{"id":558,"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/claims/claim-intimation-form-death-individual.pdf","sha256":"b9cb5614bd4dcc47a3efead30974f2d27f4d4c922285b22f8767f74b6b313346","pages":3,"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 under an individual life insurance policy.","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.","Please attach this form fully completed along with original death certificate to help process your claim promptly.","IndiaFirst does not demand any fees to process claims; contact customer service if such demand is made.","It is mandatory to provide a cancelled cheque and copy of bank passbook & account statement.","The payout mode selected in this form will be used for all payouts to the claimant.","The company may call for additional documents depending on the cause or nature of claim.","Use block letters to fill the form."],"title":"Claim Intimation form - Death","submit":{"to":"IndiaFirst Life Insurance Company Ltd.","how":"mail","address":"12th and 13th Floor, North [C] Wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai – 400063"},"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":"Full address including city, state, pin code","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":"","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"Age at death in years, months, days","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":"Full address including city, state, pin code","type":"text","label":"Current Residential Address:","options":[],"required":null,"pdf_field":""},{"help":"","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":"Check if claimant is son","type":"checkbox","label":"Son :","options":["Son"],"required":null,"pdf_field":""},{"help":"Check if claimant is daughter","type":"checkbox","label":"Daughter :","options":["Daughter"],"required":null,"pdf_field":""},{"help":"Check if claimant is father","type":"checkbox","label":"Father :","options":["Father"],"required":null,"pdf_field":""},{"help":"Check if claimant is mother","type":"checkbox","label":"Mother :","options":["Mother"],"required":null,"pdf_field":""},{"help":"Check if claimant is spouse","type":"checkbox","label":"Spouse :","options":["Spouse"],"required":null,"pdf_field":""},{"help":"Specify other relationship if applicable","type":"text","label":"Others ( Please specify) :","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Death Benefit Option","fields":[{"help":"Select if death benefit payout as lump sum","type":"checkbox","label":"Lump Sum","options":["Lump Sum"],"required":null,"pdf_field":""},{"help":"Select if payout on monthly basis for 5 years","type":"checkbox","label":"5 years","options":["5 years"],"required":null,"pdf_field":""},{"help":"Select if payout on monthly basis for 10 years","type":"checkbox","label":"10 year","options":["10 year"],"required":null,"pdf_field":""},{"help":"Select if payout on monthly basis for 15 years","type":"checkbox","label":"15 year","options":["15 year"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Assignment details","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the policy assigned?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide assignee name and details if policy assigned","type":"text","label":"If yes, please provide the following assignee’s details","options":[],"required":null,"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":"","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 ofAccident :","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 death due to road accident","type":"checkbox","label":"Road accident:","options":["Road accident"],"required":false,"pdf_field":""},{"help":"Check if accident at home","type":"checkbox","label":"Accident at home:","options":["Accident at home"],"required":false,"pdf_field":""},{"help":"Check if accident at work","type":"checkbox","label":"Accident at work:","options":["Accident at work"],"required":false,"pdf_field":""},{"help":"Check if death due to homicide","type":"checkbox","label":"Homicide:","options":["Homicide"],"required":false,"pdf_field":""},{"help":"Check if other cause, specify below","type":"checkbox","label":"Other:","options":["Other"],"required":false,"pdf_field":""},{"help":"Specify other cause of accident","type":"text","label":"In case of other, please specify:","options":[],"required":false,"pdf_field":""},{"help":"Describe accident circumstances","type":"text","label":"How did the accident occur ?","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Mode of Payment","fields":[{"help":"Select mode for claim payout","type":"choice","label":"Mode of Payment (Mandatory to be Filled):","options":["Direct Credit (Bank of Baroda and Andhra Bank only)","NEFT / RTGS"],"required":true,"pdf_field":""},{"help":"Name of bank for payout","type":"text","label":"Bank name","options":[],"required":true,"pdf_field":""},{"help":"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":"Bank MICR code","type":"text","label":"MICR Code","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"Account holder name as per bank","type":"text","label":"Name as per Bank Records","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"Claimant name for payment","type":"text","label":"Name of the claimant:","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Witness details","fields":[{"help":"","type":"text","label":"Name of Witness:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Claimant:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Details:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"Witness must sign","type":"signature","label":"Name and Signature of the Witness:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Authorization","fields":[{"help":"Claimant must sign to confirm declaration","type":"signature","label":"Name and Signature of the Claimant:","options":[],"required":true,"pdf_field":""},{"help":"Witness must sign","type":"signature","label":"Name and Signature of Witness","options":[],"required":null,"pdf_field":""},{"help":"Declaration to be explained in vernacular language","type":"text","label":"Declaration For signing In Vernacular Or For Uneducated Persons","options":[],"required":null,"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":"Claims process requirements","fields":[{"help":"Tick whichever documents are submitted","type":"table","label":"List of Mandatory Documents required","options":[],"required":true,"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 Life Assured Age proof","Copy of claimant's photo identification proof","current address proof","Nominee PAN Card","FIR/Panchnama/Inquest Report along with the final Police investigation report (if death due to unnatural causes)","Postmortem Report and chemical viscera report (if death due to unnatural causes)","Death summary from 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)","Employer's questionnaire (applicable only for salaried individuals)","Death certificate issued by country of Death (if death abroad)","Embassy confirmation letter / certificate (if death abroad)","Embalmment certificate (if mortal remains repatriated to India)","Copy of passport with visa (if death abroad)"],"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 agree to help IndiaFirst gather any information needed to process this claim.","I declare that the company shall not be responsible for non-credit or delay of payout due to incorrect bank details provided by me.","I take sole responsibility for the correctness of my bank account details."],"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/558-claim-intimation-form-death"}