{"id":316,"title":"Claim Form- IFFCO-Tokio Drone Rakshak Insurance Policy","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/claim-form-IFFCO-Tokio-drone-rakshak-insurance-policy-(Death-and-PTD).pdf","sha256":"f95303b04ccd02813bee42a4e925c9e35772f287024f3b481cb19aa5a40465fa","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person or claimant to file a claim under the Drone Rakshak Insurance Policy for death, permanent total disablement, or hospitalization expenses due to accident.","notes":["Fill all details in CAPITAL letters.","In case space provided is insufficient, attach a separate sheet.","Attach self-attested photocopies of KYC documents.","Attach proof of bank details (Cancelled Cheque or Bank Passbook Copy).","Annexure I (Medical Certificate) must be filled by the treating doctor.","Use original documents as required.","This form is issued without prejudice to the terms and conditions of the policy and does not admit liability."],"title":"Claim Form- IFFCO-Tokio Drone Rakshak Insurance Policy","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Person’s Details and Accident Information","fields":[{"help":"Tick the appropriate benefit for which claim is made","type":"choice","label":"Claim under which Benefits (Please Tick the Appropriate Box)","options":["Accidental Death","Permanent Total Disablement (PTD)","Hospitalization Expenses due to Accident"],"required":true,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Enter full name of the claimant","type":"text","label":"Claimant Name","options":[],"required":true,"pdf_field":""},{"help":"Enter full name of the insured person","type":"text","label":"Insured Name","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter city name","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email Address","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Tick applicable KYC document and specify if other","type":"checkbox","label":"KYC Details (Please attach self-attested photo copies)","options":["PAN No.","AADHAR No.","Any other (Please Specify)"],"required":true,"pdf_field":""},{"help":"Enter number of the selected KYC document","type":"text","label":"KYC Document Number","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Accident / Incident","options":[],"required":true,"pdf_field":""},{"help":"Enter time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":true,"pdf_field":""},{"help":"Describe the accident or incident","type":"text","label":"Details of Accident / Incident","options":[],"required":true,"pdf_field":""},{"help":"Enter address where accident/incident occurred","type":"text","label":"Accident/Incident Address","options":[],"required":true,"pdf_field":""},{"help":"Enter city of accident/incident","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter state of accident/incident","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter pin code of accident/incident location","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Has the loss been reported to Policy Authority?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain reason if loss not reported","type":"text","label":"If No reason for not reporting","options":[],"required":false,"pdf_field":""},{"help":"Enter FIR number if applicable","type":"text","label":"First Information Report No (F.I.R)","options":[],"required":false,"pdf_field":""},{"help":"Enter MLC number if applicable","type":"text","label":"Medico Legal Case No (MLC)","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Is there any Accidental Hospitalization?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter admission date in DD/MM/YYYY format","type":"date","label":"If Yes, Please Confirm Date of Admission","options":[],"required":false,"pdf_field":""},{"help":"Enter admission time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":false,"pdf_field":""},{"help":"Enter discharge date in DD/MM/YYYY format","type":"date","label":"Date of Discharge","options":[],"required":false,"pdf_field":""},{"help":"Enter discharge time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":false,"pdf_field":""},{"help":"Enter hospital name if hospitalized","type":"text","label":"Name of the Hospital","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Details of Other Insurance","fields":[{"help":"Fill details for each other insurance policy: Name of Insured Person, Policy No., Name of Insurance Co., Sum Insured, Period of Insurance (From, To)","type":"table","label":"Details of others Insurance","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Details of Nominee and Payee","fields":[{"help":"Enter nominee's full name (if insured is deceased)","type":"text","label":"Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"Enter relationship of nominee with insured","type":"text","label":"Relationship with Insured","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's address","type":"text","label":"Nominee Address","options":[],"required":false,"pdf_field":""},{"help":"Enter city of nominee","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"Enter state of nominee","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter pin code of nominee","type":"number","label":"Pin code","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's email","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's mobile number","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name for claim payment","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code of bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Tick the document submitted as proof of bank details","type":"checkbox","label":"In Support of Bank Details (Please tick the proof submitted)","options":["Cancelled Cheque","Bank Passbook