{"id":332,"title":"Claim Intimation form - Death","purpose":"claim","insurer":{"slug":"indiafirst-life-insurance","name":"IndiaFirst Life Insurance Company Limited"},"source_pdf":"https://www.indiafirstlife.com/content/dam/ifliwebsite/in/en/download-center/all-product-related-documents/withdrawn-products/claim-intimation-form-death-individual.pdf","sha256":"00cb46f8ac9f288715d4ba4b506c300a066f6489fbe757da1a91fd4e4cb11526","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant to notify the insurer of the death of the life assured and to initiate the death claim process.","notes":["All claim payments will be made through electronic fund transfer only.","Issuance of this form does not amount to admission of any claim or liability by the insurer.","IndiaFirst does not charge any fees to process claims; contact customer service if any such demand is made.","Use original death certificate and mandatory documents as listed.","Provide cancelled cheque and bank passbook copy for bank details verification.","Fill the form completely and sign where required.","If claimant is uneducated or signing in vernacular, a witness declaration is required."],"title":"Claim Intimation form - Death","submit":{"to":"Kindly mail this completely filled form along with the documents","how":"e-mail","address":"customer.first@indiafirstlife.com"},"purpose":"claim","sections":[{"title":"Life Assured’s details","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy number:","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of death:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of death:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of death:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Age at death","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claimant’s Details","fields":[{"help":"","type":"text","label":"Name of the Claimant:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Current Residential Address:","options":[],"required":null,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Contact No: Residential","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E Mail ID:","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claimant’s relationship with the life assured","fields":[{"help":"Select one and specify if Others","type":"choice","label":"Claimant’s relationship with the life assured (Check Relevant Option):","options":["Son","Daughter","Father","Mother","Spouse","Others ( Please specify)"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Death Benefit Option","fields":[{"help":"If no option selected, proposal form option applies","type":"choice","label":"If you want to change the death benefit option, then please select the below mentioned options :","options":["Lump Sum","5 years","10 year","15 year"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Assignment details","fields":[{"help":"","type":"yes-no","label":"Is the policy assigned?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide assignee name and address","type":"text","label":"If yes, please provide the following assignee’s details","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Family/Last Attending Doctor’s details","fields":[{"help":"","type":"text","label":"Name of the doctor/ hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Consultation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for consultation/ admission","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Other doctors/specialists/hospitals consulted","fields":[{"help":"Provide details if applicable","type":"text","label":"Name:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin code:","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Other life insurance details","fields":[{"help":"If any other life insurance policies exist","type":"text","label":"Name of the company","options":[],"required":false,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Issue date","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum assured","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Accident details (in case of death due to accident)","fields":[{"help":"DD MM YYYY format","type":"date","label":"Date of Accident :","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Cause of death:","options":[],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Road accident:","options":["Road accident"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Accident at home:","options":["Accident at home"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Accident at work:","options":["Accident at work"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Homicide:","options":["Homicide"],"required":false,"pdf_field":""},{"help":"Check if applicable and specify","type":"checkbox","label":"Other:","options":["Other"],"required":false,"pdf_field":""},{"help":"Describe other cause","type":"text","label":"In case of other, please specify:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"How did the accident occur ?","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Mode of Payment","fields":[{"help":"","type":"text","label":"Bank name","options":[],"required":true,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Account number","options":[],"required":true,"pdf_field":""},{"help":"Savings/Current etc.","type":"text","label":"Type of account","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"Name exactly as in bank records","type":"text","label":"Name as per Bank Records","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"Attach cancelled cheque and bank passbook/statement copy","type":"attachment","label":"It is mandatory to provide a cancelled cheque and copy of bank pass book & A/C statement.","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Police Investigation details","fields":[{"help":"","type":"text","label":"Police Station:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"FIR/ Case No:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Findings:","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Authorization","fields":[{"help":"","type":"signature","label":"Name and Signature of the Claimant:","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Name and Signature of the Witness:","options":[],"required":true,"pdf_field":""},{"help":"Declaration to be signed by witness if claimant is uneducated or signing in vernacular","type":"text","label":"Declaration For signing In Vernacular Or For Uneducated Persons","options":[],"required":false,"pdf_field":""},{"help":"For vernacular declaration","type":"signature","label":"Name and Signature of the Claimant:","options":[],"required":false,"pdf_field":""},{"help":"For vernacular declaration","type":"signature","label":"Name and Signature of Witness","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"death claims under individual life policies","attachments":["original death certificate","copy of Bank Passbook / Bank Statement","cancelled cheque","Copy of Identification & Address proof of Nominee/Claimant","Copies of First Information Report Duly attested by Police Officials (if death due to unnatural causes)","Copies of Post Mortem Report Duly attested by Police Officials (if death due to unnatural causes)","Copies of Panchanama Report Duly attested by Police Officials (if death due to unnatural causes)","Discharge / Death Summary of Hospital (if treated for illness related to cause of death)","All investigation/Diagnostic Reports (if treated for illness related to cause of death)","Hospital Summary/Indoor Case Sheets (if treated for illness related to cause of death)"],"declarations":["I am the rightful claimant and the details provided are true to the best of my knowledge.","I authorize hospitals, doctors, insurance companies, government organizations and others to provide IndiaFirst with any medical or other information about the deceased.","I am entitled to make these authorizations and will assist IndiaFirst in gathering information to process the claim.","The payout mode selected will be used for all claim payments and the company is not responsible for delays or errors due to incorrect bank details.","I undertake not to hold the company responsible for any transactions affected due to incorrect bank account details provided by me."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"IndiaFirst Life Insurance Company Ltd., 12th and 13th Floor, North [C] wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai – 400063","label":"Claims documents submission address","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"ntative will reach out to you soon to guide you through our life insurance plans that fit your life goals\nHome\nClaims - IndiaFirst Life Insurance\nClaims Overview\nLife Insurance Claim Process\nAt IndiaFirst Life, we stand firmly with our customers in their hour of grief. We provide a streamlined claim registration and settlement process, ensuring a worry-free future for our customers. With a focus on efficiency","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims.support@indiafirstlife.com","label":"Claims support email","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"rstlife.com/claims/claims-overview/register-claim-online\n\"\nEmail:\nShare soft copies of all the mandatory documents at '\nclaims.support@indiafirstlife.com\n'\nCall:\nContact us at 1800-209-8700 for assistance. Our representative will guide you through the claim process registr","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-209-8700","label":"Claims assistance phone","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"\"\nEmail:\nShare soft copies of all the mandatory documents at '\nclaims.support@indiafirstlife.com\n'\nCall:\nContact us at 1800-209-8700 for assistance. Our representative will guide you through the claim process registration.\nVisit Us:\nDrop soft/hard copi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"url","value":"https://www.indiafirstlife.com/claims/claims-overview/register-claim-online","label":"Register your claim online","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"Claim Process\nClaim Documents\nFAQs for Claim\nStep 1. Claim Registration\nAnswer\nOnline:\nRegister your claim online at \"\nhttps://www.indiafirstlife.com/claims/claims-overview/register-claim-online\n\"\nEmail:\nShare soft copies of all the mandatory documents at '\nclaims.support@indiafirstlife.com\n'\nCall:\nContact us at","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/indiafirst-life-insurance/332-claim-intimation-form-death"}