{"id":20,"title":"Death Claim Application Form","purpose":"claim","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Death_Claim_form_b0c0c1aa93.pdf","sha256":"50f3fd50faba710f35b33ca62ba39d2b8eacc6edec395fb1072b57e6aa0298f7","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for submitting a death claim by the claimant or their guardian/appointee to Acko Life Insurance Limited.","notes":["Form should be filled by the claimant only; guardian/appointee may fill if claimant is a minor.","Claims under multiple policies can be registered by filling a single form with all policy numbers.","Ensure address, phone number and email ID are current and active for correspondence.","Submit a cancelled personalised cheque or latest bank statement/passbook copy with NEFT mandate.","Acko Life Insurance Ltd. reserves the right to ask for more information/documents if required."],"title":"Death Claim Application Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Section A- Policy details","fields":[{"help":"Enter all applicable policy numbers if claiming under multiple policies.","type":"text","label":"Policy No(s):","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the life insured:","options":[],"required":null,"pdf_field":""},{"help":"Enter the date of death of the insured.","type":"date","label":"Date of Death:","options":[],"required":null,"pdf_field":""},{"help":"Enter the time of death of the insured.","type":"text","label":"Time of Death:","options":[],"required":null,"pdf_field":""},{"help":"Enter the place where the death occurred.","type":"text","label":"Place of Death:","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of death.","type":"text","label":"Cause of Death:","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name of the claimant.","type":"text","label":"Claimant Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter the claimant's date of birth.","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Enter the claimant's full address.","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter a current and active phone number.","type":"phone","label":"Contact No:","options":[],"required":null,"pdf_field":""},{"help":"Enter a current and active email address.","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"Select the claimant's relation to the life insured; specify if 'Others'.","type":"choice","label":"Relation with the Life Assured:","options":["Spouse","Children","Parents","Others"],"required":null,"pdf_field":""},{"help":"Enter the claimant's PAN number.","type":"text","label":"Claimant's PAN No:","options":[],"required":null,"pdf_field":""},{"help":"Enter the claimant's bank account number for NEFT.","type":"text","label":"Bank Account No. :","options":[],"required":null,"pdf_field":""},{"help":"Enter the name of the bank account holder.","type":"text","label":"Account Holder Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter the bank name and branch.","type":"text","label":"Bank Name & Branch:","options":[],"required":null,"pdf_field":""},{"help":"Select the type of bank account.","type":"choice","label":"Account Type:","options":["Savings","Current"],"required":null,"pdf_field":""},{"help":"Enter the bank's IFSC code.","type":"text","label":"IFSC:","options":[],"required":null,"pdf_field":""},{"help":"Enter the bank's MICR code.","type":"text","label":"MICR:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Authorization by Claimant","fields":[{"help":"Enter the date of signing the declaration.","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter the place of signing the declaration.","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign the form here.","type":"signature","label":"Signature of Claimant:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"","attachments":["Cancelled personalised cheque with the account no. and IFSC or latest bank statement/copy of passbook","Death certificate issued by local authority","Claimant's PAN CARD","Claimant's ID and address proof","Medical cause of death certificate (if death due to illness)","Medical records for all treatments taken in the past (Admission notes, History/Progress sheet, Discharge/Death summary, Test reports, etc.)","First Information Report (FIR) (if accidental death)","Panchnama / Inquest report (if accidental death)","Post-mortem report (PMR) (if accidental death)","Final Police Investigation Report (if accidental death)","Viscera report (if applicable)","Newspaper cutting(s), if any","Others as applicable"],"declarations":["All details provided are true and correct to the best of the claimant's knowledge and nothing material has been concealed.","Submission of this form does not guarantee claim admission; claim payable after due consideration of documents.","A photocopy of this declaration has the same purpose as the original.","Claimant authorizes Acko Life Insurance Ltd. to obtain medical, employment or other information required for claim processing.","Claimant authorizes Acko Life Insurance Ltd. to share and obtain information/documents from various sources for claim processing.","Claimant consents to Aadhaar authentication and use of demographic information for identity and address verification.","Claimant understands alternatives to Aadhaar exist and biometric details will not be stored by Acko Life.","Claimant declares all information furnished is true, correct and complete and will not hold Acko Life responsible for incorrect information.","Claimant consents to verification of physical or electronic Aadhaar copies through QR code or other UIDAI accepted methods."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Claims Department, ACKO LIFE INSURANCE LIMITED., 36/5, Hustle Hub One East, Somasandrapalya, 27th Main Road, Sector 2, HSR Layout, Somasandrapalya HSR 2nd Sector Bus Stop, Bengaluru, Bengaluru Urban, Karnataka, 560102","label":"Claims postal address","level":null,"hours":null,"applies_to":"life","source_url":"https://acko-cms.ackoassets.com/2_Acko_Life_Group_Term_Protect_Micro_Insurance_Master_Policy_Document_ca9093f4de.pdf","quote":"at claims.life@acko.com or by sending the documents to the address mentioned below or any other office of the Company:\nClaims Department, ACKO LIFE INSURANCE LIMITED., 36/5, Hustle Hub One East, Somasandrapalya, 27th Main Road, Sector 2, HSR Layout, Somasandrapalya HSR 2nd Sector Bus Stop, Bengaluru, Bengaluru Urban, Karnataka, 560102\n\nAny person claiming the Death Benefit under this Policy can download the claim request documents from Our website www.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-210-1992","label":"Claims phone number","level":null,"hours":"9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/claims/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nACKO Life Insurance Claims Process\nGroup Claims Process\nClaims Pro","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/acko-life-insurance/20-death-claim-application-form"}