraullia, BatulahiBadhara, Pipar Patti, DeoriaMishraulia, batulahi, DeoriaC.C. Road, Ramnath, Deoria917, Ramnath North, Deoria

Premshankar Kushwaha

Rampravesh Kushwaha

Vill-Mishroliya, Babhana, Deoria178, Ward NO-5, Khand-3, Ramnath, Deoria

Harijan Basti rd, Terha Sthan Ward no. 1, Rrudrapur

33/5, C.C. Road, Ram Nath, Deoria-274001

133, Maheshpur, Baurdih, Rudrapur, Deoria-274204

Vill- Khora, Bara Dixit, Deoria-274603

Vill- Bhikhampur, Po-Khori, Deoria-274603

124, Laltoli ward, Rudrapur, Deoria-274204

Ishwar Chandra Sharma

Vill- Aghav, Bankata, Deoria-274704

77, Parsoni, Jiraso, Bhatni, Deoria-274701

80, tedha sthan, room no.7, Rudrapur, Deoria

100 Sushila Devi Narbda Tiwari 7572031102 24/04/17 Cashless in process

101 Anju Devi Pramod Singh 9839203793 23/04/17 Cashless in process

102 Vinay Kumar Sharma Budhisagar Sharma 8601459107 22/04/17 Cashless in process

103 Ajay Kumar Maurya Ram Prakash NA 27/04/17 Cashless in process

104 Shivam Singh Chandan Singh 7704984562 27/04/17 Cashless in process

105 Reena Ram Dulare 8576021580 ,01/05/17 Cashless in process

106 Kiran Ramprit Yadav 7080297578 ,03/05/17 Cashless in process

107 Amin Jamadar 8601229873 02/05/17 Cashless in process

108 Shiu Shiu 9125562393 30/04/17 Cashless in process

109 Mahendra Mahendra 7619852916 01/05/17 Cashless in process

110 Dulari Devi Shiv Maurya 9628024177 04/05/17 Cashless Original Documents awaited

111 Usha Devi Ram Ashish 9648642033 08/05/2017 CashlessOriginal Documents awaited

112 Reeta Devi Shyam Bihari 9616843255 09/05/2017 CashlessOriginal Documents awaited

113 Saloni Ram Ashish 9648642033 09/05/2017 CashlessOriginal Documents awaited

114 Sameer Khan Salamat 8354843050 15.05.2017 CashlessOriginal Documents awaited

115 Shahid Husain Sahjaha 7233029291 28/05/17 CashlessOriginal Documents awaited

116 R. N. Yadav Pannelal 9628795722 12/05/2017 CashlessOriginal Documents awaited

117 Vivek Yadav Vivek Yadav 9479283771 17/05/17 CashlessOriginal Documents awaited

118 Shivtahal Shivtahal NA 20/01/17 Reimbursement

119 Ashma Khatoon Ashma Khatoon 7505204744 21/05/17 Cashless

120 Tetari Devi Tetari Devi 8115552961 21/05/17 Cashless

Noonkhar, Deoria, Noonkhar, Uttar Pradesh

Narauli Sangram, Deoria-274501

124, Laltoli ward, Rudrapur, Deoria-274204

114, RampurBuzurg, Salempur, Deoria

Vill- Anwara Chauri, Betalpur, Deoria

Medanapur Urf Bilaspur, Mahiganj, Deoria

Akathia, Urf Matiyari, Rudrapur, DeoriaGram Jamunahi, Mednapur, Urf Bilaspur, Mahiganj, Deoria

27, Phulwaria Lachi, Deoria-274001

Vill Parsauni, Po-Bhatani, Deoria-

27, Phulwaria Lachi, Deoria-274001

Vill & Po- Garer, Deoria-274001

Vill-Tavakkalpur, Post-Belwa bazar, Deoria-274001

Vill- Sonbarsa, Bharhawa, Deoria

Vill & Po- Sallahpur, Salempur, DeoriaH. No. 205, Ingurishray-3, Bankata, Bhatpar rani, Deoria-274704

Initial amount approved, final bill discharged awaited

Vill- Lohraili, Pathardeva, Deoria


Vill & Post- Phoolwaria, Deoria-274182


121 Mukesh Rajbhar Parshuram Rajbhar 8948277380 27/05/17 Cashless

122 Aysha Khatoon Aysha Khatoon 7607534611 29/05/17 Cashless

123 Beuty Pandey Vindhyachal Pandey 8858564611 29/05/17 Cashless

124 Ajay Ranju Devi 9721271976 31/05/17 Cashless

125 Amalawati Devi Shailendra Singh 7379374380 26/05/17 Cashless

126 Ranju Devi Ranju Devi 9721271976 31/05/17 Cashless

127 Pramila Devi Ishwarchand 9628284236 04/06/2017 Cashless

128 Amrita Singh Ishwarchand 9628284236 04/06/2017 Cashless

129 Raunak Kushwaha 7618953448 01/06/2017 16800 03/07/17 Cashless Paid

130 Naseem Aara Naseem Aara 8127389166 25/05/17 Cashless

131 Beli Devi Beli Devi 9794519154 04/06/2017 Cashless

132 Sunil Sharma Sunil Sharma 9415363869 Rudrapur, Deoria-274204 01/06/2017 Cashless

133 Manoj Kumar Manoj Kumar 8933899174 09/06/2017 Cashless

134 Samim Ansari Jamadar 8601229873 04/06/2017 23228 03/07/17 Cashless Paid

135 Pramila Devi Ishwarchand 9628284236 04/06/2017 25305 03/07/17 Cashless Paid

136 Phoolkali Devi 9956367371 09/06/2017 Cashless

137 Anushka Yadav Ramashish 9648641033 09/06/2017 Cashless

138 Doma Prasad Doma Prasad 7068330222 16/06/17 Cashless

139 Panmati Devi Lalji 7800495090 15/06/17 Cashless

140 Jainath Gulab Chandra 9170762032 20/06/17 Cashless

141 Harindra Harindra 9792622715 15/06/17 Cashless

Vill & Post- Mangraich, Post- Baidauli Deoria


Vill- Tarkulaha, Bhaluani, Deoria


Phoolwariya pandey, Mirzapur, Deoria


Vill & Post- Ranighat, Pipara chandrabhan, Deoria


Vill & Post- Sonari, Deoria-274001


Vill & Post- Ranighat, Pipara chandrabhan, Deoria


Vill & Post – Nakail, Deoria – 274205




Rakesh Ramchandra Kushwaha

Vill & Post- Bahsua, Somogar, Barhaj, Deoria-

274205

Vill & Post- Nawalpur Urf Shampur, Deoria-274509



Initial amount approved, final bill discharged awaitedInitial amount approved, final bill discharged awaited

Khadesar, Meelanpur, Deoria-274205


Bhangari Bazar, Bhatparrani, Deoria-274702


Akshyavar Prasad Gupta

211, Machchhar hatta Rudrapur, Deoria-274204


Vill & Post – Phoolwaria lachi, Deoria – 274001


Narauli Sangram, Deoria-274501


Vill & Post – Gauri Bazar; Deoria – 274202


Vill & Post – Pndi; Deoria – 274508


Vill & Post – Birjapur, Jhantaur, Ghhangtour,

barhaj, Deoria – 274501Initial amount approved, final bill discharged awaited

142 Ram Pravesh Rm Pravesh Gautam 9648705250 Sonda, Bhatpur Rani, Deoria 23/06/17 Cashless

143 Shanti Devi Om Prakash 9721442201 21/06/17 Cashless


Vill Shankar nagar, postSalem pur Deoria



Jun-17Insurance Company Name:- National Insurance Company Ltd. District Name:-Kushinagar

Sl.No. Name of Injured Name of Beneficiary Mobile No Address Date of Accident Amount Paid Date of Payment

1 Guddi Devi Indrajeet 9648472107 Ahirwati, Tola Pindara 15/10/16 6449 07/11/16 Cashless Paid

2 Sunaina Devi Janki Kushwaha 967030167730/10/16

9476 18/11/16 Cashless paid

3 Atul Chandrika 8052143152 10/11/16 NA NA Cashless

4 Kanchan Singh Narendra Pratap Singh 8808207433 19/11/16 7606 23/03/17 Cashless paid

5 Raghubar Yadav Raghubar Yadav 9494183241 27/12/16 44381 09/03/17 Cashless paid

6 Tajrun Nisha Intaf Ali 9161134299 28/11/16 NA NA Cashless

7 Sudama Sudama 9415855232 14/11/16 25000 13/02/17 Cashless paid

8 Fekani Devi Mudrika 7272873166 18/12/16 18675 28/02/17 Cashless paid

9 Khilendra Khilendra Not provided 28.10.2016 NA NA Cashless

10 Rafeek Ali Rafeek Ali Not provided 21.11.2016 NA NA Cashless

11 Harendra Harikesh Not provided Laukaria, Kushinagar 10.12.2016 24806 28/02/17 Cashless paid

12 Sakuntala Devi 9120408676 28/01/17 28104 01/03/17 Cashless paid

13 Mahesh Kumar Ram Bahadur 9889645098 ,08/02/17 15409 21/03/17 Cashless paid

14 Kaushki Satyam 8127984790 12/01/17 24815 09/03/17 Cashless paid

15 Manjesh Kumar Tiwari 9936070525 ,10/04/17 8976 02/05/17 Cashless paid

16 Sanjay Sanjay 8869906019 ,08/04/17 Cashless

17 Kusum Kusum ,07/04/17 Cashless

18 Bandhu Gupta Bandhu Gupta 9956519199 Mishauli, Kushinagar 13/12/16 Reimbursement compliance awaited




Gambheeriya Khurd, Padrauna

Dogra Tola,Tima Sahun,Kushinagar

No Claim, due to over writing/cutting in original documents which could not be justified by hospital.Vill- & Post-Dandopur,

Padrauna, Kushinagar229, Sirasiya, Tehsil-

Hata, KushinagarBadhara, Bodawar,

KushinagarNo Claim, because HOF is above 70 years (Over Age)

Madanpur, Sukrauli, Padrauna

292, Madar, Vindwaliya, Laxmiganj, Padrauna

885K, Bulahwa, Chitauni, Kushinagar

Awaiting compliance of documents from hospital.

