{"id":647,"title":"Claim Form A - Waiver of Premium Payment","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+A+-+WOPP_BPD.pdf","sha256":"fa9e7f57b44d348e24a5a7419380510e3d0dcbb81b5f9d0987698546eb087780","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant to apply for waiver of premium payment under a life insurance policy after the death of the proposer. The claimant fills this form.","notes":["All answers to be in BLOCK LETTERS without dots or dashes.","Use original policy schedule and AML/KYC documents as enclosures.","Beware of spurious phone calls and fraudulent offers; lodge police complaint if received.","The form is to be completed by the claimant or a declarant if claimant is unable."],"title":"Claim Form A - Waiver of Premium Payment","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant and Proposer Details","fields":[{"help":"Enter the date of filling the form in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter full name in block letters without dots or dashes","type":"text","label":"Name of Claimant","options":[],"required":null,"pdf_field":""},{"help":"Enter full address including flat no., building, road, landmark, district, city, state, pin code","type":"text","label":"Correspondence Address/ Usual place of residence","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email Address","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the deceased or proposer","type":"text","label":"Name of the Deceased/Proposer","options":[],"required":null,"pdf_field":""},{"help":"Specify your relationship to the proposer","type":"text","label":"Relationship of Claimant to Proposer","options":[],"required":null,"pdf_field":""},{"help":"Select the applicable title","type":"choice","label":"Nature of title under which the claim for Policy Monies is submitted: Nominee/Assignee/Trustee/Others","options":["Nominee","Assignee","Trustee","Others"],"required":null,"pdf_field":""},{"help":"Enter the policy number for which claim is made","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter client number if available","type":"text","label":"Client Number","options":[],"required":false,"pdf_field":""},{"help":"Provide Policy Number, Date of Commencement, Sum Assured, Name of the Company for each policy","type":"table","label":"Mention details of all other Policies on the Life of the deceased taken with other companies which has now resulted in a death claim","options":[],"required":false,"pdf_field":""},{"help":"Enter date of death in DD/MM/YYYY format","type":"date","label":"Date of Death of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Enter age of proposer at death","type":"number","label":"Age at Death","options":[],"required":null,"pdf_field":""},{"help":"Describe cause of death","type":"text","label":"Cause of Death of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Enter employer details if applicable","type":"text","label":"Name & Address of Business/Employer of Proposer","options":[],"required":false,"pdf_field":""},{"help":"Provide doctor and hospital details","type":"text","label":"Name of the doctor and address of the hospital where the proposer was last treated","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"Date of signature in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Enclosures","fields":[{"help":"Tick if enclosing original policy schedule","type":"checkbox","label":"I am enclosing herewith Original Policy Schedule","options":["Yes"],"required":null,"pdf_field":""},{"help":"Witness must sign here","type":"signature","label":"Signature of the Witness","options":[],"required":null,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Claimant must sign here","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of witness","type":"text","label":"Name of the Witness","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration by Declarant (if form filled by other than claimant)","fields":[{"help":"Enter full name of the person filling form on behalf of claimant","type":"text","label":"Name of the Declarant","options":[],"required":null,"pdf_field":""},{"help":"Declarant must sign here","type":"signature","label":"Signature of the Declarant (in English)","options":[],"required":null,"pdf_field":""},{"help":"Date of declarant signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""}],"filled_by":"declarant"}],"deadlines":[],"applies_to":"waiver of premium payment claims under life insurance policies","attachments":["Original Policy Schedule","AML/KYC Document of Claimant"],"declarations":["The claimant declares that the statements made in this claim form are true and correct to the best of their knowledge and belief.","The claimant authorizes any doctor, hospital, employer, police or related authorities to provide information to IndusInd Nippon Life Insurance for claim consideration.","If the claimant cannot read, write or speak English, another person may complete the form on their behalf and must declare that the form contents were explained and understood."],"dropped_labels":5},"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/647-claim-form-a-waiver-of-premium-payment"}