{"id":577,"title":"INDUSIND PERSONAL LOAN CARE INSURANCE POLICY - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/indusind-personal-loan-care-insurance-policy-claim-form","sha256":"803f09e2b014bd2d8ea003b7cdc679d0c0d55eea7a40ec9bceea4ae3437d15f5","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the IndusInd Personal Loan Care Insurance Policy for various covered events such as personal accident, critical illness, loss of employment, or child care allowance.","notes":["Fill the form in BLOCK LETTERS.","Attach original cancelled cheque and PAN card copy for bank verification.","All payments to the insured are made only through electronic mode as per IRDAI guidelines.","Attach self-attested Aadhaar card copy if opting for Aadhaar based payment.","Use the date format DD/MM/YYYY where applicable.","The form includes sections for different claim types; fill only the relevant section(s).","Office use only fields are not to be filled by the claimant.","Politically Exposed Person (PEP) declaration is mandatory."],"title":"INDUSIND PERSONAL LOAN CARE INSURANCE POLICY - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"Select appropriate title and enter full name in block letters","type":"text","label":"Name of the Insured","options":["Mr.","Mrs.","Ms.","M/S."],"required":null,"pdf_field":""},{"help":"Enter full address including Flat/Building/Door/Block No., Road/Street/Sector, Nearest Landmark, Area, City, Pin Code, State, Country","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Phone","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN No.","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Select monthly income range","type":"choice","label":"Monthly Income","options":["Upto ` 20,000","` 20,001 to ` 50,000","` 50,001 to ` 1,00,000","` 1,00,001 and above"],"required":null,"pdf_field":""},{"help":"Select profession or occupation","type":"choice","label":"Profession/Occupation","options":["Business","Profession","Salary","Agricultural Income","Savings","Others"],"required":null,"pdf_field":""},{"help":"Indicate if you have a loan account number; if yes, specify it","type":"yes-no","label":"Loan A/C No.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, state name & address of company or companies & amount insured","type":"text","label":"Do you have any other Insurance","options":[],"required":null,"pdf_field":""},{"help":"Select the claim type","type":"choice","label":"Claim pertains to","options":["Personal Accident","Critical Illness","Loss Of Employment","Child Care Allowance"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of the Insured/Claimant - NEFT and Bank Details","fields":[{"help":"Provide NEFT details","type":"text","label":"NEFT details of the Insured/Claimant","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's name","type":"text","label":"Name of Claimant","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's mobile number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter customer name as per bank records","type":"text","label":"Customer Name (As Per Bank Record)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account","options":["Saving","Current"],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch address","type":"text","label":"Address of Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"Pan No","options":[],"required":null,"pdf_field":""},{"help":"Enter 9 digit MICR code from cheque","type":"text","label":"MICR Code (9 digit MICR code number of the bank and branch appearing on the cheque issued by the bank)","options":[],"required":null,"pdf_field":""},{"help":"Enter 11 character IFSC code from cheque leaf","type":"text","label":"IFSC Code (11 character code appearing on your cheque leaf)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Section (A) Personal Accident","fields":[{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of loss / injury","options":[],"required":null,"pdf_field":""},{"help":"Enter time in HH/MM AM/PM format","type":"text","label":"Time Of Accident","options":[],"required":null,"pdf_field":""},{"help":"Enter place of loss or injury","type":"text","label":"Place of loss/injury","options":[],"required":null,"pdf_field":""},{"help":"Describe particulars of loss or injury","type":"text","label":"Particulars of loss/injury","options":[],"required":null,"pdf_field":""},{"help":"Explain reason for injury","type":"text","label":"Reason for injury","options":[],"required":null,"pdf_field":""},{"help":"Describe nature of injury and specify side if applicable","type":"text","label":"Nature of injury received (if to eye or limbs, please state left or right?)","options":[],"required":null,"pdf_field":""},{"help":"Describe nature of disablement","type":"text","label":"Nature of disablement","options":[],"required":null,"pdf_field":""},{"help":"Describe current disability status","type":"text","label":"Present state of disability","options":[],"required":null,"pdf_field":""},{"help":"Provide names, addresses, city, pin code, state, country, and phone of treating physicians and hospitals","type":"text","label":"Names & Addresses of treating physicians & hospitals","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Section (B) Critical Illness","fields":[{"help":"Describe disease, illness, injury or surgery","type":"text","label":"Nature of disease/illness contracted, injury sustained or surgery performed?","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is the disease/illness contracted or surgery performed due to any accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide accident details if applicable","type":"text","label":"If YES, please provide the details of accident","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date on which you first visited a doctor with complaints related to this illness/injury","options":[],"required":null,"pdf_field":""},{"help":"Enter doctor's name","type":"text","label":"Dr. Name","options":[],"required":null,"pdf_field":""},{"help":"Enter hospital name","type":"text","label":"Hospital Name","options":[],"required":null,"pdf_field":""},{"help":"Enter admission date in DD/MM/YYYY format","type":"date","label":"Hospitalisation Details - Date of Admission","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Have you ever been hospitalised before?