Amawa Dube, Shripata Khad, Kasya, Kushinagar

Awaiting compliance of documents from hospital.

Chandan Chauhan

Baulia, Captainganj, Hata

Babhani, Sagath, Dudhara

Tola-Thuthi, Bharsar Khas, Kushinagar

Manjesh Kumar Tiwari

Vill-Rakba Dulma Pattii, Bhagwanpur, Sewrahi

1092, Mainpur, Kasya, Kushinagar

Original Documents awaited

55, Dhanaha, Fajilnagar, Kushinagar

Original Documents awaited

19 Mantu Sharma Mantu Sharma 7800428819 Reimbursement compliance awaited

20 Manoj Bharti Manoj Bharti 7379048613 10/03/17 Reimbursement compliance awaited

21 Anirudh Anirudh 8052647136 20/01/17 Reimbursement compliance awaited

22 Vijay Bahadur Vijay Bahadur 8400637945 12/09/16 Reimbursement compliance awaited

23 Arun Jitendra Not Provided 01/08/17 Reimbursement compliance awaited

24 Jitendra Jitendra Not Provided 01/08/17 Reimbursement compliance awaited

25 Sanjay Kumar Ram Parvesh Not Provided 01/08/17 Reimbursement compliance awaited

26 Suraj Kumar Verma Santosh Varma 7570040058 Nebua, Rayganj, Kushinagar 01/08/17 Reimbursement compliance awaited

27 Ramesh Verma Ramesh Verma NA Nebua, Rayganj, Kushinagar 01/08/17 Reimbursement compliance awaited

28 Mantu Sharma Mantu Sharma 7800428819 13/03/17 Reimbursement compliance awaited

29 Hema Chaurasia Bechai Chaurasia 8127010810 29/01/17 Reimbursement compliance awaited

30 Virendra Pal Virendra Pal 8009617900 22/02/17 Reimbursement compliance awaited

31 Byash Patel Byash Patel 9792483134 10/02/17 Reimbursement compliance awaited

32 Sudhan Singh Jitendra Singh 7704801088 03/04/17 Reimbursement compliance awaited

33 Amit Singh Radheshyam 9918853744 15/02/17 Reimbursement compliance awaited

34 Hema Chaurasiya Bechai Chaurasiya 8127010810 NA Reimbursementin Process

35 Bindu Devi Sriram 7390965927 25/03/17 Reimbursementin Process

36 Chanchal Prasad Chanchal Prasad 9721921620 NA Reimbursementin Process

37 Harihar Giri Harihar Giri 7571969020 17/04/17 Reimbursementin Process

38 Durjan Yadav Durjan Yadav 7379512937 NA Reimbursementin Process

39 Raj Kishore Raj Kishore 7234088664 16/04/17 Reimbursementin Process

40 Dhannu Vishwanath Gupta 7388385858 25/02/17 Reimbursement compliance awaited

65, Sanermal, Chapra, Kushinagar

Shivmurat Bharti, Sanremal, Chapra, Parsauni, Kushinagar

55, Nandlal Chappra, Vishnupura, Kushinagar

Vill & Po- Akatahiya, Khottha, Turkdiha, Kushinagar-274149

Vill-Nebua, Po-Rayganj, Kusinagar



65, Sanermal, Chapra, Kushinagar

Keshaw Chappra, Makhanaha, Khairi,

KushinagarVill & Po- shuliya, Turkdiha,

KushinagarVill- Basgaon, Ghurpatti, Po-

Dudahi, Vishunpura, Kushinagar-274302

Mahuawa bujurg, Purandpur, Kushinagar-274402

Gopalpur Biraich, Hata, Kushinagar-274203

Vill & Po-Makhanaha, Keshav patti, Khairtti, Kushinagar-

274802Vill- Lamuha, Po-Dewariya

Pandey, Padrauna, Kushinagar-274304

Vill – Badhara Bujurg, Dudahi, Kushinagar-274302

Vill – Badhara Bujurg, Dudahi, Kushinagar-274302

Vill-Jokawa Khurd, Po-Sohang, KushinagarDhanha, Karmaini, Premwalia, Kasya,

Kushinagar-274402bandhu Chapra, Kohargaddi,

Kushinagar-274802

41 Dhananjay Kumar Dhananjay Kumar 9792294231 22/02/17 Reimbursement compliance awaitedVill- Sekhpurwa, Bodarwar, Hata, Kushinagar-274149

42 Puspa Devi Sugreev 8953925051 14/05/17 Reimbursement compliance awaitedMansoorganj, Meghadabar, Kushinagar-274149


Jun-17Insurance Company Name:- National Insurance Company Ltd. District Name:-Ballia

Sl.No. Name of Injured Mobile No Address Date of Accident Amount Paid Date of Payment

1 Manish Kumar Mahendra Prasad 8417892551 236, Bijlipur, Kajipur, Balia 28/11/16 ### 15291 02/02/17 Cashless paid

2 Gudiya Devi Ram Pravesh Not provided Madanpur, Sukrauli, Padrauna 04/12/16 NA NA Re-imbursement

3 Girija Devi Ram ji Yadav 9793451444 Vajirapur, Diyar Balia 17/12/2016 ### 14718 14/04/17 Re-imbursement paid

4 Ram Vachan Ram 01/02/2017 27402 26/04/17 Reimbursement paid

5 Ashok Kumar yadav Ashok Kumar Yadav 8739627081 20/12/16 Cashless Original Documents awaited

6 Deepak Kr Shukla Deepak Kr Shukla 9919652971 111, Vishunpura, Karnai, Balia 20/01/17 Reimbursement compliance awaited

7 9918279832 Vill- Nasirabad, Sagarpali, Balia ,07/11/2016 Reimbursement compliance awaited

8 Kusum Devi Kusum Devi 9721078750 ,01/03/17 Reimbursement compliance awaited

9 Rajkumar Rajkumar 8808308048 14/04/17 Reimbursement compliance awaited

10 Bachhi Devi Bachhi Devi 9670499668 08/05/17 Reimbursement compliance awaited

11 Vinay Kumar Vinay Kumar 9452107792 01/11/16 Reimbursement compliance awaited

12 Tadak Nath Tadak Nath 7309416052 Amao, PS Narhi, Distt Ballia 30/03/2017 Re-imbursement compliance awaited

13 Prabhakar Prabhakar Prasad 8858608674 Kusaura, Bansdeeh, Distt Balia 29/04/17 Re-imbursement compliance awaited

Name of Beneficiary


Death / Disablement/ Cashless/ Reimbursement

Status as on date (Paid/

rejected/ under process )

22/02/17

No Claim, HOF is 72 years old (Over Age)

Ram Vachan Ram

34, Rampur Udaybhan ward no. 1, Balia

26/04/17

Shivpur, New Basti, Shivpur Mumberi, Balia-277401

Laxmi Narayan Kharwar

Laxmi Narayan Kharwar

Jagdishpur, Suryapura, Balia – 277301

Vill- Sanwara, Khalilpur, Chilkahar, Balia-221701

Vill & Po- Sidri, Ibrahimpur, Balia

Vill & Po- Bariyarpur, Kheosar, Balia-277219


Jun-17Insurance Company Name:- National Insurance Company Ltd. District Name:-Mau

Sl.No. Name of Injured Mobile No Address Date of Accident

1 Mangal Chauhan Mangal Chauhan 8423571304 Tahsil-Maunath Bhanjan, Mau 01/10/16 04/11/2016 NA 29/11/16 Cashless

2 Shanti Devi Shanti Devi 7309123797 Ahmedpur Asna, Mau 04/10/16 04/11/2016 NA 29/11/16 Cashless

3 Sunil Kumar Sunil Kumar 7052325675 05/10/16 04/11/2016 NA 29/11/16 Cashless

4 Vishal Kumar Suneshwari Devi Khyaigarh, lauda, Chandauli 02/11/16 22/02/17 Re-imbursement claim rejected, HOF is 77 years old (Over Age)

5 Kedar Ram Kedar Ram Bhopora, Mau 20/04/17 Reimbursement compliance awaited

6 Rajeev Kumar Rajeev Kumar 9118153183 23/04/17 Cashless Original Documents awaited

7 Bajrangi Bajrani Not Provided ,10/03/16 Reimbursement compliance awaited

8 Gayatri Devi 9450542627 28/03/16 Reimbursement compliance awaited

9 Rahul Maurya Manju Devi 9795559130 26/111/16 Reimbursement compliance awaited

10 Radhika Devi Shyam lal 9795245251 Vill & Po- Gahana, Mau – 221705 24/09/16 Reimbursement compliance awaited

11 Ganesh Prasad Ganesh Prasad 9795274339 27/03/17 24418 03/07/17 Re-imbursement

12 Saurabh Kumar Swatantra Ram 8543825028 02/06/17 Re-imbursement compliance awaited

Name of Beneficiary


Amount Paid

Date of Payment




claim rejected due to non compliance of any documents by hospital despite repeated remindersclaim rejected due to non compliance of any documents by hospital despite repeated reminders

Katai Chavar, Badgaon, Tahsil- Ghosi, Mau

claim rejected due to non compliance of any documents by hospital despite repeated reminders

