{"id":1791,"title":"Group Employee Benefit Form Master Application Form","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withdrawn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/group-ul-super-and-employee-benefit-plans-mph-form.pdf","sha256":"ab2dc7071a6e993e6bfac508f5acd3c3bd41d6fd6c54adab7c7e53f3b7b6e232","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by employers or proposed master policyholders to apply for group employee benefit insurance plans with IndiaFirst Life Insurance. It collects details about the employer, trust, scheme, benefits, contributions, and investment preferences.","notes":["Use BLOCK CAPITALS and tick boxes where appropriate.","Scheme cover starts from acceptance of this proposal.","Sum Assured: Uniform cover of Rs. 5000 for every member in Superannuation and Rs. 1000 in Gratuity/Leave Encashment if opted.","Attach original Scheme Rules, Trust Deed, Deed of variation and member details in electronic format.","Material facts must be disclosed to avoid cancellation under Section 45 of the Insurance Act.","Section 41 prohibits rebates on commission or premium except as per published prospectuses.","Refer to Section 45 of the Insurance Act for policy contestability and fraud provisions.","It is mandatory to choose either investment strategies or fund options in this policy."],"title":"Group Employee Benefit Form Master Application Form","submit":{"to":"IndiaFirst Life Insurance Company Ltd.","how":"","address":"12th and 13th Floor, North [C] Wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai - 400063"},"purpose":"proposal","sections":[{"title":"Details of the Employer","fields":[{"help":"Enter full name in BLOCK CAPITALS","type":"text","label":"Name of the Employer/ Proposed Master Policyholder","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Type of Business/ Trade/ Activity","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Registered/ Head Office Location","options":[],"required":false,"pdf_field":""},{"help":"Provide full mailing address with state, city and pin code","type":"text","label":"Mailing Address/ State/ City and Pin code","options":[],"required":false,"pdf_field":""},{"help":"Include area code","type":"phone","label":"Telephone No .","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"E-Mail","options":[],"required":true,"pdf_field":""},{"help":"Describe the business activity in detail","type":"text","label":"Describe fully- Trade or Nature of Business :","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN","options":[],"required":false,"pdf_field":""},{"help":"Goods and Services Tax Number","type":"text","label":"GST No.","options":[],"required":false,"pdf_field":""},{"help":"Name of authorized signatory","type":"text","label":"Authorized Signatory Details (Other than Trustees) Name :","options":[],"required":false,"pdf_field":""},{"help":"Designation of authorized signatory","type":"text","label":"Authorized Signatory Details (Other than Trustees) Designation :","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorized signatory","type":"signature","label":"Authorized Signatory's Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Details of the Trust (Applicable for Gratuity/ Superannuation Plan only)","fields":[{"help":"","type":"text","label":"Name of the Trust","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Scheme","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Trustee 1 Name","options":[],"required":false,"pdf_field":""},{"help":"Signature of Trustee 1","type":"signature","label":"Signature","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Trustee 2 Name","options":[],"required":false,"pdf_field":""},{"help":"Signature of Trustee 2","type":"signature","label":"Signature","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Trustee 3 Name","options":[],"required":false,"pdf_field":""},{"help":"Signature of Trustee 3","type":"signature","label":"Signature","options":[],"required":false,"pdf_field":""},{"help":"Address of the Trust","type":"text","label":"Mailing Address/ State/ City and Pin code","options":[],"required":false,"pdf_field":""},{"help":"Telephone number of the Trust","type":"phone","label":"Telephone No .","options":[],"required":false,"pdf_field":""},{"help":"Email of the Trust","type":"email","label":"E-Mail","options":[],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Scheme Details","fields":[{"help":"Select applicable scheme(s)","type":"choice","label":"Superannuation Gratuity Leave Encashment","options":["Superannuation","Gratuity","Leave Encashment"],"required":false,"pdf_field":""},{"help":"DDMMYYYY format","type":"date","label":"Proposed Date of Commencement :","options":[],"required":false,"pdf_field":""},{"help":"Select contribution frequency","type":"choice","label":"Frequency of Contribution :","options":["Annual","Half Yearly","Quarterly (Applicable for Superannuation Plan only)","Monthly"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the company/ group have existing superannuation/ gratuity/ leave encashment policy with some other insurer?