{"id":638,"title":"FORM C - Certificate of Identity","purpose":"claim","insurer":{"slug":"indusind-nippon-life-insurance","name":"IndusInd Nippon Life Insurance Company Limited"},"source_pdf":"https://www.indusindnipponlife.com/documents/34625/224924/claim-form-c-certificate-of-identity.pdf","sha256":"d501bcb723a4ba54f0f93ffe2c20e4885f898a998ce7d8ac341bf2ac4033bcbb","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is to be completed and signed by a person associated with, but not related to, the Deceased or Claimant, who attended the burial or cremation of the deceased to certify the identity of the deceased.","notes":["This form must be completed by a person associated with but not related to the deceased or claimant who attended the burial or cremation.","Use full and accurate details to avoid delays.","Beware of spurious phone calls and fraudulent offers; lodge police complaints if received."],"title":"FORM C - Certificate of Identity","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of the Deceased and Burial/Cremation","fields":[{"help":"","type":"text","label":"Name of the Life Assured","options":[],"required":null,"pdf_field":""},{"help":"Enter the date in DD/MM/YYYY format","type":"date","label":"Date of Death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of Death","options":[],"required":null,"pdf_field":""},{"help":"Enter age in years","type":"number","label":"Age at Death","options":[],"required":null,"pdf_field":""},{"help":"Specify duration if known","type":"text","label":"Duration of Illness","options":[],"required":null,"pdf_field":""},{"help":"Specify duration or relationship period","type":"text","label":"How long was the deceased/Life Assured known to you?","options":[],"required":null,"pdf_field":""},{"help":"Describe your relationship with the deceased","type":"text","label":"Relationship with Life Assured","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were you present at the time of death of the Life Assured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were you present at the final rites of the Life Assured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was he/she buried or cremated?","options":["Buried","Cremated"],"required":null,"pdf_field":""},{"help":"Full address including road name, landmark, city, state, and pin code","type":"text","label":"Please provide address of the burial or cremation ground where the last rites were performed","options":[],"required":null,"pdf_field":""},{"help":"Enter the date in DD/MM/YYYY format","type":"date","label":"Date of burial/cremation","options":[],"required":null,"pdf_field":""},{"help":"Provide occupation and employer/business address if applicable","type":"text","label":"If the deceased/Life Assured was employed, mention his occupation and the address of the Employer / Business","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you aware that the deceased/Life Assured was insured with IndusInd Nippon Life Insurance","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"declarant (person attending burial/cremation)"},{"title":"Declaration and Declarant Details","fields":[{"help":"Check to certify the declaration","type":"checkbox","label":"I certify that the body which was buried or cremated was that of the person named above (Deceased/Life Assured), and do hereby declare that the foregoing statements are true and correct to the best of my knowledge and belief.","options":["I agree"],"required":true,"pdf_field":""},{"help":"Full name of the declarant","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Declarant's occupation","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"Full address including building, flat no., road name, landmark, city, state, and pin code","type":"text","label":"Correspondence Address/ Usual place of residence","options":[],"required":true,"pdf_field":""},{"help":"Date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place where the form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Declarant","options":[],"required":true,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Email address of the declarant","type":"email","label":"Email Address","options":[],"required":false,"pdf_field":""}],"filled_by":"declarant"}],"deadlines":[],"applies_to":"","attachments":[],"declarations":["The declarant certifies that the body buried or cremated was that of the named deceased.","The declarant declares that all statements made are true and correct to the best of their knowledge and belief."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Claims Department, Office no. 701 & 702, 7th floor, Silver Metropolis, Off Western Express Highway, Goregaon East, Mumbai – 400063","label":"Claims Department postal address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.indusindnipponlife.com/claims","quote":"nearest\nINLIC branch\nfor in-person assistance.\nEmail scanned documents at\nclaims@indusindnipponlife.com\n.\nCourier to\n: Claims Department, Office no. 701 & 702, 7th floor, Silver Metropolis, Off Western Express Highway, Goregaon East, Mumbai – 400063.\nIn case of assistance, contact us on\n1800 102 3330\nor email us on\ncustomerservice@indusindnipponlife.com\nTrack A Claim","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims@indusindnipponlife.com","label":"Claims Department email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.indusindnipponlife.com/claims","quote":"ou Can Register your claim easily:\nVisit your nearest\nINLIC branch\nfor in-person assistance.\nEmail scanned documents at\nclaims@indusindnipponlife.com\n.\nCourier to\n: Claims Department, Office no. 701 & 702, 7th floor, Silver Metropolis, Off Western Express Highway, Gore","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 102 3330","label":"Claims Helpline","level":null,"hours":null,"applies_to":"all","source_url":"https://www.indusindnipponlife.com/claims","quote":"r, Silver Metropolis, Off Western Express Highway, Goregaon East, Mumbai – 400063.\nIn case of assistance, contact us on\n1800 102 3330\nor email us on\ncustomerservice@indusindnipponlife.com\nTrack A Claim\nFile a Claim\nLiving Benefits / Rider Claims\nGet the","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-nippon-life-insurance/638-form-c-certificate-of-identity"}