42 A, Bardi Hauf, Haleemabad, Bardeeha, Mohammadabad,

Gohana, MauVill & Po- Dhekawara, Bhdsa

Manwpur, Kopaganj, MauAshwani Kumar

YadavVill & Po- Meudi Kala, Ratanpura,

MauVill & Po- Raghauli, Maurbojh,

Mau

Vill & Po- Chhichor, Karaudi, Mau-221706

Vill- & Post – Kamalpur, Kolaura, Mau-276403


Jun-17Insurance Company Name:- National Insurance Company Ltd. District Name:-Sant kabir Nagar

Sl.No. Name of Injured Mobile No Address Date of Accident

1 Pradeep Kumar Ram Subhag 7754879302 Takiya, Kativa 28/10/16 17384 21/03/17 Cashless paid

2 Sanju Maurya Chotelal 7897767392 147, Vill-Katya, Haisar Bazar, 29/10/16 18491 21/03/17 Cashless paid

3 Manoj Kumar Haripat 8948928396 Khamharia, Sant Kabir Nagar 07/11/16 12734 02/02/17 Cashless paid

4 Priyanka Indrawati Devi 8874230023 Manpur, Hathnagar 10/11/16 NA NA Cashless

5 Surendra Kumar Ram Nayan 8874542230 382, Sonhan, Pauli, Sant kabir Nagar 17/11/16 16691 21/03/17 Cashless paid

6 Shiva Ajay Kumar 9792589110 20/11/16 16355 21/03/17 Cashless paid

7 Meena Devi Meena Devi 9918644230 Tahsil-Panpata, Sant Kabir Nagar 09/11/16 NA NA Cashless

8 Neeraj Ram Milan 7800887718 Post-Meerganj, Atraulia, Khalilabad 21/11/16 NA NA Cashless

9 Abhishek Jitendra Kumar 9044757291 Bhatpar, Khalilabad 15/11/16 NA NA Cashless

10 Ram Suresh Ram Suresh 7080110239 431-H, J.J. colony, Ghangata 12/11/16 13573 21/03/17 Cashless paid

11 Mativar Mativar 8127402014 208, Badgo, Khalilabad 24/11/16 NA NA Cashless

12 Anita Dharmdev 9833968295 Prajapati pur Sant Kabir Nagar 01/12/16 15120 29/03/17 Cashless paid

13 Alimun Nisha Bauchari 8948432878 Post-Baniyabari, Khalilabad 25/11/16 NA NA Cashless No Claim, HOF is over age

14 Kumari Devi Ram Swarth 9956440610 Ghatramha, Khalilabad 28/11/16 18664 21/03/17 Cashless paid

15 Dinesh Dinesh 9648087129 Baghua, Kopia, Baghauli, 21/11/16 19965 21/03/17 Cashless paid

16 Shani Kumar Dukhi Ram 9839381243 Khalilabad Dehat, Khalilabad 01/12/16 14042 21/03/17 Cashless paid

17 Mohd. Naseem Abdul Kala 9792426906 Gangwali, Baghauli, Khalilabad 29/11/16 11411 02/02/17 Cashless paid

Name of Beneficiary

Amount Paid

Date of Payment





No Claim, beneficiary proof, copy of FIR GD not submitted despite mail dated 29.12.16, 07.01.17, 14.01.17, 27.02.17 and final notice dated 16.00317

Vill-Sourha, Post-Rajediha, Sant Kabir Nagar No Claim, claim rejected

due to non compliance of any documents by hospital despite repeated reminders

No Claim, copy of FIR GD not submitted despite mail dated 14.01.17, 06.02.17, 24.02.17, and final notice dated 16.03.17

No Claim, due to discrepancy in date of accident as per intimation to police and other medical documents and X-ray film. (manupulation in date of accident)No Claim, HOF is above 71 years as per Adhar Card (Age Barred)

18 Satyam Vishambhar 9005560588 08/12/16 10743 21/03/17 Cashless paid

19 Virendra Virendra 9794683108 Anantpur, Sahjanwa,Gorakhpur 02/12/16 15670 29/03/17 Cashless paid

20 Dheeraj Kumar Baijnath 9361930337299, Bayara, Khalilabad

30/11/16 21238 21/03/17 Cashless paid

21 Prabhawati Devi Prahlad 84602260164 12/12/16 17115 21/03/17 Cashless paid

22 Madan Lal Shiv Prasad 7408610171 14/12/16 17014 02/02/17 Cashless paid

23 Shiv Govind Shiv Govind 7071777491 20/12/16 22943 02/02/17 Cashless paid

24 Chaitu Chaitu 9161277849 22/12/16 25538 29/03/17 Cashless paid

25 Riya urf Anshu Narhari 9794470220 16/12/16 16685 01/03/17 Cashless paid

26 Sharvan Pandey Sharvan Pandey 9565523989 22/12/16 12788 02/02/17 Cashless paid

27 Geeta Devi Vinod Bharti 9984510791 Khalilabad, Sant Kabir Nagar 21/12/16 12741 02/02/17 Cashless paid

28 Lal ji Lal ji 9838005484 Siktaha, Belrai, Sant Kabir Nagar 27/12/16 16662 02/02/17 Cashless paid

29 Mohd. Idreesh Mohd. Idreesh 9918418631 24/12/2016 12349 02/02/17 Cashless paid

30 Shakuntala Devi Dharmraj 9919419633 31/12/2016 10402 02/02/17 Cashless paid

31 Smt. Genda Devi Smt. Genda Devi 8756736443 10/12/16 19605 21/03/17 Cashless paid

32 Nizamuddin Nizamuddin 8808489744 26/12/2016 13500 21/03/17 Cashless paid

33 Jitendra Taulan Prasad 8175093603 11/01/17 18445 21/03/17 Cashless paid

34 Kamrun Nisha Kamrun Nisha 9984012301 Nihalpur, Manpur, Mahuli 18/01/17 22157 21/03/17 Cashless paid

35 Sabreen Valimuhmmad 8400063160 17/01/2017 17209 09/03/17 Cashless paid

36 Ram Sagar Ram Sagar 8400063160 09/01/17 13115 21/03/17 Cashless paid

37 Jagdish Jagdish 8858495164 10/01/17 21952 21/03/17 Cashless paid

38 Kamruddin Kamruddin 9971647063 27/01/2017 19199 21/03/17 Cashless paid

88, Sirmohani, Raura pur, Khalilabad

Banda bazar, Dhanghata, Sant Kabir NagarBadkela, Khalilabad, Sant Kabir NagarRam Samujh Mangal bazar, Sant Kabir NGRDhaurhara, Govindganj, Sant Kabir NagarBanparva, Haisar Bazar, Sant Kabir NagarRaurapar, Sirmohni, Khalilabad, Sant Kabir Nagar

Sihorawa, Badhauli, Sant Kabir nagarVill- & Post- Atraulia Urf Mathiya, Sant Kabir NagarVill- & Post- Ghanghata, Sant Kabir NagarVill- & Post- Sarhi,Khalilabad, Sant Kabir NagarVill- & Post- Mangera,Khalilabad, Sant Kabir Nagar

Vill- & Post- Taryapaah, Sant Kabir NagarVill- & Post- Echakat, Chakdahi,Khalilabad, Sant Kabir NagarVill- & Post- Digha,Khalilabad, Sant Kabir NagarVill- & Post- Koailbhar,Agiavana, Sant Kabir Nagar

39 Hari Lal Hari Lal 9628718536 14/02/2017 29989 21/03/17 Cashless paid

40 Phoolmati Devi Fekoo 9005584479 ,11/01/17 30364 21/03/17 Cashless paid

41 Ishrawati Devi Basant Singh 9794706935 ,04/02/17 25432 21/03/17 Cashless paid

42 Ram Karan 7897448995 19.11.2016 NA NA Re-imbursement

43 Ankit Kumar Chandra Prakash 9506361023 ,11/02/17 9921 21/03/17 Cashless paid

44 Phoolkali Phoolkali 9005159717 ,11/02/17 NA NA Cashless

45 Anari Anari 9889879750 23/02/2017 NA NA Cashless

46 Kalawati Devi Ram Murat 9918724260 Vill & Post-Rajaur, Sant Kabir Nagar 27/02/2017 21166 29/03/17 Cashless paid

47 Kulsum Bano Vaish Mohd. 9792922677 17/02/2017 11703 29/03/17 Cashless paid

48 Shiwang Seth Prasad 91982399698 ,07/03/17 12230 29/03/17 Cashless paid

49 Motilal Motilal 9919032344 Vill-Pipri, Bardadu, Tehsil Mehdawal ,02/03/17 13504 29/03/17 Cashless paid

50 Sandeep Sandeep 9838343960 Vill-Pipri, Bardadu, Tehsil Mehdawal ,05/03/17 17222 29/03/17 Cashless paid

51 Pinku Ram Jawahir 7408678861 13/03/2017 9607 02/05/17 Cashless paid

52 Dileep Dileep 9792122037 20/03/17 11265 26/04/17 Cashless paid

53 Rojna Khatoon Mohd. Saeed 7232948224 Kolbhar, Block-Santaha 26/03/17 20793 26/04/17 Cashless paid

54 Munshi Munshi 9984542520 Rewta, Ghanghata, ,12/03/2017 10763 26/04/17 Cashless Paid

55 Kawalpati Devi Gyan Das 7784047360 Inayatpur, Sant Kabir Nagar-272170 ,06/04/2017 13951 02/05/17 Cashless Paid

56 Malti Devi Jaglal 9559807320 ,11/04/17 14932 02/05/17 Cashless Paid

57 Mohd. Sayeed Mohd. Hasan 8976117367 ,09/04/17 16098 02/05/17 Cashless Paid

58 Mevalal Mevalal 7379203208 santkabirnagar ,08/04/17 15105 02/05/17 Cashless Paid

59 9984953156 19/04/17 18797 02/05/17 Cashless Paid

Vill- & Post- Joori, Khalilabad, Sant Kabir NagarVill- & Post-Jamuni khurd, Dewapar Ghanghata, Sant Kabir NagarVill- & Post Atraula, Sant Kabir Nagar

Ravi Shankar (Sudhakar)

Vill- & PostKurthiya, Sant Kabir Nagar

Compliance awaited from patient

71, Gaighat, gopalganj, Sant Kabir NagarVill & Post- Kolhugada, Ghaipokhar, Ghanghata, Sant Kabir Nagar

No Claim, HOF is Over Age (77 Years)

Vill & Post- Atraula, Gaura Paar, Sant Kabir Nagar

No Claim, HOF is 76 years as per family register.

