{"id":260,"title":"PRAVASI BHARATIYA BIMA YOJANA 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/Pravasiya%20Bharatiya%20Bima%20Yojana_Claim%20Form.pdf","sha256":"2b24dc6f454fbfa9b7a93c4bdd91645e281b1e7c57847fac2e4af329bdec708b","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person (emigrant) or claimant to file a claim under the Pravasi Bharatiya Bima Yojana insurance policy for personal accident, hospitalization, loss of employment, or litigation expenses.","notes":["Please return this Form duly completed together with relevant Reports/Bills/Certificates from concerned authorities."],"title":"PRAVASI BHARATIYA BIMA YOJANA CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Person Details","fields":[{"help":"","type":"text","label":"POLICY NUMBER","options":[],"required":null,"pdf_field":"Text 6"},{"help":"","type":"text","label":"CLAIM NUMBER","options":[],"required":null,"pdf_field":"Text 25"},{"help":"Full name of the insured emigrant","type":"text","label":"a) Name of the Emigrant (Insured Person)","options":[],"required":null,"pdf_field":"Text 41"},{"help":"Age in years","type":"number","label":"b) Age","options":[],"required":null,"pdf_field":"Text 26"},{"help":"Full residential address","type":"text","label":"c) Address","options":[],"required":null,"pdf_field":"Text 27"},{"help":"Current occupation of the insured person","type":"text","label":"d) Occupation","options":[],"required":null,"pdf_field":"Text 28"},{"help":"Passport number of the insured person","type":"text","label":"e) Passport Number","options":[],"required":null,"pdf_field":"Text 29"},{"help":"Passport validity date","type":"date","label":"f) Valid upto","options":[],"required":null,"pdf_field":"Text 30"},{"help":"Work permit details if applicable","type":"text","label":"g) Details of work permit","options":[],"required":null,"pdf_field":"Text 31"},{"help":"Name of employer or sponsor abroad","type":"text","label":"h) Name of the employer/sponsor","options":[],"required":null,"pdf_field":"Text 32"},{"help":"Location of employment","type":"text","label":"i) Place of work/employment","options":[],"required":null,"pdf_field":"Text 33"}],"filled_by":""},{"title":"Personal Accident Claim","fields":[{"help":"Name of the insured person involved in accident","type":"text","label":"a) Name of the Insured Person.","options":[],"required":null,"pdf_field":"Text 43"},{"help":"Location of accident","type":"text","label":"b) Where did the accident occur?","options":[],"required":null,"pdf_field":"Text 44"},{"help":"Describe injuries and attach medical report","type":"text","label":"c) Give full details of injuries sustained with medical report.","options":[],"required":null,"pdf_field":"Text 46"},{"help":"Indicate if insured was under influence","type":"yes-no","label":"d) Was the person under the influence of drug/alcohol at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":"Text 53"},{"help":"Provide witness details","type":"text","label":"e) Give name and address of witness to accident.","options":[],"required":null,"pdf_field":"Text 60"},{"help":"Provide post-mortem details if applicable","type":"text","label":"f) Details of Post-mortem. (In case of death of person, separate Medical Report, Post-mortem Report and Death Certificate are to be enclosed)","options":[],"required":null,"pdf_field":"Text 61"},{"help":"Attach medical and employment loss certificates","type":"text","label":"g) In case of permanent total disablement the Medical Report regarding extent of injury, the percentage of loss of physical capacity and loss of employment certificate to be enclosed.","options":[],"required":null,"pdf_field":"Text 62"},{"help":"Provide transport details and bills","type":"text","label":"h) Details of transportation of dead body to India and supporting bills.","options":[],"required":null,"pdf_field":"Text 63"},{"help":"Attach certificate and cost details from Indian