{"id":346,"title":"Claim Intimation form - Micro Insurance","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/claim-intimation-form-micro-insurance1.pdf","sha256":"750945492d4ec9dca40651250d3c59c8eb617b306e270931ee1f2b861a989050","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for intimating a claim under a micro insurance policy and is filled by the claimant or nominee of the life assured.","notes":["It is mandatory to provide a cancelled cheque and copy of bank pass book & A/C statement.","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.","Attach this form fully completed along with original death certificate to process the claim promptly.","IndiaFirst does not demand any fees to process claims; contact customer service if such demand is made."],"title":"Claim Intimation form - Micro Insurance","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant's/ Nominee's Details","fields":[{"help":"","type":"email","label":"E Mail ID:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Current Residential Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile:","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD MM YYYY format","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"Check one option 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 or nominee"},{"title":"Member's (Life Assured) Details","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD MM YYYY format","type":"date","label":"Date of death:","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD MM YYYY format","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"Check one option","type":"choice","label":"Cause of death:","options":["Accidental","Non-Accidental","Suicide","Others"],"required":null,"pdf_field":""},{"help":"Check one option","type":"choice","label":"Gender:","options":["Male","Female"],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Master Policyholder's details","fields":[{"help":"","type":"text","label":"Master Policyholder's Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Membership no / Certificate of Insurance no:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Assured:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Account number","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"MICR Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Declaration and Signature by Claimant/ Nominee","fields":[{"help":"","type":"signature","label":"Signature of the Claimant/ Nominee - Mandatory","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature :","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name:","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.:","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD MM YYYY format","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Declaration by Master Policy Holder","fields":[{"help":"","type":"text","label":"Loan Account Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Member","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Original amount of loan (INR)","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Assured for which the member of the group Insurance Policy was Insured (INR)","options":[],"required":null,"pdf_field":""},{"help":"Details of recoveries made","type":"text","label":"Particulars of the recoveries made by the Master Policy Holder","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Outstanding loan Balance as on the date of death (INR)","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Balance claim amount (Difference between the sum assured and outstanding loan balance) payable to the insured on the happening of the other contingent event or to the nominee / beneficiary of the deceased member in case of death (INR)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Nominee","options":[],"required":null,"pdf_field":""}],"filled_by":"master policyholder"}],"deadlines":[],"applies_to":"micro insurance claims","attachments":["cancelled cheque","copy of bank pass book","A/C statement","original death certificate"],"declarations":["The company is not responsible for non-credit or delayed credit of bank account due to incorrect details provided.","The claimant/nominee declares they are the rightful claimant and that the details provided are true and correct.","The claimant/nominee agrees to assist IndiaFirst or its representatives in gathering information to process the claim.","The Master Policy Holder declares the information submitted is true and verified from bank records.","Benefits will be paid to nominee/beneficiary if no authorization is given to pay outstanding loan to Master Policy Holder."],"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/346-claim-intimation-form-micro-insurance"}