{"id":25,"title":"ACKO ALL IN ONE SECURE POLICY CLAIM FORM","purpose":"claim","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Acko_All_in_One_Secure_Policy_Claim_form_4da33bc99f.pdf","sha256":"7df9f89030870be381ebe0bcd4c8832fd22e470a25be29f3613c40fce2ebca30","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person or claimant to submit a claim under the Acko All in One Secure Policy.","notes":["Complete the form in CAPITAL LETTERS.","Do not leave any column unanswered; mention 'N/A' if not applicable.","Attach all original witness statements if already obtained.","Attach original blank cancelled cheque signed by payee and PAN card copy for EFT.","Submission of claim form does not imply admission of liability by insurer.","Use original bills and documents as required.","Follow regulatory requirements for NEFT and KYC details.","The form includes sections for multiple covers; fill only those applicable.","The form is 8 pages long; ensure all relevant sections are completed."],"title":"ACKO ALL IN ONE SECURE POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"I. DETAILS OF INSURED","fields":[{"help":"","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Insured Name","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","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":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone number","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Office","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email (Optional)","options":[],"required":false,"pdf_field":""}],"filled_by":"Insured Person / Claimant"},{"title":"II. DETAILS OF THE INSURED IN RESPECT OF WHOM CLAIM IS MADE","fields":[{"help":"","type":"text","label":"Name of claimant","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","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":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone number","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Office","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email (Optional)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy/Certificate No","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Incident","options":[],"required":null,"pdf_field":""},{"help":"Format HH:MM hrs","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Incident","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident in detail","type":"text","label":"Details of Incident","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Whether reported to Police","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if reported to police","type":"text","label":"If Yes, Name, Address and Contact of Police Station","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"First Information Report (FIR) No","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"FIR Date","options":[],"required":null,"pdf_field":""}],"filled_by":"Insured Person / Claimant"},{"title":"III. DETAILS OF WITNESSES","fields":[{"help":"Select Yes or No","type":"choice","label":"Was there any witness to the Incident","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes, provide witness details","type":"text","label":"Name of claimant","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","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":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone number","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Office","options":[],"required":null,"pdf_field":""}],"filled_by":"Insured Person / Claimant"},{"title":"IV. DETAILS OF BENEFITS CLAIMED","fields":[{"help":"Fill Yes or No and claim amount for each cover listed in the form","type":"table","label":"Section Name of the Covers Claim made (Yes/No) Claim Amount (If known)","options":[],"required":null,"pdf_field":""}],"filled_by":"Insured Person / Claimant"},{"title":"VI. DETAILS OF BANK ACCOUNT FOR CLAIM PAYMENT","fields":[{"help":"","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Branch","options":[],"required":null,"pdf_field":""},{"help":"Provide account number for claim payment","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR Code","options":[],"required":null,"pdf_field":""}],"filled_by":"Insured Person / Claimant"},{"title":"VII. DECLARATION","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"Claimant"},{"title":"VIII. DIRECT FUND TRANSFER / EFT MANDATE FORM","fields":[{"help":"Select Yes or No","type":"choice","label":"Would you like to opt for Electronic Fund Transfer as mode of payment?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payee Name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payee Account No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Type of Account","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"IFSC Code of the Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"MICR Code No. of the Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Permanent Account Number (PAN) of Payee","options":[],"required":null,"pdf_field":""},{"help":"Attach original cancelled cheque","type":"attachment","label":"Attach an ORIGINAL BLANK CANCELLED CHEQUE signed by the Payee","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"Attach a PAN CARD copy of Payee","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"Claimant"}],"deadlines":[],"applies_to":"Claims under the Acko All in One Secure Policy","attachments":["All original witness statements if already obtained","Duly filled claim form","Copy of vehicle RC and driver’s license (for Motor Related sections)","Photographs (if required by insurer)","Any other document (if required)","FIR copy (for Key Replacement Cover)","Receipts for replacing locks and/or keys","Repair invoice and job card (for Garage Cash and Loss of Income due to damage of Vehicle)","Proof of vehicle downtime","Income