Mission/Post","type":"text","label":"i) In case the transportation of dead body is arranged by Indian Mission/Post, then please attach certificate and details of cost incurred by them.","options":[],"required":null,"pdf_field":"Text 64"},{"help":"Name of attendant accompanying the body","type":"text","label":"j) Name of the Attendant accompanying.","options":[],"required":null,"pdf_field":"Text 65"},{"help":"Provide cost details with bills","type":"amount","label":"k) Amount of cost incurred for transportation of mortal remains with supporting bills and cost of return airfare for Attendant including the particulars of place covered in the journey.","options":[],"required":null,"pdf_field":"Text 66"}],"filled_by":""},{"title":"Hospitalisation Details","fields":[{"help":"Name of patient","type":"text","label":"a) Name of the Insured Person or family member (in respect of whom claim is made).","options":[],"required":null,"pdf_field":"Text 67"},{"help":"Age of patient","type":"number","label":"b) Present completed age.","options":[],"required":null,"pdf_field":"Text 68"},{"help":"Relationship to insured emigrant","type":"text","label":"c) Relationship with the Emigrant (Insured Person).","options":[],"required":null,"pdf_field":"Text 69"},{"help":"Describe illness or injury","type":"text","label":"d) Nature of disease/illness contracted or injury sustained, including Maternity claim.","options":[],"required":null,"pdf_field":"Text 70"},{"help":"Date when injury or illness started","type":"date","label":"e) Date of injury sustained or disease/illness first detected.","options":[],"required":null,"pdf_field":"Text 71"},{"help":"Hospital or nursing home details","type":"text","label":"f) Name and address of the Hospital/Nursing Home.","options":[],"required":null,"pdf_field":"Text 72"},{"help":"Admission date (DD/MM/YYYY)","type":"date","label":"g) Date of admission.","options":[],"required":null,"pdf_field":"Text 73"},{"help":"Discharge date (DD/MM/YYYY)","type":"date","label":"h) Date of discharge.","options":[],"required":null,"pdf_field":"Text 74"},{"help":"Provide expense details with supporting documents","type":"amount","label":"i) Details of expenses incurred. (supporting Bills/Receipts/Cash Memos along with Discharge Summary are to be enclosed to this Claim Form)","options":[],"required":null,"pdf_field":"Text 75"}],"filled_by":""},{"title":"Loss/Termination of Employment","fields":[{"help":"Explain why employment ended","type":"text","label":"a) Reasons for loss/termination of employment.","options":[],"required":null,"pdf_field":"Text 76"},{"help":"Provide reasons certified by Indian Mission/Post","type":"text","label":"b) Reasons for not being employed by the Employer. (should be certified by the concerned Indian Mission/Post)","options":[],"required":null,"pdf_field":"Text 77"}],"filled_by":""},{"title":"Litigation Details","fields":[{"help":"Describe litigation and costs","type":"text","label":"Nature of litigation and amount incurred including details of litigation","options":[],"required":null,"pdf_field":"Text 78"},{"help":"Lawyer's name","type":"text","label":"Name of lawyer","options":[],"required":null,"pdf_field":"Text 79"},{"help":"Court location","type":"text","label":"Place of court","options":[],"required":null,"pdf_field":"Text 80"},{"help":"Date suit was filed (DD/MM/YYYY)","type":"date","label":"Date of filing suit","options":[],"required":null,"pdf_field":"Text 81"}],"filled_by":""},{"title":"Previous Losses","fields":[{"help":"Provide details of previous similar claims","type":"text","label":"Has the Insured Person sustained similar loss(es) prior to this loss? If yes, give details of Insurer and claim amount.","options":[],"required":null,"pdf_field":"Text 82"}],"filled_by":""},{"title":"Details of Amount Claimed","fields":[{"help":"Enter amount claimed under section A","type":"amount","label":"A.","options":[],"required":null,"pdf_field":"Text 