Vill & Post-Panchpokhari, Khalilabad, Sant Kabir NagarVill & Post-Molanapur, Ghanghata, Sant Kabir Nagar

Vill-Katya, Post- Takiya, Sant Kabir NagarVill-Berampur, Post-Umri Kala, Khalilabad

Chandhar, Kakrahi, Sant Kabir Nagar-272164Lakhnokhar, Devkali Kalan, Ali Nagar

Santosh Vishavkarma

Smt. Ilayachi Devi

Vill & Post - Kushara, Bakhira, Sant Kabir nagar

60 Smt. Chanvahi Smt. Chanvahi 7317535636 ,11/04/2017 24341 02/05/17 Cashless Paid

61 Baijantimala Fagulal 9936668556 15/04/17 19007 02/05/17 Cashless Paid

62 Sumit Lalchand 9628337528 ,01/04/2017 13530 02/05/17 Cashless Paid

63 Aditya Shukla Sangam Shukla 7379333585 26/04/17 Cashless

64 Ram Agrahari Geeta 9198238457 18/04/17 Cashless

65 Elaichi Devi Elaichi Devi 9919234244 Vill-Patkholi, Po-Badhgo, Khalilabad, 18/05/17 Cashless

66 Sitaram Sitaram 9918331742 14/05/17 Cashless

67 Amrita Devi Amrita Devi 8795503112 18/05/17 Cashless

68 Sumiitra 9721244564 15/05/17 Cashless

69 Nurul Hak Nurul Hak 9918284596 21/05/17 Cashless

70 Ram Vilas Ram Vilas 9839404316 Patkholi, Sant Kabir Nagar-272175 25/05/17 Cashless Compliance awaited

71 Atik Ahmed Abdool Latif 9936797511 06/06/2017 16139 03/07/17 Cashless Paid

72 Meena Devi Meena Devi 9918644230 09/11/2016Re-imbursement

73 Digvijai Nath Digvijai Nath 9919570556 21/04/17Re-imbursement

Vill & Post - Dadwa, Ghanghata, Sant Kabir nagarVill & Post - Girdharpur, Sant Kabir nagar-272173Vill & Post - Babhani, Sangar, Sant Kabir nagar-272125Vill & Post - Sukrauli, Pidiya Bazar,

Balhara, Sant Kabir nagarInitial amount approved, final bill discharged awaitedInitial amount approved, final bill discharged awaitedInitial amount approved, final bill discharged awaited

Nainaghala, Bhagarta, Santkabeer Nagar.


Vill- Mainadad, Saugath, Sant Kabir Nagar-272125


Lal ji Rudal Kanojiya

Vill & Post- Belhar, Sant Kabir Nagar-272270


Vill & Post- Girdharpur, Sant Kabir Nagar-272173


Chandidiha, Sugapankhi, sant Kabir Nagar-272175

Vill-Balghat Post -Pauli Disstt- Sant Kabir Nagar


Amargarh, Kotiya urf Sekhuee, PS Bakhira, Santkabirnagar


Praroop No. 11 Detail of Claims Under Mukhyamantri Kisan and Sarvhit Bima Yojana

Insurance Company Name:- National Insurance Company Ltd. District Name:-Varanasi June 2017

Sl.No. Name of Beneficiary Mobile No Address Amount Paid Date of Payment

1 Sheetla prasad Ramapati 9838958412 Varanasi 09/20/16 ###0 Reimbursement Repudiated

2 Birbal prasad pal Dulu pal 9307424275 Varanasi 10/13/16 ###26694 31.01.2017 Cashless Paid

3 Reshma Kumari Biraju ram bind 9198069679 Varanasi 10/14/16 ###0 07/12/16 Cashless Repudiated

4 Rajesh Kumar Kishore lal 8423807944 Varanasi 10/16/16 ###0 07/12/16 Cashless Repudiated

5 Bachau Ram GuptaLate Sarju Gupta 9455934000 Varanasi 10/18/16 ###39686 26.12.2016 Cashless Paid

6 Shyama Devi Tegari 8601924329 Varanasi 10/21/16 ###51305 26.12.2016 Cashless Paid

7 Ramwati Ramwati 8354840496 Saray Mohna 10/27/16 ###0 07.12.2016 Cashless Rejected

8 Ishravati Shivdhani 8382000654 Bachchhaon,Varansi 10/30/16 ###0 27/2/17 Cashless Repudiated

9 Ratan Kanaujiya Savita 8417811060 Bachchauv,Varanasi 11/02/16 ###13019 26.12.2016 Cashless Paid

10 Nachana Shiv nath 7379187609 Bachchauv 10/28/16 ###0 23/1/17 Cashless Repudiated

11 DayaShankar DayaShankar 7860924893 Kandhiya, Amava Khurd 11/09/16 ###0 23/1/17 Cashless Repudiated

12 Sunita Marachi devi 8604685349 Jarkhor kala 11/10/16 ###16422 30.01.2017 Cashless Paid

13 Ranjeet Jiut 9169912627 Chaitauni,Varanasi 10/31/16 ###46696 06.03.2017 Cashless Paid

14 Sushila Jay Prakash 9807202013 Bhikhipur,mirjamurad,varanasi 11/18/16 ###33025 06.03.2017 Cashless Paid

15 Mahraji Devi Mahraji Devi 991971526 Chiragaon,Varanasi 11/16/16 ###14461 26.12.2017 Cashless Paid

16 Jeeuta Bholu Tulachak 9415657767 Varanasi 12/05/16 ###37550 30.01.2017 Cashless Paid

Name of Injured

Date of Accident




Status as on date (Paid/ rejected/ under

process )

