{"id":1744,"title":"Member Form - IndiaFirst Life Group Credit Life Plans","purpose":"proposal","insurer":{"slug":"indiafirst-life-insurance","name":"IndiaFirst Life Insurance Company Limited"},"source_pdf":"https://www.indiafirstlife.com/content/dam/ifliwebsite/in/en/download-center/all-product-related-documents/withdrawn-products/member-form-group-credit-life-plus.pdf","sha256":"5915fc3572e0a49aa143714fa72db8ab1d677238d09c2f135f0dac7fc788cae1","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by members applying for the IndiaFirst Life Group Credit Life Plus insurance plan to provide personal, health, nominee, and payment details.","notes":["Fields marked with * are mandatory.","Cover Term should be in years; round up odd periods to the next higher year.","If any health question is answered 'No', provide complete details separately including dates, duration, treatment, and physician details.","DD mandate should be verified by bank branch with 'Signature verified stamp' and 'fixed specimen signature number'.","Use correct formats for dates (DDMMYYYY) and phone numbers (include country code).","Attach a blank cancelled cheque certificate for the bank named in the mandate form."],"title":"Member Form - IndiaFirst Life Group Credit Life Plans","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Member and Loan Details","fields":[{"help":"","type":"text","label":"*Account:","options":[],"required":true,"pdf_field":""},{"help":"Select applicable joint life option","type":"choice","label":"Joint Life option: Primary Life (Life 1) / Joint Life (Life 2)","options":["Primary Life (Life 1)","Joint Life (Life 2)"],"required":null,"pdf_field":""},{"help":"Select applicable loan type","type":"choice","label":"Loan- Home/ Education/Vehicle/Personal/others, please specify:","options":["Home","Education","Vehicle","Personal","others"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"New Loan:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Old Loan:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Old Loan Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter full name with title","type":"text","label":"*Primary Life Name: Mr / Ms / Mx FIRST MIDDLE LAST","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"*Gender:","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"*DOB:","options":[],"required":true,"pdf_field":""},{"help":"If applicable","type":"text","label":"Joint Life Name: Mr / Ms / Mx FIRST MIDDLE LAST","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Gender:","options":["Male","Female","Other"],"required":false,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"DOB:","options":[],"required":false,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Communication Address of the Member (Address to which policy document will be dispatched) LINE1 LINE2 CITY","options":[],"required":null,"pdf_field":""},{"help":"Include country code","type":"phone","label":"*Mobile +(","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"STATE","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of duties","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"*Insurance Details Base Sum Assured ₹","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Base Premium ₹","options":[],"required":null,"pdf_field":""},{"help":"Select payment mode","type":"choice","label":"Pay Mode","options":[],"required":null,"pdf_field":""},{"help":"In years","type":"number","label":"Premium Paying Term","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Pay Frequency","options":[],"required":null,"pdf_field":""},{"help":"In years, round up odd periods","type":"number","label":"Cover Term","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Annual Income","options":[],"required":null,"pdf_field":""},{"help":"Select applicable cover","type":"checkbox","label":"Life Cover","options":["Life Cover","Life Cover + Accidental Total Permanent Disability","Life Cover + Accidental Death","Life Cover + Accidental Total Permanent Disability + Accidental Death"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Premium paid from loan (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Premium paid account number:","options":[],"required":null,"pdf_field":""},{"help":"Provide PAN or Form 60","type":"text","label":"Life 1 PAN/Form 60:","options":[],"required":null,"pdf_field":""},{"help":"If applicable","type":"text","label":"Life 2 PAN/Form 60:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Sum Assured Type:","options":["Reducing","Level"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Installment