{"id":322,"title":"SECTION 8 - 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/Comprehensive_Home_Protector_Policy-Claim_Form.pdf","sha256":"9611d93495302203ae5ca6ddb71a2c6d7113f242f3da56d84555b40583571fb7","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for filing a personal accident insurance claim under the Comprehensive Home Protector Policy. It is filled by the claimant or their representative.","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.","Submit duly filled and signed claim form."],"title":"SECTION 8 - PERSONAL ACCIDENT INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claim Details","fields":[{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Issue","options":[],"required":null,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Specify the coverage limits as per your policy","type":"text","label":"Limits of Liability under the Policy","options":[],"required":null,"pdf_field":""},{"help":"Provide the exact date and time when the accident occurred","type":"date","label":"Date and Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Write full names of all claimants","type":"text","label":"Name of Claimant (in full) [If claimants are more than one, state names of all]","options":[],"required":true,"pdf_field":""},{"help":"Provide complete postal address of the claimant","type":"text","label":"Full Postal Address","options":[],"required":true,"pdf_field":""},{"help":"State your relationship to the deceased if applicable","type":"text","label":"Relationship of Claimant with the deceased (in case of a death claim)","options":[],"required":null,"pdf_field":""},{"help":"Mention the specific benefit claimed under the policy","type":"text","label":"State the benefit of the policy under which the claim is preferred","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Particulars of the Insured Person","fields":[{"help":"Full name of the insured person","type":"text","label":"i) Name (in full)","options":[],"required":true,"pdf_field":""},{"help":"Address of the insured person","type":"text","label":"ii) Postal Address","options":[],"required":true,"pdf_field":""},{"help":"Occupation of the insured person at time of accident","type":"text","label":"iii) Occupation","options":[],"required":null,"pdf_field":""},{"help":"Age in years","type":"number","label":"iv) Age at the time of the accident","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Accident Details","fields":[{"help":"Date and time of accident","type":"date","label":"When did the accident happen? (Please give date and exact time)","options":[],"required":true,"pdf_field":""},{"help":"Location of accident","type":"text","label":"Where did the accident happen?","options":[],"required":true,"pdf_field":""},{"help":"Describe how the accident occurred and injuries","type":"text","label":"Please give full description of the accident, its cause and injuries sustained","options":[],"required":true,"pdf_field":""},{"help":"Provide details if death occurred","type":"text","label":"State date, time and place of death (in case of a death claim)","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Additional Information","fields":[{"help":"Date and source of information about accident","type":"text","label":"On which date did the claimant receive information with regard to the accident and from whom?","options":[],"required":null,"pdf_field":""},{"help":"Provide contact details of two witnesses","type":"text","label":"Please give the names and addresses of two persons who witnessed the accident","options":[],"required":null,"pdf_field":""},{"help":"State any infirmities if present","type":"text","label":"Was the Insured person free from infirmity at the time of accident? If not, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the Insured person under the influence of drugs or alcohol at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the Claimant satisfied that the death was directly due to the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Medical treatment facility details","type":"text","label":"Please give the names and addresses of the Hospital, Clinic or Nursing Home where the Insured Person was treated after the accident.","options":[],"required":null,"pdf_field":""},{"help":"Name of attending doctor or surgeon","type":"text","label":"The Medical Practioner / Surgeon who attended on the Insured Person after the accident","options":[],"required":null,"pdf_field":""},{"help":"Name of regular doctor if applicable","type":"text","label":"Regular Physician of the Insured Person, if any","options":[],"required":null,"pdf_field":""},{"help":"Details of other accident insurance policies if any","type":"text","label":"Does the Insured Person have any other Accident Insurance on his life? If so, state the name of the Insurer/s and amount/s claimed.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declarations and Signatures","fields":[{"help":"Signature of a witness to the claim","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Signature of the claimant","type":"signature","label":"Signature of Claimant","options":[],"required":true,"pdf_field":""},{"help":"Name of claimant signing","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Address of claimant signing","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant and witness"}],"deadlines":[],"applies_to":"Personal accident insurance claims under the Comprehensive Home Protector Policy","attachments":["Death Certificate from the Hospital or the Medical Attendant (in case of death claim)","Post Mortem Certificate (in case of death claim)","Police Panchanama (if there is any, in case of death claim)"],"declarations":["All statements made on this form are true to the best of the claimant's knowledge and belief.","If any false or fraudulent statement, suppression or concealment is made, the claim shall be forfeited and the policy null and void."],"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/322-section-8-personal-accident-insurance-claim-form"}