Portal for Submission of Claims for Refund of Unitech Fixed Deposits

Cummalative (B) Registration Form

Non-Cummalative (A)

Cummalative (B)

(Fields marked * are mandatory)

FD Number*

6 digit number, use 0 (zero) before a 5 digit number

New Password *

Confrim Password *

Name*

Upload Proof of ID*

PAN card, passport, aadhar, drivers licence; the file size must be less than 1 megabyte

Address

Date of Birth*

Mobile Number*

Upload FD Receipt*

Term of FD *

Amount Invested in FD(Rs.) *

Date of FD

Date of Maturity

FD Interest Rate (%)

As mentioned in the FD receipt

Amount Due on Maturity (Rs.)

Amount Received from Unitech (Rs.)

Details of Pending Case / Remarks (if any)

Upload Order Copy of Case (if any)

Principal Amount Paid by Unitech (Rs.)

Does FD holder suffer from any Serios Medical Conditon *

Describe the Nature of the serious Medical Condition

Supporting Documents From Hospital/Institution

Upload scan of document from hospital/Medical Institution from which treatment for medical condition has been availed of

Name of Hospital/Doctor (Primary illness)

Date of Medical prescriptions uploaded on portal (latest one)

Expenses incurred for the medical treatment from 01.01.2021 onwards

Have the medical expenses been re-mbursed by the employer or claimed by him under any Medi-claim policy

Explanation (if any) of above

Undertaking *

The above information submitted by me/us is true and correct to the best of my/our knowledge. I/we undertake that I/we shall be held liable in case of any of the above Information is found to be incorrect.