{"id":31,"title":"Claim Form- Acko Life Group Credit Protect","purpose":"claim","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Claim_form_Acko_Life_Group_Credit_Protect_f53d5da7c8.pdf","sha256":"2bb228b610e0e011f57e0fa8b0e20b6ba6e30c9f82b1554ffc9848c8fca205a2","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for filing a death claim under the Acko Life Group Credit Protect insurance policy. It is filled by the claimant or their guardian/appointee.","notes":["Form must be filled by claimant or guardian/appointee if claimant is minor.","Claims under multiple policies can be registered with a single form providing all policy numbers.","All supporting documents must be self-attested by nominee.","Claim payments will be made only through electronic fund transfer.","No fee or commission should be paid to anyone to process this claim.","Ensure address, phone number and email ID are current and active for correspondence.","Mask first 8 digits of Aadhaar number if submitted as KYC proof.","Submit a cancelled personalized cheque or latest bank statement/passbook copy with NEFT mandate.","For NRE accounts, submit bank statement or confirmation letter as evidence of premium payment through NRE account.","In case of proportionate payout to NRE and non-NRE accounts, provide two NEFT mandates.","Acko Life Insurance Ltd. reserves the right to ask for more information/documents if required."],"title":"Claim Form- Acko Life Group Credit Protect","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Master Policy Holder Details","fields":[{"help":"","type":"text","label":"Master Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Master Policyholder Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the life insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Member Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loan Account No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Assured (INR)","options":[],"required":null,"pdf_field":""},{"help":"Enter the date coverage started","type":"date","label":"Coverage Start date","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Original Loan Amount (INR)","options":[],"required":null,"pdf_field":""},{"help":"Last employer details if applicable","type":"text","label":"Name of the Company","options":[],"required":false,"pdf_field":""},{"help":"Last employer contact person if applicable","type":"text","label":"Name of contact person","options":[],"required":false,"pdf_field":""},{"help":"Last employer contact number if applicable","type":"phone","label":"Contact No","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Death Claim","fields":[{"help":"","type":"date","label":"Date of Death","options":[],"required":null,"pdf_field":""},{"help":"Enter time of death","type":"text","label":"Time of Death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Death","options":[],"required":null,"pdf_field":""},{"help":"Describe the immediate cause of death","type":"text","label":"Exact/Immediate Cause of Death","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Rider Claim (Critical Illness/ Total and Permanent Disability or Terminal Illness)","fields":[{"help":"Specify the illness type","type":"text","label":"Type of Illness","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Diagnosis","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Nature of Illness and Habit of the Insured","fields":[{"help":"","type":"checkbox","label":"Hypertension","options":["Hypertension"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Diabetes","options":["Diabetes"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Heart disease","options":["Heart disease"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Liver disease","options":["Liver disease"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Kidney disease","options":["Kidney disease"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Cancer","options":["Cancer"],"required":false,"pdf_field":""},{"help":"Specify other illness if any","type":"text","label":"Other","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Smoking","options":["Smoking"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Tobacco","options":["Tobacco"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Drugs","options":["Drugs"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Alcohol","options":["Alcohol"],"required":false,"pdf_field":""},{"help":"Provide duration and quantity if any habit is checked","type":"text","label":"If yes, Duration & Quantity of consumption","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of Diagnosis of illness","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Other Insurance Details (Life/Mediclaim/Health)","fields":[{"help":"Enter other insurance policy numbers if any","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Name of other insurance company","type":"text","label":"Company Name","options":[],"required":false,"pdf_field":""},{"help":"Sum assured under other policies","type":"amount","label":"Sum Assured","options":[],"required":false,"pdf_field":""},{"help":"Status of other policies","type":"text","label":"Policy Status","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Claimant","fields":[{"help":"","type":"text","label":"Claimant Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Phone number of claimant","type":"phone","label":"Contact No","options":[],"required":null,"pdf_field":""},{"help":"Email address of claimant","type":"email","label":"Office & / or Personal Email ID","options":[],"required":false,"pdf_field":""},{"help":"Select relation and specify if Others","type":"choice","label":"Relation with the Life Assured","options":["Spouse","Children","Parents","Others"],"required":null,"pdf_field":""},{"help":"Provide PAN or Form 60 details","type":"text","label":"Claimant's PAN/Form 60 details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Politically exposed person","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes, fill FATCA / CRS certification","type":"yes-no","label":"US Person","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claimant NEFT Mandate/ Bank Account Details","fields":[{"help":"Enter bank account number for claim payment","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Name of bank account holder","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""},{"help":"Bank name and branch details","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account Type","options":["Savings","Current","NRO","NRE"],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC","options":[],"required":null,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Authorization by Claimant","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration to be made by a Third Person","fields":[{"help":"Name of the person explaining the form","type":"text","label":"Name of the Declarant","options":[],"required":null,"pdf_field":""},{"help":"Address of the declarant","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of the declarant","type":"signature","label":"Signature of third Person","options":[],"required":null,"pdf_field":""}],"filled_by":"third person"}],"deadlines":[],"applies_to":"death claims under group credit protect policies","attachments":["Copy of the original death certificate issued by local authority","Claimant's PAN CARD","Claimant's ID and address proof","Cancelled cheque/Bank passbook","Medical cause of death certificate (if death due to illness)","Medical records for all treatments taken in the past (Admission notes, History / Progress sheet, Discharge / Death summary, Test reports, etc.)","First Information Report (FIR) (if accidental death)","Panchnama / Inquest report (if accidental death)","Post-mortem report (PMR) (if accidental death)","Police Final Report (if accidental death)","Viscera report (if applicable)","Newspaper cutting(s), if any","Others as applicable"],"declarations":["All details provided are true and correct to the best of claimant's knowledge.","Submission of this form does not guarantee claim admission; claim payable after document verification.","Photocopy of declaration has same purpose as original.","Nominee(s) authorize insurer to pay outstanding loan amount to Master Policyholder and balance to nominee(s), discharging insurer from further liability.","Claimant authorizes insurer to obtain medical, employment or other information required for claim processing.","Claimant authorizes insurer to share and obtain information/documents from various entities for claim processing.","Claimant acknowledges Aadhaar details will be used for authentication and KYC verification with consent.","Claimant confirms all information furnished is true, correct and complete and consents to Aadhaar verification methods."],"dropped_labels":0},"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/31-claim-form-acko-life-group-credit-protect"}