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Have any of your blood relatives suffered from similar or related illness?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of diagnosis date","type":"text","label":"If YES, give details of when it was initially diagnosed","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Section (C) Loss of Employment","fields":[{"help":"Enter employer's name","type":"text","label":"Name of Employer","options":[],"required":null,"pdf_field":""},{"help":"Enter employer's address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter HR contact details","type":"text","label":"HR Contact details","options":[],"required":null,"pdf_field":""},{"help":"Enter your designation","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"Enter department","type":"text","label":"Department","options":[],"required":null,"pdf_field":""},{"help":"Enter joining date in DD/MM/YYYY format","type":"date","label":"Date of Joining the Organisation","options":[],"required":null,"pdf_field":""},{"help":"Explain reason for separation","type":"text","label":"Reason For Separation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Section (D) Child Allowance","fields":[{"help":"Enter child's name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Enter child's date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Enter birth mark if any","type":"text","label":"Birth Mark","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Aadhaar Based Payment (For Reimbursement claims)","fields":[{"help":"Enter Aadhaar number and attach self-attested copy","type":"text","label":"Aadhaar Card No.","options":[],"required":null,"pdf_field":""},{"help":"Tick to confirm claim amount to be credited to Aadhaar linked bank account","type":"checkbox","label":"I wish to collect claim reimbursement directly in my Bank account linked with my aforementioned Aadhaar Card.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Declarations and Signatures","fields":[{"help":"Enter date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured / Claimant","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"PEP Declaration: Are you a Politically Exposed Person (PEP)?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide position if PEP","type":"text","label":"If yes, please mention the position held","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is any of your close relation or family member a PEP?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please mention the name and relation and the position held by such close relative/family member.","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"}],"deadlines":[],"applies_to":"Claims under IndusInd Personal Loan Care Insurance Policy for Personal Accident, Critical Illness, Loss of Employment, and Child Care Allowance","attachments":["Original cancelled cheque","Copy of PAN card","Self-attested Aadhaar card copy (if Aadhaar based payment is opted)"],"declarations":["The details given are true and correct to the best of my knowledge and belief.","If any information is found incorrect, all rights under the policy will be forfeited.","I agree to provide additional information if required and indemnify the company for any loss due to misstatement.","I agree not to receive any rebate other than that mentioned in the published prospectus as per Insurance Act provisions.","I confirm that all premiums have been/will be paid from bonafide sources and not from proceeds of crime.","The company has the right to call for documents to establish sources of funds.","The company may cancel the insurance contract if found guilty under money laundering laws.","I consent to verification of my KYC and PAN details and accept responsibility for any mismatch consequences.","I will inform the company if I or my close relatives become Politically Exposed Persons (PEPs) in future."],"dropped_labels":5},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"services@indusindinsurance.com","label":"Health Insurance Claims Email","level":1,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"nce Claim\nTravel Insurance Claim\nCommercial Insurance Claim\nSupport\nSign In\nSelf Help\nVideo Chat\nContact Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"indusind@europ-assistance.in","label":"Travel Insurance Claims Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance App\nWebsite:\nOnline Claim Intimation\nOffline Visit:\nLocate your nearest branch\nh","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91 22 48903009","label":"Car Insurance Claim Intimation","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934189","label":"Motor Claims Helpline","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"ation.\nNeed Guidance on Car Coverage?\nTalk to Our Professional Advisors\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nSteps to Take After a Car ​Accident\nThe following steps can expedite the road accident insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934188","label":"Health Claims Helpline","level":null,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"your nearest location.\nExpert health advice you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934184","label":"Travel Claims Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"e you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation\nYour claim gets rejected when you don't gi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+912248903009","label":"Inland Travel Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"rds your registered bank account.\nHow to Contact Us For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 552","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"91-22-67347843","label":"International Travel Helpline (abroad)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 209 5522","label":"International Travel Helpline (in India)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance","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/indusind-general-insurance/577-indusind-personal-loan-care-insurance-policy-claim-form"}