{"id":1797,"title":"Member Form – IndiaFirst Life Group Living Benefits Plan","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withdrawn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/indiafirst-life-group-living-benefits-plan-member-form-feb-2023-group.pdf","sha256":"bfa4e1a6be1380245473edb7becedab7b4b9c4e3afd63928110ca77cd2bfd596","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by members to apply for coverage under the IndiaFirst Life Group Living Benefits Plan. The primary member fills it, including details for family members if applicable.","notes":["Only a child above 18 years of age can sign the Member Form.","Use correct titles Mr / Ms / Mx as applicable.","Health declaration must be answered truthfully to avoid claim issues.","OTP verification is mandatory and done by Primary Member for all covered lives."],"title":"Member Form – IndiaFirst Life Group Living Benefits Plan","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Communication Address and Insurance Details","fields":[{"help":"","type":"text","label":"Communication Address of the Member (Address to which policy document /COI will be dispatched) LINE 1","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Communication Address of the Member (Address to which policy document /COI will be dispatched) LINE 2","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"CITY","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"STATE","options":[],"required":null,"pdf_field":""},{"help":"Enter postal PIN code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Include country code","type":"phone","label":"Mobile* +(","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Country dialing code","type":"text","label":"Country Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Primary Member","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Client Id:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SMS/RLE Branch Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SMS/RLE LG Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"DSA Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch LG Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Account/Reference No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"MPH Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Transaction No.","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Transaction","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Staff","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"primary member"},{"title":"Details of the Member(s)","fields":[{"help":"Enter full name with title","type":"text","label":"*Primary Member Name: Mr / Ms / Mx FIRST MIDDLE LAST","options":["Mr","Ms","Mx"],"required":true,"pdf_field":""},{"help":"Date of birth in DD/MM/YYYY format","type":"date","label":"DOB:","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender:","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"IndiaFirst Life Group Living Benefits Plan - 143N040V01","type":"text","label":"Product UIN No.","options":[],"required":null,"pdf_field":""},{"help":"Describe occupation","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"Describe nature of duties","type":"text","label":"Nature of duties","options":[],"required":null,"pdf_field":""},{"help":"Select if applicable","type":"yes-no","label":"Is the plan Family Floater? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Fill only if Family Floater is Yes","type":"text","label":"Family Member Details - Spouse Name: Mr / Ms / Mx FIRST MIDDLE LAST","options":["Mr","Ms","Mx"],"required":null,"pdf_field":""},{"help":"Date of birth in DD/MM/YYYY format","type":"date","label":"DOB:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender:","options":["Male","Female","Other"],"required":null,"pdf_field":""},{"help":"Provide PAN or Form 60 number","type":"text","label":"Pan Card / Form 60","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Fill only if Family Floater is Yes","type":"text","label":"#Child 1 Name: Mr / Ms / Mx FIRST MIDDLE LAST","options":["Mr","Ms","Mx"],"required":null,"pdf_field":""},{"help":"Date of birth in DD/MM/YYYY format","type":"date","label":"DOB:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender:","options":["Male","Female","Other"],"required":null,"pdf_field":""},{"help":"Provide PAN or Form 60 number","type":"text","label":"Pan Card / Form 60","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Fill only if Family Floater is Yes","type":"text","label":"#Child 2 Name: Mr / Ms / Mx FIRST MIDDLE LAST","options":["Mr","Ms","Mx"],"required":null,"pdf_field":""},{"help":"Date of birth in DD/MM/YYYY format","type":"date","label":"DOB:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender:","options":["Male","Female","Other"],"required":null,"pdf_field":""},{"help":"Provide PAN or Form 60 number","type":"text","label":"Pan Card / Form 60","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Columns: Sum Insured, Premium, Pay Frequency, Coverage Term (Months) for each coverage type","type":"table","label":"Coverage","options":[],"required":null,"pdf_field":""}],"filled_by":"primary member"},{"title":"Health Declaration for Member(s)","fields":[{"help":"Answer for each member if they have had any listed medical conditions in last 4 years","type":"yes-no","label":"Health Declaration for Member(s) (Non disclosures or misrepresentation of facts will highly impact claim settlement)*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter nominee full name","type":"text","label":"Nominee/ Appointee Details* Nominee Name","options":[],"required":true,"pdf_field":""},{"help":"Enter percentage share for nominee","type":"number","label":"Percentage Share","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of nominee","type":"date","label":"DOB of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Relationship of nominee to insured","type":"text","label":"Relationship with Life Assured","options":[],"required":true,"pdf_field":""},{"help":"If nominee is minor, provide appointee name","type":"text","label":"Appointee Name (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"Date of birth of appointee","type":"date","label":"Appointee DOB","options":[],"required":false,"pdf_field":""},{"help":"Relationship of appointee to nominee","type":"text","label":"Relationship with Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"primary member and family members"},{"title":"Declaration by the Member(s)","fields":[{"help":"OTP verification by Primary Member for all lives covered","type":"text","label":"OTP Verified","options":[],"required":true,"pdf_field":""}],"filled_by":"primary member and family members"}],"deadlines":[],"applies_to":"IndiaFirst Life Group Living Benefits Plan","attachments":[],"declarations":["Answers in the Health Declaration are true and complete and form basis of contract.","Failure to disclose material facts may lead to cancellation under Section 45 of Insurance Act.","Consent given for due diligence and data sharing with authorities for verification and servicing.","Authorization given to seek medical information from doctors/hospitals for underwriting and claims.","Agreement that risk commences only on acceptance of proposal by the Company.","Consent to exclude family members who answered 'No' in health declaration from coverage.","OTP verification creates legally binding agreement with the Company.","Section 41 of Insurance Act prohibits inducement rebates on insurance premiums or commissions.","Section 45 of Insurance Act allows policy to be questioned within 3 years for fraud or misstatement."],"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/1797-member-form-indiafirst-life-group-living-benefits-plan"}