17 Chaman Lal Chaman Lal 7905644939 Betwar,Bachav,Varanasi 11/22/16 ###32550 31.01.2017 Cashless Paid

18 Gudani Devi Gudani Devi 8924999296 Varanasi 12/07/16 ###11669 31.01.2017 Cashless Paid

19 Prabhavati Devi Prabhavati Devi 9651647743 Gram,Newadi,Post,Newadi 12/23/2016 ###15876 27/2/17 Cashless Settled

20 Awdesh Ghanshyam 8127751696 Varanasi 11/1/2016 ###23694 31.01.2017 Cashless Paid

21 Bhagwani Bhagwani NA Varanasi 12/29/2016 ###9000 31.01.2017 Cashless Paid

22 Lakshman Lakhsman 8299224602 Varanasi 1/2/2017 ###11199 31.01.2017 Cashless Paid

23 Vikash kumar Vikash kumar 8858841145 Kajipur,Odhapur,varanasi 1/12/2017 ###0 27/3/17 Cashless Repudiated

24 Satyendra Kumar Satyendra Kumar 9936452558 Varanasi 1/16/2017 ###8470 06.03.217 Cashless Paid

25 Usha Devi Usha Devi 8858986868 Sarai,Dangari,kalar,tikari,Varansi 1/19/2017 ###0 14/4/17 Cashless Repudiated

26 Jadawati Devi Jadawati Devi 8853833872 Varanasi 1/22/2017 ###26108 06.03.217 Cashless Paid

27 Teju Ram Teju Ram 7086909626 Varanasi 1/26/2017 ###48400 06.03.217 Cashless Paid

28 Indu Devi Indu Devi NA Varanasi 1/29/2017 ###16700 06.03.217 Cashless Paid

29 Kishor Kishor 8896309814 Rohania Varanasi 2/1/2017 ###37125 06.03.217 Cashless Paid

30 Mausam Mausam 7068967339 Varanasi 2/1/2017 ###21950 28.03.2017 Cashless Paid

31 Suhel Khan Suhel Khan Vasani,Pindara,varansi 12/28/2016 ###11693 06.03.2017 Reimbursement Paid

32 Namvar Namvar 9452961806 Varanasi 2/5/2017 ###25849 06.03.2017 Cashless Paid

33 Ramvriksha Ramvriksha 9318189542 Varanasi 2/7/2016 ###16660 06.03.2017 Cashless Paid

34 Ramji Ramji 8564002152 Varanasi 2/9/2017 ###32862 21.03.2017 Cashless Paid

35 Roshan Kumar Shrimati Shyam pyari 9452952815 Varanasi 2/7/2017 ###0 26/4/17 Cashless Rejected

36 Dinesh Kumar Yad Dinesh Kumar Yadav 916972230 Varanasi 2/10/2017 ###20855 28.03.2017 Cashless Paid

37 Neeraj Shanti 8416925232 Varanasi 2/13/2017 ###9345 06.03.2017 Cashless Paid

38 Faudi Yadav Faudi Yadav NA Sindhora,road,Belwaria,varansi 2/15/2017 ###3000 21/4/17 Cashless Under process

39 Rajnath Patel Rajnath Patel 8127777489 Varanasi 2/4/2017 ###20410 19.04.2017 Cashless Paid

40 Munni Devi Munni Devi 9808445778 Chandpur,Varanasi 2/18/2017 ###10130 17.04.2017 Cashless Paid

41 Lalji Shrimati Jahari 9935466756 Varanasi 2/17/2017 ###19473 19.04.2017 Cashless Paid

42 Shiv Kumar yadav Shiv Kumar Yadav 9651935145 Varanasi 2/15/2017 ###43055 06.03.2017 Cashless Paid

43 Manjeet Patel Shri Mati Rajmani 7347898197 Varanasi 2/7/2017 ###32862 28.03.2017 Cashless Paid

44 Pramod Kumar PalShri Mati Bindo 8175058567 Arjaline,Sultanpur,Varansi 2/19/2017 ###24192 7/2/2017 Cashless Settled

45 Mairu Nisha Mairu Nisha 9129359304 Rudali,Mirzapur,Varansi 2/21/2017 ###20640 03.5.17 Cashless Settled

46 Hari Narayan Hari Narayan 9005919274 Varanasi 2/23/2017 ###2340 27.04.2017 Cashless Paid

47 Madhuri Sonkar Madhuri Devi 7839424983 Munari,Kadipur,Chaubey pur,Var3/1/2017 ###19020 19.04.2017 Cashless Paid

48 Sahodara Devi Sahodara Devi 800513317 Siyaram,Gajari,Varanasi 3/3/2017 ###48980 20.04.2017 Cashless Paid

49 Rajendra Yadav Hiramani 7607003082 Varanasi 3/13/2017 ###19660 19.04.2017 Cashless Paid50 Kurashai Bibi Mo.Ushman 82992403221 Chilpi tola Avadh garvi,Hanuman 3/16/2017 ###8694 19.04.2017 Cashless Paid51 Santosh kumar Chandrika Prasad 8840715735 Tulsi.Pachhimpur,varanasi 3/18/2017 ###8694 27.04.2017 Cashless Paid52 Harishankar Lalit Mohan 9415997067 Vinayka,chhitupur,varanasi 3/20/2017 ###12127 19.04.2017 Cashless Paid53 Santosh Kumar GaSantosh Kumar Gautam Bhelkha,pindara,varanasi 4/6/2016 ###0 Reimbursement Repudiated54 Santosh kumar Santosh kumar 7309784822 Madhopura,Kurahaun,varanasi 3/13/2017 ###23516 19.04.2017 Cashless Paid55 Jhamal Barsati 88582541 Akhari,Kurhua,Varansi 3/27/2017 ###33750 27.04.2017 Cashless Paid56 Rukshana Begum Nisar Ahmad 8694685349 Shivala,Varanasi 4/1/2017 ###0 Cashless Repudiated57 Matabadal rajbharMata badal rajbhar 738079760 Medani Koilar,varanasi ###11950 27.04.2017 Cashless Paid58 Mo. Sarif Khan Mo. Sarif Khan 7785031823 Varanasi 3/29/2017 ###8694 27.04.2017 Cashless Paid59 Lalmani Lalmani 7785980332 Gajadharpur,Kashividyaoitha 4/7/2017 ###21387 27.04.2017 Cashless Paid60 Akhilesh Lalbahadur 9838841098 Bachrawan,Varanasi ###24875 Cashless Under process61 Vijay Kumar Vijay Kumar NA Karauwa,Varanasi ###38182 27.04.2017 Cashless Paid62 Baby Mohmad Firoj Islampur Lohta Varanasi 1/5/2017 ### Cashless Under process63 Durga Prasad Durga Prasad NA Kahuwa,Varanasi ###36232 Cashless Paid64 Ram sagar Ram sagar 9807202013 Danpur,Varanasi ### Cashless Under process65 Samar Bahadur Samar Bahadur Bharhariya 4/14/2017 ###5000 Cashless Under process66 Rohit Kumar Rohit Kumar Mirzamurad,Gaura,varanasi ###53539 27.04.2017 Cashless Paid

67 Hazi Okas Anasari Hazi Okas Anasari Lati Sarai,Varanasi ###14267 13.02.2017 Cashless Paid68 Ram Khelawan Ram Khelawan 9415970397 Chhitauni coat Bachhawan,Varanasi ###38397 Cashless Paid69 Dudh Nath Dudh Nath 857484802 deurayia,Varansi 4/13/2017 ###16400 Cashless Paid70 Ravi Yadav Ravi dayad 7744916976 Badagaon,Varaansi 3/22/2017 ###19312 Cashless Paid71 Kusum lata Akashbair Nath 8808119784 susuwahi varanasi 12/7/2016 ###0 Cashless Rejected72 Rajbali Rajbali 9839019197 Bansipur,Rajatalab,Varanasi 4/20/2017 ###50485 Cashless Paid73 Mo.Nseem Mo. Naseem Rajghat,varansi 4/21/2017 ###15000 Cashless Under process74 Jyoti Patel Jawahir Patel 7268804386 Sarnath Sarai No. 2 ###17110 Cashless Paid75 Pachho devi Rajendra kumar maurya 8853607504 Suichak,Gangapur,Varanasi 2/16/2017 ###0 Cashless Repudiated76 Sant Lal Sant Lal 9454161999 Bhavapura,Industrial state ,varan4/30/2017 ###40715 Cashless Paid77 Vinod Kumar Vinod Kumar` 8474371807 Jayrampur,Varanasi 5/3/2017 ###22959 Cashless Paid78 Somaru Mathuri 7703000007 Pillori,Varanasi 5/2/2017 ###34104 Cashless Paid79 Sandip pal Baldev 8858986555 Mundadev,Tikari,Varansi 5/8/2017 ###30616 Cashless Paid80 Subash Chandra Laximan 9140107092 Mubarakpur, Mubarakpur ganeshpu5/9/2017 ###10000 Cashless Under process81 Asha Devi Suresh Kumar Hariom nagar Colony, Bhagwanpur5/10/2017 ###24404 Cashless Paid82 Parvati Devi Girdhari 8423826896 Baurahawan, baragaon, varanasi 5/12/2017 ###17334 Cashless Paid83 babu lal gupta babu lal gupta 9519129040 basani ###10000 Cashless Under process84 Nirmala Devi Ramdas Verma 9450353868 Kamadari,Kashipur, Varanasi 5/21/2017 ###10000 Cashless Under process85 Avadhesh Kumar PAvadhesh Kumar Pandey 8858916402 Chhateri manapur thathara,Varanasi ###10000 Cashless Under process86 Mahendra Prasad Mahendra Prasad 9807028734 Khanaw,bachhawn,bachhaon,Varanasi ###5000 Cashless Under process87 Sujit kumar Sujit kumar 8418905385 Nat masti amaut mangari,Varanas5/16/2017 ###10000 Cashless Under process88 Abhishek Kumar SoBiraju Prasad 8604950445 Shevo Chiraigaun Domanpur,Vara5/27/2017 ###5000 Cashless Cashless approved89 Abhay kumar Abhay kumar 9795 Badibari sucheehak,Gangapur,Var5/29/2017 ###15000 Cashless Under Process90 Disha Banwal Prahalad Das banwal 8953124332 Phulwaraya railway crossing gate5/28/2017 ###30000 Cashless Cashless approved91 Vandana Kumari Samarjeet Prasad 7271087493 Pashu Farm laskariya Jakhini,Vara5/26/2017 ###5000 Cashless Under process92 Akash Modanwal Ajay Modanwal 8400098141 basani bazar, varanasi 4/19/2017 ###13429 6/20/2017 Cashless Paid93 Ramchandra Ramchandra 9415201741 Chandapur,Udaypur,Varanasi 5/12/2017 ###26250 6/20/2017 Cashless Paid94 sarita devi sarita devi 9198925359 Manjhanpur 2/24/2017 ###46250 Cashless Settled95 Ram lakhan Ram lakhan 7905644939 Raudali ###22584 Cashless Settled96 Lalmani Lalmani Patti ###43182 Cashless Settled97 Rajaram Chhedani Devi 7607568994 Arajaline,sultanpur ###7340 Cashless Settled98 ANAND KUMAR MAHENDRA NA 8/16/2016 ### Reimbursement Document Pending99 Sita Sita NA Post baragaon,pacharasi, Varanas6/1/2017 ###5000 Cashless Cashless approved100 PREETI RAVISHANKAR GUPTA NA Chittauni,bachhawan,Varanasi 5/31/2017 ###5000 Cashless Cashless approved101 ashok kumar ashok kumar NA Domalia,varanasi 5/31/2017 ###15000 Cashless Under Process102 Amrita Maurya Ramraj Maurya 9151328268 Akhiri,Sadar,Varanasi 6/3/2017 ###5000 Cashless Cashless approved103 Manboodha Lalchandra 7272806316 Ramasipur,karnadadi,kashipur,Va6/6/2017 ###15000 Cashless Cashless approved104 Mahesh Prasad Mahesh Prasad 7275086152 Rajapur,tatepur kamauli,varanasi6/9/2017 ###5000 Cashless Under Process105 Kashi Prasad Ram Khelawan 9307663709 Chhitauni kot, bchchawan,bachao6/9/2017 ###5000 Cashless Cashless approved106 Mangal Prasad Mangal Prasad 7505044451 Salarpur,rasoolgarh,varanasi 6/12/2017 ###5000 Cashless Cashless approved107 Kanti devi Dilip Sonkar 7275429207 Salarpur,rasoolgarh,varanasi 4/20/2017 ###5000 Cashless Under Process108 Mania Mannia 9268804468 Mustafabad,Varanasi 6/12/2017 ###5000 Cashless Under process109 Manju Sonkar Manju Sonkar NA 48/49,Chhaterimanapur,tatehara5/25/2017 32501 6/20/2017 Cashless Paid