Premium","options":[],"required":null,"pdf_field":""},{"help":"If applicable","type":"number","label":"Rate of Interest","options":[],"required":null,"pdf_field":""},{"help":"If applicable","type":"number","label":"Moratorium Period","options":[],"required":null,"pdf_field":""},{"help":"Specify percentage or 100%","type":"text","label":"In case of Joint Life sum assured (%) Life 1 / Life 2 Or 100% for both life (Policy terminates in case of death of any one life)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Health Declaration for Member","fields":[{"help":"Provide height and weight","type":"text","label":"Primary Life: Feet inches: Weight in kg:","options":[],"required":true,"pdf_field":""},{"help":"If applicable","type":"text","label":"Joint Life: Feet inches: Weight in kg:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Nominee / Appointee Details","fields":[{"help":"","type":"text","label":"*Nominee Name","options":[],"required":true,"pdf_field":""},{"help":"Percentage share of nominee","type":"number","label":"Percentage Share","options":[],"required":null,"pdf_field":""},{"help":"Date of birth of nominee","type":"date","label":"DOB of Nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Life Assured","options":[],"required":null,"pdf_field":""},{"help":"If nominee is minor","type":"text","label":"Appointee Name (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Appointee DOB","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration by the Member","fields":[{"help":"","type":"signature","label":"*Primary Life Signature/Thumb impression:","options":[],"required":true,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"If applicable","type":"signature","label":"*Joint Life Signature/Thumb impression:","options":[],"required":false,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Authorisation for Settlement of Claim amount","fields":[{"help":"","type":"signature","label":"*Primary Life Signature/Thumb impression:","options":[],"required":true,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"If applicable","type":"signature","label":"*Joint Life Signature/Thumb impression:","options":[],"required":false,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration by a 3rd Person (if applicable)","fields":[{"help":"Person attesting the declaration","type":"text","label":"Name of the Declarant :","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relation with Member","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Declarant :","options":[],"required":null,"pdf_field":""}],"filled_by":"third person"},{"title":"Customer Declaration Form & COVID Questionnaire","fields":[{"help":"","type":"text","label":"Name of Life Assured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Application No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Life to be Assured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Mandate Form - Direct Debit / NACH","fields":[{"help":"Unique Mandate Reference Number","type":"text","label":"UMRN","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Sponsor Bank Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Utility Code","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"I/We hereby authorize IndiaFirst Life Insurance Company Ltd to debit (tickv) SB /CA /CC /SB-NRE /SB-NRO /Other","options":["SB","CA","CC","SB-NRE","SB-NRO","Other"],"required":null,"pdf_field":""},{"help":"Bank account number to debit","type":"text","label":"Bank a/c number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of customers bank","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC","options":[],"required":null,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR","options":[],"required":null,"pdf_field":""},{"help":"Amount to be debited","type":"amount","label":"an amount of Rupees ₹","options":[],"required":null,"pdf_field":""},{"help":"Select debit frequency","type":"choice","label":"FREQUENCY Mthly / Qtly / H-Yrly / Yrly / As & when presented","options":["Mthly","Qtly","H-Yrly","Yrly","As & when presented"],"required":null,"pdf_field":""},{"help":"Select debit type","type":"choice","label":"Debit type Fixed Amount / Maximum Amount","options":["Fixed Amount","Maximum Amount"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Application No. / Loan Account No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature Primary Account holder","options":[],"required":null,"pdf_field":""},{"help":"Signatures of all account holders","type":"signature","label":"Signature of Account holder(s)","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Policyholder's