83"},{"help":"Enter amount claimed under section B","type":"amount","label":"B.","options":[],"required":null,"pdf_field":"Text 84"},{"help":"Enter amount claimed under section C","type":"amount","label":"C.","options":[],"required":null,"pdf_field":"Text 85"}],"filled_by":""},{"title":"Declaration and Signature","fields":[{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date","options":[],"required":null,"pdf_field":"Text 86"},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":"Text 87"},{"help":"Sign here","type":"signature","label":"Signature of Insured Person","options":[],"required":true,"pdf_field":""}],"filled_by":"insured person"}],"deadlines":[],"applies_to":"","attachments":["Relevant Reports/Bills/Certificates from concerned authorities","Medical Report","Post-mortem Report","Death Certificate","Loss of employment certificate","Supporting Bills for transportation of dead body","Certificate and cost details from Indian Mission/Post if transportation arranged by them","Supporting Bills/Receipts/Cash Memos along with Discharge Summary for hospitalisation","Separate sheet for furnishing relevant litigation details"],"declarations":["The issue of this Form does not constitute admission of liability.","I/we declare that the above information furnished are correct in all aspects."],"dropped_labels":0},"pdf_fields":[{"name":"Text 6","page":1,"type":"text"},{"name":"Text 25","page":1,"type":"text"},{"name":"Text 41","page":1,"type":"text"},{"name":"Text 26","page":1,"type":"text"},{"name":"Text 27","page":1,"type":"text"},{"name":"Text 28","page":1,"type":"text"},{"name":"Text 29","page":1,"type":"text"},{"name":"Text 30","page":1,"type":"text"},{"name":"Text 31","page":1,"type":"text"},{"name":"Text 32","page":1,"type":"text"},{"name":"Text 33","page":1,"type":"text"},{"name":"Text 43","page":1,"type":"text"},{"name":"Text 44","page":1,"type":"text"},{"name":"Text 46","page":1,"type":"text"},{"name":"Text 53","page":1,"type":"text"},{"name":"Text 60","page":1,"type":"text"},{"name":"Text 61","page":1,"type":"text"},{"name":"Text 62","page":1,"type":"text"},{"name":"Text 63","page":1,"type":"text"},{"name":"Text 64","page":1,"type":"text"},{"name":"Text 65","page":1,"type":"text"},{"name":"Text 66","page":1,"type":"text"},{"name":"Text 67","page":1,"type":"text"},{"name":"Text 68","page":1,"type":"text"},{"name":"Text 69","page":2,"type":"text"},{"name":"Text 70","page":2,"type":"text"},{"name":"Text 71","page":2,"type":"text"},{"name":"Text 72","page":2,"type":"text"},{"name":"Text 73","page":2,"type":"text"},{"name":"Text 74","page":2,"type":"text"},{"name":"Text 75","page":2,"type":"text"},{"name":"Text 76","page":2,"type":"text"},{"name":"Text 77","page":2,"type":"text"},{"name":"Text 78","page":2,"type":"text"},{"name":"Text 79","page":2,"type":"text"},{"name":"Text 80","page":2,"type":"text"},{"name":"Text 81","page":2,"type":"text"},{"name":"Text 82","page":2,"type":"text"},{"name":"Text 83","page":2,"type":"text"},{"name":"Text 84","page":2,"type":"text"},{"name":"Text 85","page":2,"type":"text"},{"name":"Text 86","page":2,"type":"text"},{"name":"Text 87","page":2,"type":"text"},{"name":"Text 1019","page":2,"type":"text"},{"name":"Text 1020","page":2,"type":"text"},{"name":"Text 1021","page":2,"type":"text"},{"name":"Text 1022","page":2,"type":"text"},{"name":"Text 1023","page":2,"type":"text"},{"name":"Text 1024","page":2,"type":"text"},{"name":"Text 1025","page":2,"type":"text"},{"name":"Text 1026","page":2,"type":"text"},{"name":"Text 1027","page":2,"type":"text"},{"name":"Text 1028","page":2,"type":"text"},{"name":"Text 1029","page":2,"type":"text"},{"name":"Text 1030","page":2,"type":"text"},{"name":"Text 1031","page":2,"type":"text"},{"name":"Button 20","page":2,"type":"button"},{"name":"Button 21","page":2,"type":"button"}],"fillable_pdf":true,"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/260-pravasi-bharatiya-bima-yojana-claim-form"}