Copy"],"required":true,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Declaration","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the account holder","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter full name of account holder","type":"text","label":"Name of Account holder","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or account holder"},{"title":"Hospital and Treating Doctor Details","fields":[{"help":"Enter hospital address","type":"text","label":"Address of the Hospital","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital city","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital state","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital pin code","type":"number","label":"Pin code","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital email","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital contact number","type":"phone","label":"Contact No","options":[],"required":false,"pdf_field":""},{"help":"Enter name of treating doctor","type":"text","label":"Name of the Treating Doctor","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant or hospital"},{"title":"Annexure I (Medical Certificate)","fields":[{"help":"Enter date of certificate in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Doctor to sign and stamp here","type":"signature","label":"Signature of the Doctor with Stamp","options":[],"required":true,"pdf_field":""},{"help":"Enter patient’s full name","type":"text","label":"Name of the Patient","options":[],"required":true,"pdf_field":""},{"help":"Enter inpatient registration number if any","type":"text","label":"IP Registration No","options":[],"required":false,"pdf_field":""},{"help":"Tick appropriate gender","type":"choice","label":"Gender","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Enter patient’s date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Enter admission date in DD/MM/YYYY format","type":"date","label":"Date of Admission","options":[],"required":true,"pdf_field":""},{"help":"Enter admission time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":true,"pdf_field":""},{"help":"Enter discharge date in DD/MM/YYYY format","type":"date","label":"Date of Discharge","options":[],"required":true,"pdf_field":""},{"help":"Enter discharge time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":true,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Hospitalization due to Injury","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe cause of injury hospitalization","type":"text","label":"If Yes Please give cause","options":[],"required":false,"pdf_field":""},{"help":"Describe cause of accident or incident","type":"text","label":"Cause of Accident / Incident","options":[],"required":true,"pdf_field":""},{"help":"Describe injuries sustained","type":"text","label":"Details of Injuries sustained","options":[],"required":true,"pdf_field":""},{"help":"Tick yes or no if permanent total disablement","type":"yes-no","label":"Nature of Disablement Permanent Total Disablement","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe disablement details","type":"text","label":"Details of Disablement","options":[],"required":false,"pdf_field":""},{"help":"Describe treatment given","type":"text","label":"Details of Treatment Given","options":[],"required":true,"pdf_field":""},{"help":"Enter start date of confinement","type":"date","label":"According to Doctor, how long should the patient be confined to bed/house, as the direct and sole consequence of the Injury sustained? From","options":[],"required":true,"pdf_field":""},{"help":"Enter end date of confinement","type":"date","label":"To","options":[],"required":true,"pdf_field":""},{"help":"Enter total amount claimed","type":"amount","label":"Total Claimed Amount","options":[],"required":true,"pdf_field":""},{"help":"Enter doctor’s full name","type":"text","label":"Name of the Treating Doctor","options":[],"required":true,"pdf_field":""},{"help":"Enter doctor’s qualifications","type":"text","label":"Qualifications","options":[],"required":true,"pdf_field":""},{"help":"Enter doctor’s registration number","type":"text","label":"Registration No","options":[],"required":true,"pdf_field":""},{"help":"Enter hospital address","type":"text","label":"Address of Hospital","options":[],"required":true,"pdf_field":""},{"help":"Enter hospital city","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter hospital state","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter hospital pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter hospital contact number","type":"phone","label":"Contact Details","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital email","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""}],"filled_by":"treating doctor"}],"deadlines":["Please return this form, duly filled & signed within 15 days from the date of occurrence"],"applies_to":"Claims under Drone Rakshak Insurance Policy for Accidental Death, Permanent Total Disablement (PTD), and Hospitalization Expenses due to Accident","attachments":["Self-attested photocopies of KYC documents","Proof of bank details (Cancelled Cheque or Bank Passbook Copy)","Medical Certificate (Annexure I) filled by Treating Doctor"],"declarations":["The information furnished in this claim form is true and correct to the best of the claimant's knowledge and belief.","If any false or untrue statement, suppression or concealment of material fact is made, the right to claim reimbursement shall be forfeited.","Consent and authorization is given to seek necessary information/documents from hospital, medical practitioner, police, bank, or network provider.","All documents for the purpose of this claim have been included."],"dropped_labels":1},"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/316-claim-form-iffco-tokio-drone-rakshak-insurance-policy"}