" style="margin-right: 23px;">
Claim = $ticket_form ?>
Employee Details
Employee ID
*
Employee Name
*
Employee Mobile No
*
Employee Mail ID
*
Employee Personal Mail ID
Policy No
Corporate Name
*
Insurer
*
Policy
*
>
= $ticket_data['client_policy_id_text'] ?>
Select Policy
Account Manager
*
$value) { $selected = (isset($ticket_data) && $ticket_data['acm_id'] == $value['id']) ? 'selected' : ''; echo "
" . $value['first_name'] . "
"; } } ?>
Claim Details
Policy Type
$value) { if ($key != 1) { $selected = (isset($ticket_data) && $ticket_data['ticket_type_id'] == $key) ? 'selected' : ((isset($selected_ticket_type) && $selected_ticket_type == $key) ? 'selected' : ''); echo "
" . $value . "
"; } } } ?>
Status
*
$value) { $selected = (isset($ticket_data) && $ticket_data['claim_status_id'] == $value['id']) ? 'selected' : ''; echo "
" . $value['claim_status'] . "
"; } } ?>
Claim Type
*
$value) { $selected = (isset($ticket_data) && $ticket_data['claim_type'] == $key) ? 'selected' : ''; echo "
" . $value . "
"; } } ?>
Date of joining
Date of Inception
Date of Birth
*
Date of Accident
Date of Death
Date of Intimation
*
Sum insured
*
Additional Details
Approved Amount
Approved Date
Approved Letter
Approved Description
UTR Details
Settled Date
Settle Letter
Cancel Remark
= isset($ticket_data['cancel_remark']) ? $ticket_data['cancel_remark'] : '' ?>
Return Remark
= isset($ticket_data['return_remark']) ? $ticket_data['return_remark'] : '' ?>
AWB No with Courier Name
Submit
Rejected Approve
More Information
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