{"id":224,"title":"Group Claim Form – Non Employer Employee (MFI)","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/group-claim-form-non-employer-employee-MFI.pdf","sha256":"505c26c2852a0b28541eddba7425bf9b8c1bd46980f2093ff1f9b5e3eb86b794","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant (nominee or beneficiary) to claim the death benefit under a group insurance policy for a non-employer employee (Micro Finance Institution).","notes":["Use self-attested copies for documents where specified.","Attach original death certificate issued by municipal authority or gram panchayat.","Attach police and post mortem reports for unnatural deaths.","Cancelled cheque must have printed account holder name, account number and IFSC; if not printed, attach latest 6 months bank statement.","Further documents like Loan Account Statement, Credit Analysis Memorandum (CAM) sheet may be requested by HDFC Life as needed.","For queries, call 022-68446530 (Mon-Sat 10 am to 7 pm) without country code prefix.","Email service@hdfelife.com or nriservice@hdfclife.com for NRI customers.","Signatures and dates are required in multiple sections.","The form is two pages long."],"title":"Group Claim Form – Non Employer Employee (MFI)","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Cause of Death","fields":[{"help":"Tick the appropriate cause of death","type":"choice","label":"Cause of Death (Please tick): Heart Disease Kidney Disease Liver Disease Cancer Accidental Suicide Natural","options":["Heart Disease","Kidney Disease","Liver Disease","Cancer","Accidental","Suicide","Natural"],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Section I - Information regarding the Claimant","fields":[{"help":"","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"11 digit alphanumeric code appearing on your cheque leaf","type":"text","label":"IFSC ^","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Full Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Gender","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Specify your relationship to the insured member","type":"text","label":"Relationship with Member","options":[],"required":null,"pdf_field":""},{"help":"","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":"PAN Number/ Form 97 (corresponding Form 60)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"CKYC Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Lending Institution/Master Policyholder Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Member Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Member No.","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Certificate/Loan Account No.","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of commencement of Risk","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Death","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section II - Instruction-cum-Confirmation-cum Discharge Voucher and Declaration of Claimant","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section III - Declaration to be made by the Third person where the Claimant has affixed his/her thumb impression/has signed in vernacular /has not filled the application","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature of the Third Person","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Name of the person who explained the form contents","type":"text","label":"Declarant Name","options":[],"required":true,"pdf_field":""}],"filled_by":"third person"},{"title":"Section IV – Consent to receive communication from HDFC Life","fields":[{"help":"Sign and date to give consent","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claimant Name","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Section V - Declaration from Master Policyholder","fields":[{"help":"Sign, stamp and date the form","type":"signature","label":"Company Seal and Autorised Signatory / Signature of Master Policyholder","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"master policyholder"},{"title":"Section VI - Declaration and Authorisation & Consent for usage of Aadhaar Information","fields":[{"help":"Sign and date to give consent","type":"signature","label":"Signature of Claimant","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"death claims under group insurance policies for non-employer employees (MFI)","attachments":["Claim Form - Complete filled, signed by claimant & signed, stamped by the Master Policyholder (MPH), as per applicability","Member enrollment form/Member Authorisation form (Lender – Borrower Schemes) (Not applicable for GTI Employer /Employee Claim)","Death Certificate - Issued by Municipal Authority/ Gram Panchayat - under section 12/17 & self attested by the claimant","Nominee/ Beneficiary NEFT details – A Cancelled copy of printed cheque with Account holder's Name, Account No. and IFSC where the cheque is not printed, latest 6 months (Not applicable if the entire payout is towards the Master Policyholder (MPH))","Sum assured Bifurcation - (Sum Assured / Original Loan Amount/Recovery made by Master Policyholder (MPH) towards the loan/Outstanding loan balance as on the date of death) to confirm break up of amount payable to MPH & balance amount payable to Claimant","Police Record – Copy of First Information report, Police Panchnama, Police Inquest report, Final closure report, attested by police authority","Post Mortem report - Copy attested by hospital authority & final Viscera/Chemical analysis report, if preserved for confirming cause of death on the Post Mortem Report","Self-attested copy of the Pan card or KYC document of Life Assured & Nominee","6 months bank statement or copy of passbook with first page and transactions for last 6 months"],"declarations":["Claimant declares receipt of all amounts due and discharges HDFC Life of all liabilities under the policy.","Claimant authorises doctors and others to provide health information of the deceased to HDFC Life.","Nominee(s) confirm eligibility to receive insured amount and authorise payment of outstanding loan to Master Policyholder with balance to claimant.","Claimant confirms accuracy of outstanding loan amount as per credit account statement.","Third person declares that the claimant has signed or affixed thumb impression in their presence after explanation.","Claimant consents to receive communications from HDFC Life via phone, SMS, email, and WhatsApp.","Master Policyholder declares correctness of credit account statement details and authorises claim payout.","Claimant authorises HDFC Life to share and obtain information for servicing policy and claim without specific consent.","Claimant consents to Aadhaar based KYC and authentication for policy servicing and claim purposes.","Claimant undertakes to refund any excess amount credited in error."],"dropped_labels":1},"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/224-group-claim-form-non-employer-employee-mfi"}