{"id":223,"title":"GTI Claim Form","purpose":"claim","insurer":{"slug":"hdfc-ergo-general-insurance","name":"HDFC ERGO General Insurance Company Limited"},"source_pdf":"https://www.hdfclife.com/content/dam/hdfclifeinsurancecompany/customer-services/form-and-download/other-documents/gti-claim-form-aadhar-consent.pdf","sha256":"bdc05f858d47cdf579d6ca0d05a5f0150705f1f2f014df2ac75d85f8f07825de","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by claimants to submit a death or critical illness claim under a group insurance policy. It is filled by the claimant and includes information about the member, claimant, and medical details.","notes":["English translation of vernacular documents is mandatory.","All claim and maturity payments shall be made only through electronic modes of payment.","Submit duly filled NEFT mandate form along with necessary documents.","Any copy of records submitted must be attested as seen and verified with the originals by the Master Policyholder.","Do not prefix country code for phone numbers when contacting HDFC Life.","Use DD/MM/YYYY date format throughout the form."],"title":"GTI Claim Form","submit":{"to":"nearest HDFC Life branch","how":"in person / upload / post","address":""},"purpose":"claim","sections":[{"title":"Section I (Information regarding the Claimant & also if the policy is not assigned)","fields":[{"help":"","type":"text","label":"Group Policyholder","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Beneficiary","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Title","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Include country code if applicable","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Member","options":[],"required":null,"pdf_field":""},{"help":"Fill bank name, account type (Saving/Current), account number, branch name & address, MICR code, IFSC code, and percentage of claim payout (total 100%)","type":"table","label":"NEFT Details","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section II (Information regarding the Member)","fields":[{"help":"","type":"text","label":"Master Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Member No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Master Policyholder Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Employee ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Assured (INR)","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Doctor Name & Address of Clinic/Hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Doctor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of Doctors/Hospital/Clinic Certifying Death","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Consultation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reasons for Consultation","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name & Address of Clinic/Hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Doctor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of Medical Consultant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Exact/Immediate Cause of Death","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Birth of Member","options":[],"required":null,"pdf_field":""},{"help":"Specify duration in days/weeks/months","type":"text","label":"Duration of Last Illness","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Last Working Day","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"For Critical Illness: Type of Illness","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Diagnosis","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section III - Employee Details","fields":[{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of joining the company by member","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"What is the exact nature of employment/job title","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for leaving (if applicable)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was member actively at work?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Fill leave type and absence dates","type":"table","label":"Please provide leave records for member during the last six months: Medical Evidence Received, Type of Leave, Absence To, Absence From","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section IV (Discharge Voucher/ Advance Discharge Voucher)","fields":[{"help":"Signature of Claimant 1","type":"signature","label":"Claimant 1: Mr./Mrs.","options":[],"required":null,"pdf_field":""},{"help":"Signature of Claimant 2","type":"signature","label":"Claimant 2 Mr./Mrs.","options":[],"required":null,"pdf_field":""},{"help":"Signature of Policyholder authorizing cheque drawal","type":"signature","label":"Signature of the Policyholder","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section V (Declaration)","fields":[{"help":"","type":"signature","label":"Signature of Claimant 1","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Claimant 2","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Master policyholder (Authorised Signatory / Company Seal)","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant and master policyholder"},{"title":"Declaration of Claimant & Consent for usage of Aadhaar Information","fields":[{"help":"Use DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section VI – Consent to receive communication from HDFC Life","fields":[{"help":"Signature consenting to receive communications","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claimant Name","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"death claims and critical illness claims under group insurance policies","attachments":["Police records (viz. First Information Report, Panchnama, Inquest Report, Death certificate issued by Municipal Authority, Cause of Death certificate issued by the treating doctor etc.) attested by Police authority","Post Mortem Report attested by hospital authority","Complete medical records (for past and current illness)","Certificate from treating doctor","A cancelled personalised cheque with account holder’s name, account no. and IFSC present or latest bank statement/passbook copy showing these details","Self-attested KYC documents of the Claimant (PAN Card/Form 97 or Form 60, Valid Passport, Voter's identity card, Valid Permanent Driving License, Aadhaar Card with first 8 digits masked)"],"declarations":["Claimants acknowledge receipt of all amounts due and declare full and final settlement of the claim.","Claimants undertake to refund any excess amount credited to their account.","Master policyholder declares the member was included in the policy and confirms the particulars are true and complete.","If the claimant is a minor, the death benefit will be passed to the legal representative.","Claimants consent to provide details and reports as required by HDFC Life for claim processing.","Claimants consent to Aadhaar based KYC and authentication for claim and policy servicing purposes.","Claimants consent to receive communications from HDFC Life via phone, SMS, email, and WhatsApp."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"phone","value":"022 6158 2020","label":"Claim/Policy related queries","level":null,"hours":null,"applies_to":"all","source_url":"https://www.hdfcergo.com/disclaimer-and-privacy-policy/dpp","quote":"usiness District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. For Claim/Policy related queries call us at\n022 6158 2020\nor Visit Help Section on\nwww.hdfcergo.com\nfor policy copy/tax certificate/make changes/register & track claim. IRDAI Re","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"08041763550","label":"Bike Insurance Claim Contact","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.hdfcergo.com/claim/register-bike-insurance-claim/cashless-claims","quote":"Buy\nRenewal\nClaim\nSupport\nOthers\nCall to Buy -\n08041763550\nHelp\nRegister claim online\nView plans now. Buy when you are ready.\nTrack Claim\nClaim already registered?\nClick Here to","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/hdfc-ergo-general-insurance/223-gti-claim-form"}