{"id":652,"title":"GROUP INSURANCE DEATH CLAIM INTIMATION FORM - CREDIT POLICIES CLAIM DISCHARGE FORM","purpose":"claim","insurer":{"slug":"kotak-mahindra-life-insurance","name":"Kotak Mahindra Life Insurance Company Limited"},"source_pdf":"https://www.kotaklife.com/assets/images/uploads/how_do_i/Group_Insurance_Death_Claim_Intimation_Form_-_Credit_Policies-Claim_Discharge_Form9.pdf","sha256":"711c64bc199a6354c1318f0295b8efdb673ec20ebdd530376021eb77d23af08b","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for the nominee or policyholder to confirm receipt of the death claim settlement under a group credit policy and to discharge the insurer from further liability.","notes":["This form is to be filled by the nominee or policyholder to confirm receipt of claim settlement.","If the form is filled by a scribe or signed in vernacular language, scribe details and declaration must be provided.","Attach a copy of Aadhaar card for identity verification.","Claim amount received will be adjusted against outstanding loan amount and balance paid to nominee/beneficiary.","Use the contact details provided for any queries."],"title":"GROUP INSURANCE DEATH CLAIM INTIMATION FORM - CREDIT POLICIES CLAIM DISCHARGE FORM","submit":{"to":"Kotak Mahindra Life Insurance Company Ltd.","how":"","address":"Registered Office: 3rd Floor, Plot # C-12, G-Block, BKC, Bandra (E), Mumbai-400 051, Maharashtra, India\nCorporate Office: 9th Floor, Intellion Square (Building No.4), Infinity IT Park, Gen. AK Vaidya Marg, Malad (E), Mumbai 400 097\nEmail id: kli.claimsmitra-group@kotak.com"},"purpose":"claim","sections":[{"title":"Claimant and Scribe Details","fields":[{"help":"Sign or provide thumb impression to confirm receipt of claim settlement","type":"signature","label":"Signature/Thumb impression of the claimant","options":[],"required":null,"pdf_field":""},{"help":"If form is filled by a scribe, scribe must sign","type":"signature","label":"Signature of scribe","options":[],"required":false,"pdf_field":""},{"help":"Name of the person filling the form on behalf of claimant","type":"text","label":"Fullname of scribe:","options":[],"required":false,"pdf_field":""},{"help":"Contact number of the scribe","type":"phone","label":"Contact no:","options":[],"required":false,"pdf_field":""},{"help":"Relationship of scribe to claimant","type":"text","label":"Relation with claimant:","options":[],"required":false,"pdf_field":""},{"help":"Date of declaration by scribe","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Email of scribe","type":"email","label":"Email:","options":[],"required":false,"pdf_field":""},{"help":"Place where form is signed","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of scribe","type":"phone","label":"Mobile:","options":[],"required":false,"pdf_field":""}],"filled_by":"nominee or policyholder; scribe if applicable"},{"title":"Claim and Deceased Member Details","fields":[{"help":"Policy number under which the deceased was covered","type":"text","label":"Credit Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Name of the deceased member","type":"text","label":"Mr./Ms. (the \"deceased Member\")","options":[],"required":null,"pdf_field":""},{"help":"Address of the deceased member","type":"text","label":"residing at","options":[],"required":null,"pdf_field":""},{"help":"Telephone numbers of the deceased member","type":"phone","label":"Tel Nos.","options":[],"required":false,"pdf_field":""},{"help":"Loan agreement number(s) related to the policy","type":"text","label":"Loan Agreement No/s.","options":[],"required":null,"pdf_field":""},{"help":"Date of the loan agreement","type":"date","label":"Dated","options":[],"required":null,"pdf_field":""}],"filled_by":"nominee or policyholder"},{"title":"Nominee / Beneficiary Certification by Policyholder","fields":[{"help":"Amount received towards outstanding loan and balance claim amount","type":"amount","label":"Claim amount received","options":[],"required":null,"pdf_field":""},{"help":"Details of payment mode and cheque number if applicable","type":"text","label":"Electronic transfer / cheque no","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Nominee / Beneficiary Declaration and Consent","fields":[{"help":"Outstanding loan amount payable to master policyholder","type":"amount","label":"Outstanding Loan Amount as on date of death","options":[],"required":null,"pdf_field":""},{"help":"Name of the policyholder","type":"text","label":"Policyholder's name","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Name of the person signing","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Designation of the person signing (if applicable)","type":"text","label":"Designation:","options":[],"required":false,"pdf_field":""},{"help":"Signature of the nominee/beneficiary or authorized person","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"nominee or beneficiary"}],"deadlines":[],"applies_to":"death claims under group credit policies","attachments":["Copy of Aadhaar card"],"declarations":["I confirm this to be the full and final settlement in regard to the death claim and discharge Kotak Mahindra Life Insurance Company Ltd. from any liability under this claim.","I voluntarily submit a copy of my Aadhaar card for identity verification.","I give consent to Kotak Life to verify my Aadhaar through QR code, e-verification or other acceptable methods as per UIDAI guidelines.","I have been informed that my Aadhaar details will be used for KYC purposes only and not for any other purpose unless required by law.","During offline verification, my Name, Age, Gender and address may be verified by Kotak Life.","I may submit other officially valid identity documents instead of Aadhaar."],"dropped_labels":8},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"kli.claimsmitra@kotak.com","label":"Claims Department Email","level":1,"hours":null,"applies_to":"life","source_url":"https://www.kotaklife.com/assets/images/uploads/how_do_i/Kotak_Signature_Legacy_UIN_107N135V01_Policy_Document.pdf","quote":"to the Insurer online from the Insurer’s website; and the Claimant can also write to the Insurer’s claims department at kli.claimsmitra@kotak.com.\nProcedure and Documentation for Death Benefit claims:\nThe Claimant shall submit the claim intimation form along with n","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/kotak-mahindra-life-insurance/652-group-insurance-death-claim-intimation-form-credit-policies-claim-discharge-form"}