Signature","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Primary Account holder's Signature (If Primary Account holder differs from Policyholder)","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Joint Account holder's 1 Signature","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Joint Account holder's 2 Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"IndiaFirst Life Group Credit Life Plus Plan","attachments":["blank cancelled cheque Certificate of the Bank Named in the Mandate"],"declarations":["The answers and statements made on the Health Declaration are full, complete and true and form the basis of the contract.","Non-disclosure or misrepresentation may lead to policy cancellation or claim rejection as per Section 45 of Insurance Act, 1938.","The maximum cover shall not exceed the amount agreed with the Master Policyholder.","The Company is authorized to seek medical information from doctors/hospitals regarding the insured's health.","The risk commences only on acceptance of the proposal by the Company.","The policyholder authorizes sharing of personal/contact information with the Company.","The policyholder authorizes claim settlement payment to the Master Policyholder by deducting from claim proceeds.","OTP authentication creates a legally binding agreement between the Company and the policyholder.","The 3rd person declaration confirms the member understood the form contents before affixing thumb impression or signing.","The mandate form authorizes IndiaFirst Life Insurance to debit the bank account for premium payments.","The policyholder agrees to maintain adequate balance and authorizes the bank to debit charges for mandate verification."],"dropped_labels":5},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"customer.first@indiafirstlife.com","label":"Service Requests Email","level":null,"hours":"24x7","applies_to":"life","source_url":"https://www.indiafirstlife.com/hi/customer-service/grievance-redressal","quote":"सी (सवाल, अनुरोध और शिकायतें) सेक्शन पर जाएँ और अनुरोध/शिकायत करें।\nहमें ईमेल करें:\nजीवन बीमा पॉलिसी के लिए:\nईमेल आईडी:\ncustomer.first@indiafirstlife.com\nहमें कॉल करें:\nहमारे टोल फ़्री नंबर\n1800-209-8700\nपर सोमवार से शनिवार, सुबह 9 बजे से शाम 7 बजे के बीच कॉल करें।\nहमारे कि","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 209 8700","label":"Customer Care Number","level":null,"hours":"Monday - Saturday, 9 AM - 9 PM","applies_to":"life","source_url":"https://www.indiafirstlife.com/hi/customer-service/grievance-redressal","quote":"रें\nव्हाट्सएप नंबर\n+91 22 6274 9898\nहमें कॉल करें\nसोमवार-शनिवार, सुबह 9 बजे से रात 9 बजे तक\nकर मुक्त नंबर\n(आईवीआर फ्लो)\n1800 209 8700\nकेवल भारत के बाहर से कॉल करने वालो के लिए\n+91 22 62749898\nहमें ईमेल करें\nहम आपकी मदद के लिए 24x7 उपलब्ध हैं\nसेवा अनुरोध","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91 22 62749898","label":"NRI Contact Number","level":null,"hours":"Monday - Saturday, 9 AM - 9 PM","applies_to":"life","source_url":"https://www.indiafirstlife.com/hi/customer-service/grievance-redressal","quote":"-शनिवार, सुबह 9 बजे से रात 9 बजे तक\nकर मुक्त नंबर\n(आईवीआर फ्लो)\n1800 209 8700\nकेवल भारत के बाहर से कॉल करने वालो के लिए\n+91 22 62749898\nहमें ईमेल करें\nहम आपकी मदद के लिए 24x7 उपलब्ध हैं\nसेवा अनुरोध\ncustomer.first@indiafirstlife.com\nदावों के लिए\nclaims.sup","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"8828840199","label":"Online Purchases Number","level":null,"hours":"Monday - Saturday, 9AM - 7PM","applies_to":"life","source_url":"https://www.indiafirstlife.com/hi/customer-service/grievance-redressal","quote":"वों के लिए\nclaims.support@indiafirstlife.com\nऑनलाइन खरीदारी\nसोमवार-शनिवार, सुबह 9 बजे से शाम 7 बजे तक\nऑनलाइन परचेज़ नंबर\n8828840199\nहमें लिखें\nइंडियाफर्स्ट लाइफ इंश्योरेंस कंपनी लिमिटेड\n12वीं और 13वीं मंजिल, उत्तरी [सी] विंग, टॉवर 4, नेस्को आईटी पार्क","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91 22 6274 9898","label":"WhatsApp Number","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/mr/customer-service/grievance-redressal","quote":"pport and grievance redressal process for timely solutions.\nChat on WhatsApp\nSpeak to our friendly team\nWhatsapp Number\n+91 22 6274 9898\nCall Us\nMonday - Saturday, 9 AM - 9 PM\nToll Free Number\n(IVR FLow)\n1800 209 8700\nConnect with our Advisor\nMonday-Saturd","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Customer Care\nIndiaFirst Life Insurance Company Ltd\n12th and 13th Floor, North [C] wing, Tower 4,\nNesco IT Park, Nesco Center, Western Express Highway,\nGoregaon (East), Mumbai – 400063","label":"Customer Care Address","level":1,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"ere\nto contact our grievance redressal officers in your city.