LAKHANSENPUR VARANASI

110 Saurabh kumar Shri Swantra Ram NA Mohmadabad Gohna Mau 2/6/2017 ###11557 Cashless Settled111 Usha Devi Shabhu Nath NA Mirzamurad,Gaura,varanasi ###10000 Cashless Under Process112 Saurabh Singh Bhai Ram Patel Mendaiganj,Raja Talab 6/6/2017 ###10000 Cashless Under Process113 Babu Lal Shri Babu Lal 9565816327 Munari Varanasi 6/8/2017 ###9000 Cashless Under Process114 Manbudha Devi Lalchandra 9415227170 Rasimpur,Kanadadi,Varanasi 6/6/2017 ###12000 Cashless Under Process115 Bihari lal Bihari Lal 9170774705 Bagha ,Mirzapur 6/20/2017 ###10000 Cashless Cashless approved116 Nakhadu Nakhadu NA Betawar ,Varanasi 6/20/2017 ###5000 Cashless Cashless approved117 Govind Yadav Govind Yadav NA Sultanpur, varanasi 6/22/2017 ###5000 Cashless Cashless approved118 Pankaj Kumar Dwarika Prasad 9616515455 Marhara,Ambedkernagar 5/10/2017 ###11935 Cashless Settled119 Ajay kumar Ajay kumar NA Ramgadhwa,khetalpur,varanasi 6/24/2017 ###8000 Cashless Cashless approved120 Jay Shree Parasnath NA Mirapur,Bachawan,Varanasi 6/12/2017 ###5000 Cashless Under Process121 Rajji Devi Ramlekhawan 9651116675 Basantpatti,Varanasi 6/10/2017 ###15000 Cashless Under Process122 Raghunath Raghunath 9554314033 House no-17,Mahada,singhpur,Va6/8/2017 ###10000 Cashless Under Process123 Ranjit Dinanath 9559116388 Bharatpur,badagaon,Varanasi 6/9/2017 ###10000 Cashless Under Process124 Khushi Bachche lal NA mehandiganj,Varanasi ###10000 Cashless Cashless approved125 Shila devi Manoj kumar pal NA Chitauni kashi vidya pith,Varanasi6/17/2017 ###5000 Cashless Cashless approved126 Hirawati Jhammal 8858252541 Akhri,kurahuwan,Varanasi 6/24/2017 ###15000 Cashless Cashless approved127 Radha Rammurat NA Bachhawan,Varanasi 6/25/2017 ###10000 Cashless Cashless approved128 Soni Devi Anand Kumar Rai NA Kashipur,Varanasi 6/27/2017 ###10000 Cashless Cashless approved129 Dinesh Rai Dinesh Rai NA Mehndiganj,Rajatalab,Varanasi 6/23/2017 ###5000 Cashless Cashless approved130 Pushpendra Nath SPushpendra Nath Singh NA Khalispur Mizamurad 6/27/2017 ###5000 Cashless Cashless approved131 Khushi Bacche Lal NA mehandiganj,Rajatalab,Varanasi 6/27/2017 ###10000 Cashless Cashless approved


Jun-17Insurance Company Name:- National Insurance Company Ltd. District Name:-Chandauli

Sl.No. Name of Injured Name of Beneficiary Mobile No Address Date of Accident Amount Paid

1 Sarangi devi Devmurat Bharti 9161063794 Chandauli 10/02/16 10935 30.01.2017 Cashless Paid

2 Dashangi Ram Dashangi Ram 9506462297 Korami,Amara,Kurmi,Cahndaul 10/03/16 10935 27.12.2016 Cashless Paid

3 Kartik Murari Singh 9956085812 Harishankarpur, Chandauli 10/23/16 5490 27.12.2016 Cashless Paid

4 Anil kumar Maurya Anil kumar Maurya 9935373280 Sakaldeah,Chandauli 11/22/2016 7050 30.01.2017 Cashless Paid

5 Surabh Chandra Lalji 7080192758 H.205,Bardiah,Bhagwan,Sakaldia11/22/2016 4674 30.01.2017 Cashless Paid

6 Vijaymal Vijaymal NA Faguiya,Khagwal,Chandauli 1/12/2017 17710 13.02.2017 Cashless Paid

7 Dhanpati devi Chandrasekhar 7388780722 shankarmod, ward, 1,ambedikar 1/20/2017 21350 19.04.2017 Cashless Paid

8 Jangi Prasad Jangi Prasad 9695335810 Shivdasi pur, Dhanpur,chandauli1/20/2017 0 Cashless Repudiated

9 Sadanand Kushwaha Sadanand Kushwaha 941597952 Dhanapur,Dhanpiur,Chandauli 12/24/2016 29620 06.03.2017 Cashless Paid

10 Rakesh Kumar Rakesh Kumar 8736827153 Sarauli,Tanda,kelan,Chandauli 1/24/2017 14675 13.02.2017 Cashless Paid

11 Ajay Yadav Jhagadu Yadav NA Keshawpur,Kashopur,Chandauli1/25/2017 18254 17.04.2017 Cashless Paid

12 Asha Devi Ramashre 786062088 Keshawpur,Kashopur,Chandauli1/30/2017 34833 17.04.2017 Cashless Paid

13 Tetra devi Sukha Ram 9651541939 Dhondhiya,Kamlapur,Chandauli 1/29/2017 21086 17.04.2017 Cashless Paid

14 Radha Nirmla Devi 7084251984 Padamnathpur,Sakaldiah,chanda2/3/2017 11853 28.03.2017 Cashless Paid

15 Abhay Yadav Chhavirath Yadav 9956583753 Safpudin,chapra,turkaha,chanda2/3/2017 13273 21.03.2017 Cashless Paid

16 Rajan Kumar Maurya Rajesh Kumar NA Chandauli 2/14/2017 0 Cashless Repudiated

Date of Payment


Cashless/ Reimbursemen

t


17 Amit Kumar Yadav Amit Kumar Yadav NA Raipur,Manipira,Chandauli 2/21/2017 2340 19.04.2017 Cashless Paid

18 Shiv shankar Maurya Moti singh Maurya NA Chari, Chiraigaon,Chandauli 2/18/2017 3040 19.04.2017 Cashless Paid

19 Baby Kumar Uday Narayn 7752950549 Naubatpur,chandauli 2/25/2017 0 Cashless Repudiated

20 Man Kumar Devi Mankumari Devi 7068387200 Chandauli 2/28/2017 8161 19.04.2017 Cashless Paid

21 Sunari devi Sunari devi 9415293257 Budhepura,Jagdish pura,Chandau2/22/2017 8694 20.04.2017 Cashless Paid

22 Sunil Kumar Sulab 7393927149 Tulsi Ashram,Nonar Chandauli 2/24/2017 8694 27.04.2017 Cashless Paid

23 Anita devi Anita devi 9616219781 Shahtri Colony,Mughlaysarai 12/8/2016 0 Reimbursement Rejected

24 Abhishek Pal Ramprakash 9696773455 Sakaldeah,Chandauli NA 22360 27.04.2017 Cashless Paid

25 Asha Devi Ashok Yadav 7505110006 Hinauli,Mughalsarai 4/13/2017 23602 27.04.2017 Cashless Paid

26 Kalawati Bachau NA Jarkhor kala 4/7/2017 19214 27.04.2017 Cashless Paid

27 Chinta devi Chinta Devi 9936132734 chandpur,Phoolpur,Sakaldeah 1/8/2017 Reimbursement Under process

28 Sukha devi Sitaram 9598857470 Badra khurd,Baghra,chandauli 4/12/2016 Reimbursement Under process

29 Alaukik upadhyay Alaukik upadhyay 9415224892 Shahtri Colony,Mughlaysarai 4/23/2017 17809 Cashless Paid

30 Suresh Kumar Buddhu NA Hathiyani,Chandauli 5/4/2017 15000 Cashless Under process

31 Janki Subedar vishvakarma 7880379806 Khor,Nonar,Tulsiashram Nonar, 5/4/2017 7340 Cashless Paid

32 Bechai Prasad Bechai Prasad 8858085828 Sakaldeah,Chandauli 5/5/2017 5000 Cashless Under process

33 Bandna Maurya Ram Naresh Maurya NA Chaten, Saiyadaraja, Barahani, 5/7/2017 15010 Cashless Paid

34 Krishna Krishna NA Jamunipur,Chandauli NA 23738 Cashless Paid

35 Subhash Rai Subhash Rai NA Sarvanandpur, Mathela, Sakaldi NA Reimbursement Under process

36 Lachi Devi Lachi Devi NA Ramgarh, Chandauli NA Reimbursement Under process

37 Shivbalak Shivbalak NA ViII Laxmangarh, Lachhiman garh2/20/2017 Reimbursement Under process

38 Sitaram Sitaram 8009448671 Hridaypur, Dadi, Chandauli 3/15/2017 Reimbursement Under process

39 Dilip Kumar Misri lal 8412260071 Kodariya, Chandauli 5/16/2017 21930 Cashless Paid

40 Usha Devi Vishvanath NA Kamlapur, Chandauli 3/3/2017 0 Reimbursement Rejected

41 Kismati devi Pachkhari,kavruva,chandNA Raja Yadav NA 10000 Cashless Under process

42 Sonu kumar Radhesyam gaud 8922020478 Khagawal, Chandauli 4/30/2017 14779 20.06.2017 Cashless Paid

43 Chandra Shekhar Ram vilas 7267812932 Bichhiya kala, Post jagdish sarai NA 10000 Cashless Cashless approved

44 Udham singh Maurya Arun Kumar Maurya 8009305845 Nonar, Tulsi ashram,chandauli 5/23/2017 5000 Cashless Cashless approved