proof","Repair Estimates or Bills of business premise (for Business Shutdown)","Shop License / Registration Certificate","Proof of Business Interruption like Bank statement showing drop in revenue, GST returns, Sales ledgers, Accountant’s certificate (if asked)","Fire Department Report (if applicable)","Municipal/Local Authority Certificate (if applicable)","Documents stating reason for termination/retrenchment/dismissal/Redundancy (for Loss of Income)","Last 3 months salary slips of the Insured Person","Proof of loss of income/Non-employment - Form 26AS and Employee Provident Fund passbook copy","Termination letter and relieving letter from the Employer","Appointment / confirmation letter issued by the Employer","Contact details of human resource personnel","Proof of job profile/role becoming redundant","Current Loan account statement","Marriage Certificate/Proof of marriage (for concurrent loss of income)","Last 3 months Salary Slips for Both","Appointment/Confirmation letter from the employer at the time of Claim for Both","Termination letter of employer for Both","Salary Bank account statement for Both","Copy of FIR filed with police authorities / cyber cell or complaint letter acknowledgement (for Cyber related covers)","Proof of Disabling of Card facility at core banking (for Fraudulent charges on Loss of card)","Card Statement/ Account Statement for last 6 months indicating Fraudulent Transactions/Unauthorized Use and loss liability","Card Copy / Declaration from the Bank/ financial institution","Medical bills in case of bodily injury (for ATM Assault & Robbery)","Original invoice/ proof of purchase of the lost wallet (for Loss of Wallet)","Receipt of cost incurred as replacement costs for the new wallet","Receipts for fee payable to the concerned authorities for new personal papers/cards","Original pre-authorisation request (for Health and Travel Related cover)","Copy of pre-authorisation approval letter(s)","Copy of Photo ID of Insured Person verified by the Hospitals","Original discharge/death summary","Operation theatre notes (if applicable)","Original Hospital main bill and break up bill","Original investigation reports, X Ray, MRI, CT Films, HPE","Medical Practitioner’s reference slips for investigations/pharmacy","Original pharmacy bills","MLC/FIR report/post mortem report (if applicable and conducted)","Original Policy (Wherever applicable) (for Asset Protection related cover)","Invoice of the Equipment/Proof of ownership, care or custody (Wherever applicable)","FIR or Police Complaint Report (for Theft and Burglary or Robbery)","Manufacturer Warranty Certificate (if not submitted during issuance of policy) (for Breakdown)","Proof of non-settlement of defects/breakdown by the OEM (optional)","Invoice or certificate/card issued by wholesaler or retailer or Service Contractor (optional)","Certificate of Uninhabitability (for Temporary Resettlement Expenses Cover)","Boarding and Lodging receipt","Invoices for storage of furniture or valuables","Bills for essential household procurement","Loss Assessment Report by surveyor (if required)","Invoice from packers and movers with GST details","FIR or Police Complaint (for Personal Liability Cover)","Written compensation claim or demand from third party","Identity and Address Proof","Legal Notice or Court Summons","Legal fee proof","Broker ID card (for Brokerage Expenses)","Verified Brokerage Bill","Employment Proof (Appointment Letter or Employment Contract) (for Delay in Salary Payment)","Last 3 Salary Slips preceding the delayed salary month","Employer Confirmation or letter confirming salary delay","Bank Statement showing non-credit of salary for the claimed month","Loan statement / EMI schedule showing EMI due","Copy of the original offer letter from the prospective employer (for Rescinding of Offer Letter)","Formal withdrawal letter or email from the employer rescinding the offer","Self-declaration confirming current unemployment status","Copy of cancelled cheque for bank details","PAN card copy of payee"],"declarations":["The information furnished in this claim form is true, complete and accurate to the best of the claimant's knowledge and belief.","If any false or untrue statement is made or material fact is concealed, the right to claim benefits under the policy shall be forfeited.","Consent is given to Acko General Insurance Ltd to seek necessary documents from the service provider who serviced the person against whom the claim is made.","Submission of documents or bank details or any other information does not imply admission of liability by the company.","The details provided in the EFT mandate form shall be considered final and Acko is not responsible for cross verification.","RTGS/NEFT facility will be effective within 15 days of receipt of mandate form or as reasonably required.","There may be risk of non-payment on the day of credit due to regulatory changes or other reasons beyond Acko's control.","The customer agrees to indemnify Acko and its agents against any claims or losses arising from RTGS/NEFT transactions.","Acko may subcontract agents to carry out obligations under RTGS/NEFT facility.","Customer may terminate RTGS/NEFT facility with 15 days prior written notice to Acko at its corporate address.","Termination notice is effective only after confirmation from Acko.","RTGS/NEFT transactions may attract charges borne by the customer.","Acko may amend terms and conditions with prior notice where feasible.","Notices may be given by hand, email, website, or post to customer's last address.","Terms governed by laws of India with legal proceedings in Mumbai courts."],"dropped_labels":1},"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/25-acko-all-in-one-secure-policy-claim-form"}