{"id":256,"title":"Group Personal Accident Insurance Claim Form","purpose":"claim","insurer":{"slug":"iffco-tokio-general-insurance","name":"IFFCO TOKIO General Insurance Company Limited"},"source_pdf":"https://www.iffcotokio.co.in/content/dam/iffcotokio/iffco-pdf/sites/default/files/pdf/Group%20Personal%20Accident%20Insurance%20Claim%20Form.pdf","sha256":"42d09311bd5b2db008856ef38c0977c4c9594514b55ebdc3c24eb464c19ccd80","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for claiming benefits under a Group Personal Accident Insurance policy. It is filled by the claimant or the insured person in case of injury or death due to an accident.","notes":["Fill in all blanks and provide complete details","If space is insufficient, attach a separate sheet","This form is issued without prejudice to the policy terms and is not an admission of liability"],"title":"Group Personal Accident Insurance Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Person Details","fields":[{"help":"","type":"text","label":"Policy No./ Sr. No. of Schedule","options":[],"required":null,"pdf_field":""},{"help":"Full name and address of the insured person","type":"text","label":"Name & Address of the Insured Person (who has suffered injury / died in accident)","options":[],"required":null,"pdf_field":""},{"help":"Age of the insured person","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"Occupation of the insured person","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Claimant Details","fields":[{"help":"Fill Sr. No., Full Name, Address, Relationship with Insured","type":"table","label":"Particulars of Claimant/(s) (to be filled in case other than insured person)","options":[],"required":null,"pdf_field":""},{"help":"Specify the claimant's title or basis of claim","type":"text","label":"Title under which the claimant is claiming","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (if other than insured person)"},{"title":"Accident Details","fields":[{"help":"Date and how the information about the accident was received","type":"text","label":"Date & Mode of Receipt of Information","options":[],"required":null,"pdf_field":""},{"help":"Date when the accident occurred","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Time when the accident occurred","type":"text","label":"Time of Accident","options":[],"required":null,"pdf_field":""},{"help":"Place where the accident happened","type":"text","label":"Exact Location of Accident","options":[],"required":null,"pdf_field":""},{"help":"Brief description of how the accident happened","type":"text","label":"Description of Accident","options":[],"required":null,"pdf_field":""},{"help":"Reason or cause of the accident","type":"text","label":"Cause of Accident","options":[],"required":null,"pdf_field":""},{"help":"Provide names and addresses of two witnesses","type":"table","label":"Name & Address of at least 2 Witnesses","options":[],"required":null,"pdf_field":""},{"help":"Describe the injuries sustained","type":"text","label":"Extent of Injury","options":[],"required":null,"pdf_field":""},{"help":"If applicable, date and time of death","type":"text","label":"Date & Time of Death","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Medical Details","fields":[{"help":"Hospital name and address","type":"text","label":"Name/Add of Hospital (where injured was treated)","options":[],"required":null,"pdf_field":""},{"help":"Name and address of the attending doctor","type":"text","label":"Name/Add of Doctor (who attended injured)","options":[],"required":null,"pdf_field":""},{"help":"Name and address of the insured person's family doctor","type":"text","label":"Name/Add of his Family Doctor","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Claim Details","fields":[{"help":"Amount being claimed under the policy","type":"amount","label":"Amount Claimed","options":[],"required":null,"pdf_field":""},{"help":"Provide Name & Address of Company, Policy No., Sum Insured","type":"table","label":"Details of Other Existing Insurances","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Declaration","fields":[{"help":"Sign and date to confirm accuracy of information","type":"signature","label":"I, undersigned confirm that above given details are true & correct to the best of my knowledge","options":[],"required":true,"pdf_field":""},{"help":"Name of the person signing","type":"text","label":"Name:","options":[],"required":true,"pdf_field":""},{"help":"Signature of the claimant or insured person","type":"signature","label":"Signature:","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or insured person"}],"deadlines":["Please return this form, duly filled & signed, within 7 days from the date of its issuance"],"applies_to":"Group Personal Accident Insurance claims","attachments":["Copy of Death Certificate/Post Mortem Report / Police Panchnama / Medical Certificate, whichever is applicable"],"declarations":["The claimant confirms that the details provided are true and correct to the best of their knowledge"],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"policy issuing Branch","label":"Walk in claim intimation","level":null,"hours":"Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays)","applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"65 days.\nToll No. 1800-103-5499\nWalk in\nShall you wish to intimate your claim in person, please feel free to visit your policy issuing Branch Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays). Please refer to our\nBranch Locator\nfor information on our","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@iffcotokio.co.in","label":"Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"se\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-103-5499","label":"Toll free","level":null,"hours":"24 X 7","applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"engali\nKannada\nAssamese\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengal","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"56161","label":"SMS “CLAIM” to 56161","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"avor to take customer service at newer heights, we now bring claim Intimation at your fingertips. Please SMS “CLAIM” to 56161 and one of our Claims representatives will get in touch with you in 4 Working Hours.\n* Note:\nPlease have all the detail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"whatsapp","value":"7993407777","label":"Say Hi to IRA","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"est\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya\nCustomer Login\nAgent Login","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/iffco-tokio-general-insurance/256-group-personal-accident-insurance-claim-form"}