{"id":340,"title":"CLAIM FORM\nIndiaFirst Pradhan Mantri Jeevan Jyoti Bima Yojana","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/claims/claimform-pmjjby-individual.pdf","sha256":"621c71f032a615feb44681711c2ff673324f65f0425c381c93853cc7a156055b","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for claiming the insurance benefit under the IndiaFirst Pradhan Mantri Jeevan Jyoti Bima Yojana scheme. It is to be filled by the claimant or the nominee (or guardian/appointee if nominee is minor) and the bank.","notes":["In case the nominee is a minor, the guardian/appointee may fill in the claim form.","Attach a copy of cancelled cheque if available.","Revenue stamp is required on the discharge receipt."],"title":"CLAIM FORM\nIndiaFirst Pradhan Mantri Jeevan Jyoti Bima Yojana","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant and Nominee Details","fields":[{"help":"","type":"text","label":"NAME OF THE SCHEME :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"ADDRESS OF THE NOMINEE :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"NAME OF THE DECEASED MEMBER :","options":[],"required":null,"pdf_field":""},{"help":"Name of the nominee","type":"text","label":"NAME OF NOMINEE * :","options":[],"required":true,"pdf_field":""},{"help":"Account number of the deceased member","type":"text","label":"SAVINGS BANK ACCOUNT NO. OF DECEASED MEMBER:","options":[],"required":null,"pdf_field":""},{"help":"Aadhaar number of the deceased if available","type":"text","label":"AADHAR NO. OF DECEASED (if available):","options":[],"required":false,"pdf_field":""},{"help":"Date when the member joined the scheme","type":"date","label":"DATE OF ENTRY INTO SCHEME BY MEMBER :","options":[],"required":null,"pdf_field":""},{"help":"Aadhaar number if available","type":"text","label":"AADHAR NO. IF AVAILABLE:","options":[],"required":false,"pdf_field":""},{"help":"Policy number under the scheme","type":"text","label":"POLICY NO. :","options":[],"required":null,"pdf_field":""},{"help":"Bank details of the deceased member","type":"text","label":"FULL NAME AND ADDRESS OF THE BANK :","options":[],"required":null,"pdf_field":""},{"help":"Date when the member died","type":"date","label":"DATE OF DEATH OF MEMBER :","options":[],"required":null,"pdf_field":""},{"help":"Reason for death","type":"text","label":"CAUSE OF DEATH :","options":[],"required":null,"pdf_field":""},{"help":"Relationship of nominee to the deceased member","type":"text","label":"RELATIONSHIP OF NOMINEE:","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of the nominee","type":"phone","label":"MOBILE NO. OF THE NOMINEE:","options":[],"required":null,"pdf_field":""},{"help":"Bank account details of the nominee","type":"text","label":"DETAILS OF SAVINGS BANK ACCOUNT OF NOMINEE:","options":[],"required":null,"pdf_field":""},{"help":"IFSC code of the nominee's bank branch","type":"text","label":"IFSC CODE:","options":[],"required":null,"pdf_field":""},{"help":"Savings bank account number of the nominee","type":"text","label":"SAVINGS BANK ACCOUNT NO. :","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant / nominee / guardian / appointee"},{"title":"Declaration and Signature","fields":[{"help":"Signature of the claimant or nominee","type":"signature","label":"Signature of the Nominee* /Claimant","options":[],"required":true,"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":""}],"filled_by":"nominee / claimant / guardian / appointee"},{"title":"Discharge Receipt for Payment","fields":[{"help":"Policy number","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Name of the bank","type":"text","label":"Name of the Bank:","options":[],"required":null,"pdf_field":""},{"help":"Name(s) of claimant(s) acknowledging receipt","type":"text","label":"I/We, ______________________________________________________do hereby acknowledge receipt from the IndiaFirst Life Insurance Company Limited., a sum of Rs.2,00,000/- (Rupees Two lakhs only) in full satisfaction and discharge of all our claim/s under the above policy on the life of Mr./Ms. _______________________________________, covered under this scheme under Savings Bank Account No.,_________________________________________.","options":[],"required":true,"pdf_field":""},{"help":"Date of receipt","type":"date","label":"Dated at ____________ this __________ day of _____ 20","options":[],"required":null,"pdf_field":""},{"help":"Name of witness","type":"text","label":"Witness:","options":[],"required":null,"pdf_field":""},{"help":"Signature of claimant or nominee","type":"signature","label":"Signature of the Nominee* /Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"nominee / claimant"},{"title":"Details of Nominee / Appointee (if nominee is minor)","fields":[{"help":"Name of guardian or appointee","type":"text","label":"Name :","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of nominee","type":"phone","label":"MOBILE NO. OF THE NOMINEE:","options":[],"required":null,"pdf_field":""},{"help":"Email address of nominee","type":"email","label":"E-mail Id:","options":[],"required":false,"pdf_field":""},{"help":"Bank account number of nominee","type":"text","label":"Bank Account No. :","options":[],"required":null,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name of the Bank :","options":[],"required":null,"pdf_field":""},{"help":"Bank branch","type":"text","label":"Branch:","options":[],"required":null,"pdf_field":""},{"help":"Address of bank branch","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"IFSC code of bank branch","type":"text","label":"IFSC Code :","options":[],"required":null,"pdf_field":""},{"help":"Signature of guardian/appointee","type":"signature","label":"Signature of the Nominee* /Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"guardian / appointee"}],"deadlines":[],"applies_to":"claims under IndiaFirst Pradhan Mantri Jeevan Jyoti Bima Yojana","attachments":["Copy of cancelled cheque to be attached (if available)","Revenue Stamp"],"declarations":["The member was covered under the scheme and premium was debited from his bank account on the renewal date prior to his death and remitted to IndiaFirst Life Insurance Company Limited.","The nominee named is as per the bank's records for the insured member.","The claimant acknowledges receipt of the sum of Rs. 2,00,000/- in full satisfaction and discharge of all claims under the policy."],"dropped_labels":0},"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/340-claim-form-indiafirst-pradhan-mantri-jeevan-jyoti-bima-yojana"}