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, pl provide details.","options":[],"required":false,"pdf_field":""},{"help":"Number of members to be covered","type":"number","label":"Total Number of Members","options":[],"required":false,"pdf_field":""},{"help":"Specify who pays the contribution","type":"text","label":"Contribution Paid by","options":[],"required":false,"pdf_field":""},{"help":"Minimum age in years","type":"number","label":"Minimum Age at Entry into the Scheme","options":[],"required":false,"pdf_field":""},{"help":"Maximum age in years","type":"number","label":"Maximum Age at Entry into the Scheme","options":[],"required":false,"pdf_field":""},{"help":"Retirement age in years","type":"number","label":"Retirement Age","options":[],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Benefit Details","fields":[{"help":"Briefly state benefits payable on retirement","type":"text","label":"On Retirement of Member","options":[],"required":false,"pdf_field":""},{"help":"Briefly state benefits payable on resignation","type":"text","label":"On Resignation of Member","options":[],"required":false,"pdf_field":""},{"help":"Briefly state benefits payable on death","type":"text","label":"On Death of Member","options":[],"required":false,"pdf_field":""},{"help":"Any other benefits payable","type":"text","label":"Any Other","options":[],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Contribution Details","fields":[{"help":"Select scheme type","type":"choice","label":"Scheme Type","options":["DB Scheme","DC Scheme (Only DC scheme is applicable under IndiaFirst Life Group UL Superannuation Plan)"],"required":false,"pdf_field":""},{"help":"Enter contribution amount in rupees","type":"amount","label":"Contribution Amount ₹","options":[],"required":false,"pdf_field":""},{"help":"Enter risk premium amount in rupees","type":"amount","label":"Risk Premium Amount ₹","options":[],"required":false,"pdf_field":""},{"help":"Enter total premium amount in rupees","type":"amount","label":"Total Premium ₹","options":[],"required":false,"pdf_field":""},{"help":"Cheque number for payment","type":"text","label":"Cheque No. :","options":[],"required":false,"pdf_field":""},{"help":"Date of cheque in DDMMYYYY format","type":"date","label":"Cheque Date :","options":[],"required":false,"pdf_field":""},{"help":"Amount on cheque in rupees","type":"amount","label":"Cheque Amount :","options":[],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Fund Details","fields":[{"help":"Specify percentage and amount for each fund: Group Growth Advantage Fund, Group Secure Capital Fund, Group Money Market Fund","type":"table","label":"Choose below funds if applying for IndiaFirst Life Group UL Superannuation Plan. Fund Name % Amount","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage and amount for each fund: Equity Advantage Fund, Dynamic Moderator Fund, Bond Fund, Cash Fund","type":"table","label":"Choose below funds if applying for IndiaFirst Employee Benefit Plan. Fund Name % Amount","options":[],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Investment Strategy Details (Applicable only for IndiaFirst Life Group UL Superannuation Plan)","fields":[{"help":"Select if opting for this strategy","type":"checkbox","label":"Systematic Transfer Option","options":["Systematic Transfer Option"],"required":false,"pdf_field":""},{"help":"Select if opting for this strategy","type":"checkbox","label":"Automatic Trigger Based Investment Strategy","options":["Automatic Trigger Based Investment Strategy"],"required":false,"pdf_field":""},{"help":"Select if opting for this strategy (only for DC scheme)","type":"checkbox","label":"Age Based Asset Allocation Strategy","options":["Age Based Asset Allocation Strategy"],"required":false,"pdf_field":""}],"filled_by":"employer or proposed master policyholder"},{"title":"Declaration by the Master Policyholder","fields":[{"help":"Signature of Trustee 1 or authorized signatory 1","type":"signature","label":"Trustee 1/ Authorised Signatory1","options":[],"required":true,"pdf_field":""},{"help":"Signature of Trustee 2 or authorized signatory 2","type":"signature","label":"Trustee 2/ Authorised Signatory2","options":[],"required":true,"pdf_field":""},{"help":"Signature of Trustee 3 or authorized signatory 3","type":"signature","label":"Trustee 3/ Authorised Signatory3","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing in DDMMYYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposed master policyholder","type":"signature","label":"Proposed Master Policyholder's Signature*","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing in DDMMYYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposed master policyholder and trustees/authorized signatories"},{"title":"Material Facts Disclosure","fields":[{"help":"If yes, provide details on a separate sheet","type":"yes-no","label":"Are there any other material facts you should disclose","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposed master policyholder"}],"deadlines":[],"applies_to":"IndiaFirst Employee Benefit Plan and IndiaFirst Life Group UL Superannuation Plan","attachments":["Copy of the Scheme Rules","Trust Deed","Deed of variation","Details of the members proposed to be covered in electronic format"],"declarations":["The group declaration form, member proposal form and alive statement form the basis of issuance of the policy.","The applicant agrees to provide all necessary information to determine cover and premiums.","The applicant agrees to furnish member details, medical reports and declarations as required.","This application and related documents form the basis of the Group Policy Contract.","The insurer may void the policy in case of fraud, misrepresentation or material non-disclosure.","Any policy changes by endorsement will be binding on all members and beneficiaries.","Premiums are not generated from proceeds of crime as per applicable laws.","Completion of this application does not guarantee policy issuance.","The applicant confirms understanding of the insurance contract and application content."],"dropped_labels":0},"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/1791-group-employee-benefit-form-master-application-form"}