45 Shivshankar Prasad Dilbahar NA Naubatpur,chandauli 5/27/2017 5000 Cashless Under process

46 Soni Kumari Shivshankar 9198706621 Naubatpur,chandauli 5/29/2017 5000 Cashless Cashless approved47 Kapil dev yadav Ramashish yadav 7317547121 Kamhariya,Chandauli 11/06/16 35632 26.12.2016 Cashless Paid48 Shiv baran Shiv baran 8400210188 Jairampur,Vishori,Chandauli 11/07/16 12150 27.12.2016 Cashless Paid49 Bindu Ramji 7607821298 Tejopur,Naubdapur,Chandauli 5/31/2017 5000 Cashless Cashless approved50 Dharmendra Kumar PalRam Prasad 9696773455 Purasonahula,sakaldiha bazar, C6/5/2017 5000 Cashless Cashless approved51 Bhagwani Devi Bhagwani Devi NA Ward no-14,Lohiya nagar,Chanda6/2/2017 10000 Cashless Under process52 Gulab Chandra MauryRajnath Maurya 7309567101 Saiyadraja,Barahani,Chandauli 6/1/2017 5000 Cashless Cashless approved53 Sunil Rajkumar NA Derhawal,sakaldiha dedgaon,cha6/6/2017 5000 Cashless Under process54 Naina Asha Devi 9506643529 Gram khagawal,Chandauli 6/6/2017 23602 Cashless Cashless approved55 Sobhnath Syamrathi Devi 8418905385 Alinagar Mughalsarai sakaldiha 5/16/2017 12939 20.06.2017 Cashless Paid56 Sandeep Kumar Ram Awadh 9598401514 Vill Gorari post bisunpura, Chan 6/9/2017 10000 Cashless Cashless approved57 Geeta Kashi NA Saruka,Chandauli 6/11/2017 5000 Cashless Under process58 Sareeta Devi Santosh Kumar Singh 7607103064 Kisunapura amara,chandauli 6/10/2017 5000 Cashless Under process59 Santosh kumar Santosh Kumar Singh 7607103064 Kisunapura amara,chandauli 6/10/2017 5000 Cashless Under process60 Devraj Radhesyam 7068587440 Jamurkha kamlapur, Chandauli 6/13/2017 10000 Cashless Cashless approved61 Grijesh Prasad Grijesh Prasad NA Rapur, Dhanapur,Chandauli 6/14/2017 5000 Cashless Under process62 Sunil Kumar Maurya Shri Kainhya Maurya NA Faguiya,Khagwal,Chandauli 6/14/2017 5000 Cashless Cashless approved63 Sandip Kumar Mishra Vinod Mishra NA Sonhuli,Chandauli 6/6/2017 Cashless Under Process64 Santosh kumar Singh Santosh kumar Singh NA Dighi Bhasila,Chandauli 20/6/2017 10000 Cashless Under process65 Ramasaray Shri ramshray NA Kadoriya,Sakaldeah,chandauli 19/6/2017 10000 Cashless Cashless approved66 Sunaina Anil kumar Maurya NA Atarauli, Dabriya,chandauli 19/6/2017 3000 Cashless Cashless approved67 Shamsuddin Shamsuddin 9198827961 Basila,Chandauli 6/21/2017 5000 Cashless Cashless approved68 Vikash Kashi 74084826 Saruka,Panchdevra,Chandauli 6/22/2017 5000 Cashless Cashless approved69 Vinod Kumar Vinod Kumar 7388421831 Narayanpur,Post maidhi,Chandau6/17/2017 5000 Cashless Cashless approved70 Akhilesh Omprakash 9125160009 Sirsi,Chandauli 6/23/2017 5000 Cashless Cashless approved71 Karan Jhinkhun Gond 7459864024 Dighi Bhasila,Chandauli 6/23/2017 5000 Cashless Cashless approved72 Priyanshu Mishra Anuj Kumar Mishra 9889865212 Alinagar,Mughalsarai,Chandauli 6/26/2017 15000 Cashless Cashless approved

Form 11Detail of Claims Under Mukhyamantri Kisan and Sarvhit Bima Yojana

Insurance Company Name:- National Insurance Company Ltd. District Name:-Gazipur June 2017

Sl.No. Name of Injured Name of Beneficiary Mobile No Address Date of Accident Amount Paid

Reason for Repudaition ( Minimum 20 words)

1Afsari Afsari NA

Karanada,Ghazipur1/7/2017 16468 Reimbursement Paid

2 Pratibha Soni Pratibha Soni NA Tulapatti,Karnda,Ghazipur 11/20/2016 Reimbursement Under process Awaited original document3 Parvati Devi Parvati Devi NA Mohanpur,Ghazipur 3/10/2017 Reimbursement Under process Awaited original document4 Vikrant Shri mati tetra Devi NA Mohanpur,Ghazipur 12/24/2016 Reimbursement Under process Awaited original document5 Anita Yadav Shri Shiv Kumar NA Patkaniya,Ghazipur 1/4/2017 Reimbursement Under process Query raised6 Amla devi Suresh NA Karanda Ghazipur 5/3/2017 Reimbursement Under process7 Lal Ji singh Lal Ji singh NA Karma dildarnagar,Ghazipur NA 5000 Cashless Under process8 Arti Mishra Satyendra Mishra 7706023583 Deendayal, Nagar, Sadat, Ghaz5/9/2017 30550 Cashless Paid9 Shyamsundar Yadav Sunnar 9670164131 Bhimapar,Saidpur,Ghazipur 11/25/2016 Reimbursement Under process10 Meena Devi Radhe Kishan NA Karma dildarnagar,Ghazipur 6/22/2017 5000 Cashless Cashless approved Patient under treatment11 Ramgahan Ram Ramgahan Ram NA Dildar Nagar,Ghazipur 6/17/2017 5000 Cashless Under Process

Date of Payment





Insurance Company Name:- National Insurance Company Ltd. District Name:-Bhadoi June 2017

Sl.No. Name of Injured Mobile No Address

1 Nirmala Bacche Lal 7275905197 89,Gulora Bhag,2 Bhadohi 10/30/16 30225 01.04.2017 Cashless Paid

2 Savitri Savitri 8574604105 Ramrai pur,Bhadohi 11/25/16 0 25.01.2017 Cashless Repudiated

3 Harischanda Harischanda 7860649707 Amurana,Nai bazar,Sant ravidas Nagar1/29/2017 33150 06.03.2017 Cashless Paid

4 Jadawati Devi Jadawati Devi 9411819949 Modhe,Barmohani,Sant ravidas nagar 1/30/2017 23475 06.03.2017 Cashless Paid

5 Samsuddin Samsuddin 8115431706 Duwa,Dharmapuri,Sant ravidas nagar 1/29/2017 17094 28.03.2017 Cashless Paid

6 Renu Renu 9793066377 Sayar Aurai,Bhadohi NA 59554 Cashless Paid

7 Chhote lal Chhote lal 7376024035 Laxman Patti, Sant Ravidas Nagar 4/8/2017 12054 Cashless Paid

8 Radheshyam Baliraj 9936073791 Bhadohi 4/10/2017 8694 Cashless Under process

9 8318156061 MUSIDEEH BHADOHI 2/23/2017 Reimbursement Under process

10 9452568641 DEVNATHPUR BHADOHI 1/25/2017 Reimbursement Under process

11 HANSHARAJ BIND RAJPATI BIND 9807672682 KATAIBANA BHADOHI 12/14/2017 Reimbursement Under process

12 GULABDHAR RAJPATI BIND 9936191956 KATAIBANA BHADOHI 12/25/2016 Reimbursement Under process

13 UMASHANKAR RAJKARAN 8546096990 SARAIYA BHADOHI 2/2/2017 Reimbursement Under process

14 BRIJMOHAN BIND SHIVRAM BIND 8009126264 HARIYAWAN BHADOHI 10/12/2016 Reimbursement Under process

15 Suresh chandar Muary 9554774222 11/18/2016 Reimbursement Under process16 MUNNA GAUTAM LT-BHAGGU RAMNA AHAMADPUR BHADOHI 6/1/2017 Reimbursement Under process17 ASHISH KUMAR RAMESH KUMARNA 12/12/2017 Reimbursement Document Pending18 LAXMAN PRASAD MITHTHULAL NA SARAIYA BHADOHI 4/18/2017 Reimbursement Document Pending19 RASHEELE PANNALAL SHARNA MUSILATPUR,BHADOHI 4/22/2017 4890 Reimbursement Paid20 SHYAMLAL GAUDNA HARIYAWAN BHADOHI 4/18/2017 7630 6/20/2017 Reimbursement Paid21 INDRAWATE DEVI NA HARIHARPUR,BHADOHI 4/17/2017 Reimbursement Under process

Name of Beneficiary

Date of Accident

Amount Paid

Date of Payment





MANOJ KUMAR VISHWAKARMA

MAHAGU VISHWAKARMA

RAJESH KUMAR MAURYA

JEET NARAYAN MAURYA

GANGA RAM MAURYA

DEEHKOIRAN BHAKORA BHADOHI

DHANAPUR PALI,BHADOHI

MAHESH KUMAR GAUD RADHESHYAM

YADAV

22 CHANDA DEVI RAJKUMAR NA KACHHAWAN,BHADOHI 4/20/2017 Reimbursement Document Pending23 Bholanath Kanhaiya lal Seth9628410824 Sant Ravidas Nagar 10/29/16 0 14/12/16 Cashless Repudiated24 Himashu Kumar Singh Yadunath Singh NA Saran,parsipur,sant ravidas nagar 6/23/2017 5000 Cashless Cashless approved


Insurance Company Name:- National Insurance Company Ltd. District Name:-Jaunpur June 2017

Sl.No. Name of Injured Name of Beneficiary Mobile No Address Date of Accident Amount Paid Date of Payment