\nMAIL/COURIER:\nWrite to us at the address mentioned below:\nCustomer Care\nIndiaFirst Life Insurance Company Ltd\n12th and 13th Floor, North [C] wing, Tower 4,\nNesco IT Park, Nesco Center, Western Express Highway,\nGoregaon (East), Mumbai – 400063\nA communication giving reasons of either redressing or rejecting the grievance will be sent to you within 14 (Fourteen)","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"customer.first@indiafirstlife.com","label":"For Life Insurance Policy","level":1,"hours":"Monday to Saturday between 9am to 7pm","applies_to":"life","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"eries, Requests and Complaints) section and raise the request/complaint.\nEMAIL US:\nFor Life Insurance Policy:\nEmail ID:\ncustomer.first@indiafirstlife.com\nCALL US:\nOn our Toll free number\n1800-209-8700\nfrom Monday to Saturday between 9am to 7pm.\nWalk in to any of our\nIndiaF","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-8700","label":"Toll free number","level":1,"hours":"Monday to Saturday between 9am to 7pm","applies_to":"life","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"aint.\nEMAIL US:\nFor Life Insurance Policy:\nEmail ID:\ncustomer.first@indiafirstlife.com\nCALL US:\nOn our Toll free number\n1800-209-8700\nfrom Monday to Saturday between 9am to 7pm.\nWalk in to any of our\nIndiaFirst Life\nbranch. Locate the nearest branch\nher","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Rajnish Kumar\nGrievance Redressal Officer\nIndiaFirst Life Insurance Company Ltd\n12th and 13th Floor, North [C] wing, Tower 4,\nNesco IT Park, Nesco Center, Western Express Highway,\nGoregaon (East), Mumbai – 400063","label":"Grievance Redressal Officer Address","level":2,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"diafirstlife.com\n.\nAlternatively, you can also write to the Grievance Redressal Officer at the address mentioned below:\nRajnish Kumar\nGrievance Redressal Officer\nIndiaFirst Life Insurance Company Ltd\n12th and 13th Floor, North [C] wing, Tower 4,\nNesco IT Park, Nesco Center, Western Express Highway,\nGoregaon (East), Mumbai – 400063\nPlease quote your Complaint/Service Request ID. This would have been provided to you on registration of your complaint","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievance.redressal@indiafirstlife.com","label":"Grievance Redressal Officer Email","level":2,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"Grievance Officer at any of our branches\nClick here\nOr you may write to our Grievance Redressal Officer through email -\ngrievance.redressal@indiafirstlife.com\n.\nAlternatively, you can also write to the Grievance Redressal Officer at the address mentioned below:\nRajnish Kumar\nGr","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"91- 40 – 6678 9768","label":"IRDAI Grievance Cell Fax Number","level":3,"hours":null,"applies_to":"all","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"thority of India,\nSy. No. 115/1, Financial District, Nanakramguda\nGachibowli, Hyderabad- 500032, Telangana\nFAX:\nNumber: 91- 40 – 6678 9768\nTags\nSTEP 4: REACH OUT TO INSURANCE OMBUDSMAN\nQuestion\nSTEP 4: REACH OUT TO INSURANCE OMBUDSMAN\nSequence\nAnswer\nIn case","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"Click here","label":"Insurance Ombudsman Address Finder","level":4,"hours":null,"applies_to":"all","source_url":"https://www.indiafirstlife.com/customer-service/grievance-redressal","quote":"ch. Locate the nearest branch\nhere\n.\nVISIT US:\nWalk in to any of our\nIndiaFirst Life\nbranch and submit your grievances.\nClick here\nto contact our grievance redressal officers in your city.\nMAIL/COURIER:\nWrite to us at the address mentioned below:\nCus","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800 209 8700","label":"Customer Care Number","level":null,"hours":"Monday - Saturday, 9 AM - 9 PM","applies_to":"life","source_url":"https://www.indiafirstlife.com/mr/customer-service/grievance-redressal","quote":"o our friendly team\nWhatsapp Number\n+91 22 6274 9898\nCall Us\nMonday - Saturday, 9 AM - 9 PM\nToll Free Number\n(IVR FLow)\n1800 209 8700\nConnect with our Advisor\nMonday-Saturday, 10AM - 6PM\nChat With Us\nEmail Us\nWe’re here to help 24x7\nService Requests\ncus","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/indiafirst-life-insurance/1744-member-form-indiafirst-life-group-credit-life-plans"}