1 Rita Devi Ranu 8808147325 Sarai moduinpur 09/21/16 ###3320 31.01.2017 Reimbursement Paid2 Dharmendra Kumar Yad Dharmendra Kumar Yad9889885103 Kerakt,Jaunpur 11/28/16 ###12150 31.01.2017 Cashless Paid3 Rekha Devi Rekha Devi 7850865680 157,khaprah road,Saunpura 11/15/16 ###11760 27.12.2016 Cashless Paid4 Lalti devi Lalti devi 8009344389 House no.172,Ramkhaprah,Jaunpur 11/14/16 ###8974 27.12.2016 Cashless Paid5 Ramesh Kumar Ramesh Kumar 7394929778 Jaunpur 11/7/2016 ###0 Cashless Repudiated6 Asha Devi Asha Devi Sikrara,Jaunpur 1/29/2017 ###8207 19.04.2017 Cashless Paid7 Satish Maurya Satish Maurya 7505089693 Jaunpur 2/4/2017 ###0 Cashless Cashless withdrawn8 Pradeep Kumar Bind Subhash Chandra 7866816940 15,Vasirpur,Khalilpur,Jaunpur 2/21/2017 ###0 Cashless Repudiated9 Kamlakant Mishra Kamlakant Mishra 8858214815 Foolpur Jaunpur 12/17/2016 ###0 Cashless Deniel

10 Sunita Devi Ajay Kumar 8318932324 Japrwaha,Sikrara,Jaunpur 1/9/2017 ###0 Cashless Deniel11 Jayprakash Jay Prakash 8896929966 Jaydaha,Shahganj,Jaunpur 2/12/2016 ### Reimbursement Under process12 Sofiyan Rafik Ahmad 8115913428 Saraiviru,Kerakat Jaunpur ### Reimbursement Under process13 Pratham Singh Vinod Kumar Singh 9453309800 Dhorail,Khalilpur,Jaunpur 1/30/2017 ###25000 27.04.2017 Reimbursement Paid14 Rita Devi Ranu 8808147325 Sarai moduinpur 9/18/2016 ###84000 Cashless Paid15 Ajay Kumar Pandey Hriday Narayan Pandey Haraipur, Kachari Line Bazar Jaunpur 1/3/2017 ### Reimbursement Document Pending16 Kamla Devi Fozdar Chhauan Chiraiyadeeah, Khalishpur, Saraykhaza 9/12/2016 ### Reimbursement Document Pending17 Suraj Verma Ram Pal Patel V-Haridari P- Baneri Marihau Jaunpur 3/3/2017 ### Reimbursement Document Pending18 Makrkund Pal Makarkud Pal V +P Parpur Block Baxa Jaunpur 8/4/2017 ### Reimbursement Document Pending19 Deepak Kumar Chandan Singh Jaunpur 11/4/2017 ### Reimbursement Document Pending20 Dhan dai Radey Shyam Yadav V- Saraya Guja, Sahapur Badlapur Jaunp14/04/17 ### Reimbursement Document Pending21 Akash Kumar Bhailal V - Majhuali P - Sambhuganj Jaunpur 8/4/2017 ### Reimbursement Document Pending22 Vishal Yadav Mahedra Kumar Yadav V Kundanpur P- Maharajganj Jaunpur 7/4/2017 ### Reimbursement Document Pending23 Surya Prakash Mishra Baijnath Mishra V- Vari P- Barhuta Machhlichar Jaunpur 13/04/17 ### Reimbursement Document Pending24 Abhayraj Pandey Sukhdev Pandey V Durgapatti P Letuka Badlapur Jaunpur 15/04/17 ### Reimbursement Document Pending25 Nirmala Devi Hawaldar V+P Nahora Kerakat Jaunpur 19/01/17 ### Reimbursement Document Pending26 Shivpujan Tiwari Shivpujan Tiwari 9869365915 Belsadi , Jaunpur ### Reimbursement Under process27 Devkali Singh Devkali Singh 8563985587 Mokalpur, Madiauh, Jaunpur 9/22/2016 ### Reimbursement Under process28 Shakuntala Maurya Shakuntala Maurya 7800543530 Jaunpur 10/20/16 ###0 27/2/17 Cashless Repudiated29 Ramesh Chandra Ramesh Chandra 7275314339 Jaunpur 11/01/16 ###0 20/12/16 Cashless Repudiated30 MANGALA SINGH RAM DULAR SINGH NA 5/9/2016 ###0 Reimbursement Rejected31 BANARASI BISARAWAN NA KOCHARI, JAUNPUR 10/11/2016 ### Reimbursement Document Pending32 Ajay Chaudhari Ajay Chaudhari NA Khapara,Jaunpur 6/27/2017 ###10000 Cashless Cashless approved




BANKI,SIKRARA,JAUNPUR


Insurance Company Name:- National Insurance Company Ltd. District Name:-Azamgarh June 2017

Sl.No. Name of Injured Name of Beneficiary Mobile No Address Amount Paid

1 Jamila Ansari Muntazim Ansari 8115008212 Azamgarh 12/02/16 20000 13.02.2017 Cashless Paid

2 Muntazim Ansari Muntazim Ansari 8115008212 Azamgarh 12/02/16 15000 19.04.2017 Cashless Paid

3 Ramdhani Pandey Ramdhani Pandey 9473880495 289,Pura Pandeypur,Jaffar,Azamg12/11/16 8694 13.02.2017 Cashless Paid

4 Tadak Nath Giri Tadak Nath Giri 9450832128/895Jodhpur ,Azamgarh 12/23/2016 17790 27.01.2017 Reimbursement Paid

5 Lalti devi Ram Nirjan Yadav 9897683088 Vajidpur,devraia,Azamgarh 1/19/2017 8450 19.04.2017 Cashless Paid

6 Ram Nirjan Yadav Ram Nirjan Yadav 9897683088 Devraiya,taharwajidpur,buddhan1/19/2017 9964 19.1.17 Cashless Paid

7 Ram Kishun Ram Kishun 9793109571 House No. 66 jairampur,Sidhari, 1/25/2017 28225 19.04.2017 Cashless Paid

8 Sourabh kumar Sourabh kumar 8543825028 89 ,Kamalpur.Kolapur 2/5/2017 5000 21.03.2017 Cashless Cashless withdrawn

9 Ramprakash Ramprakash 9795499815 Mukhlikhpur,Gudhanpur,Azamga2/7/2016 7245 28.03.2017 Cashless Paid

10 Shiv prasad Shiv prasad 7309225294 Maner khurd,mahulkhas,Azamga2/5/2017 8340 06.03.2017 Cashless Paid

11 Mithliesh Yadav Mithliesh Yadav 9450544440 Nevada,Sanjarpur,Azamgarh 2/10/2017 15000 Cashless Under process

12 Mewati Mewati 9884278034 89 ,Kamalpur.Kolapur 2/4/2017 24550 21.03.2017 Cashless Paid

13 Munaki Bhanupratap 9532721011 Chapra,Sultanpur,Azamgarh 4/4/2017 158997 Cashless Paid

14 Tara Mata prasad NA Hira Patti,Azamgarh 4/1/2017 71100 Cashless Under process

15 Indal Nishad Indal Nishad 9616585619 Sikara,Azamgarh 12/21/2016 2340 19.04.2017 Reimbursement Paid

16 Rajpal Rajpal 9415323408 Kamonpur.Azamgarh 1/25/2017 Reimbursement Under process

17 Naushadq Mo.Naushad 9889876115 Phoolpur, Phoolpur,Azamgarh 1/2/2017 Reimbursement Under process

18 Vinod Chauhan Vinod Chauhan 8423738182 Aira khurdbaragaon,Azamgarh 2/6/2017 Reimbursement Under process

19 Mangal Rai Mangal Rai NA Rani ki sarai Azamgarh Reimbursement Under process

20 Manoj Kumar Chauhan Manoj Kumar Chauan 9451829737 Hajipur ,Azamgarh Reimbursement Under process

21 Umesh Saroj Shri Bechu 9889541055 Masveer Muaya Sangi Azamgarh 4/16/2017 12294 Cashless Paid

22 Sursati Paltu 9450822166 Haffijpur,Azamgarh 20200 Cashless Paid

23 Abhinandan Abhinandan 7394815151 Baliyaraganj,Azamgarh 4/21/2017 23400 6/20/2017 Cashless Paid

24 Johri Devi Balli 9005621769 Rani ki sarai Azamgarh 4/24/2017 15194 Cashless Paid

25 Baldev Baldev 7052990872 Medi,Tabarpur,Azamgarh 4/11/2017 Reimbursement Under process

Date of Accident

Date of Payment





26 premchand Ramnepal 9793151540 Parmehawrpur,Nariyan,Azamgar 4/7/2017 Reimbursement Under process

27 Shikhar Paramhansh 9452159358 Vedpur,Pihar,Raunapur,Azamgar 4/22/2017 Reimbursement Under process28 Shyampyare Chauhan Shyampyare Chauhan 7388091350 Vill Shahgarh, Shahgarh, Azamga4/21/2017 Reimbursement Under process29 Manorma Bhagwani 9918147419 Mohanpur,Lalgaj,Azamgarh 5/19/2017 5000 Cashless Cashless approved30 Gita Birju 7860559634 Nijamabad,Azamgarh 6/15/2017 10000 Cashless Cashless approved31 Nirdesh kumar Nirdesh kumar NA Shahgarh,Azamgarh 19/6/2017 10000 Cashless Cashless approved32 Anil Anil NA Koilari,umarpur,Godhura,Azamga6/22/2017 8000 Cashless Cashless approved33 Raveendra Raveendra 9918184207 Bharauli,Auardand,Kolisa,Azamga6/24/2017 5000 Cashless Cashless approved34 Vinod Chauhan Ramraj 8423738182 Airakhurd, Post arakala,Azamgar 1/16/2017 Reimbursement Under Process35 Munnilal Munnilal 9793498363 38/450,Redopur,Azamgarh 6/22/2017 10000 Cashless Cashless approved