{"id":660,"title":"Individual - Death Claim 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/Individual_Death_Claim_Form2.pdf","sha256":"17658fdd7bf308ef7748982848bcb93d54d89abab59f5a6d88f0fa1e5f20cf99","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for notifying and claiming death benefits under a life insurance policy. It is to be filled by the policyholder, claimant, nominee, assignee, or legal heirs as applicable.","notes":["Every field should be properly, correctly and completely filled up","This form is for all death claims where waiver of premiums rider has been opted for","If the policyholder, assignee or nominee is deceased, the legal heirs must fill the form","The company may call for additional information or documents as needed","This form is only an intimation of claim and not admission of claim by the company","Submit original death certificate at branch for verification","Use block letters where applicable","Company does not charge any fees for claim processing; beware of unauthorized agencies charging fees"],"title":"Individual - Death Claim Form","submit":{"to":"nearest branch or Claims Department at Kotak Mahindra Life office address","how":"in person or by post","address":"Kotak Mahindra Life Insurance Company Ltd, Registered Office: 3rd Floor, Plot # C- 12, G- Block, BKC, Bandra (E), Mumbai - 400 051, Maharashtra, India. Office: 9th floor, Intellion Square TRIL IT 4, Off Western Express Highway, General A K Vaidya Marg, Malad (E), Mumbai - 400 097"},"purpose":"claim","sections":[{"title":"Instructions and Mandatory Documents","fields":[{"help":"Submit the completed claim intimation form.","type":"attachment","label":"Duly filled Death Claim Intimation Form","options":[],"required":true,"pdf_field":""},{"help":"Submit original policy documents.","type":"attachment","label":"Original Policy Documents","options":[],"required":true,"pdf_field":""},{"help":"Submit claimant's photo and address and ID proofs.","type":"attachment","label":"Claimant’s Photograph, Current Address Proof and Photo ID Proof","options":[],"required":true,"pdf_field":""},{"help":"Submit copy; original to be shown at branch for verification.","type":"attachment","label":"Copy of Death Certificate issued by municipality or equivalent authority","options":[],"required":true,"pdf_field":""},{"help":"Submit if Aadhaar is provided.","type":"attachment","label":"Aadhaar Consent Form (In case Aadhaar is submitted)","options":[],"required":false,"pdf_field":""},{"help":"Submit bank proof with account details.","type":"attachment","label":"Copy of Bank Passbook/Copy of Cancelled Cheque/Bank Statement of the claimant bearing Account Number, IFSC code and Beneficiary’s name","options":[],"required":true,"pdf_field":""},{"help":"Submit medical certificate for cause of death.","type":"attachment","label":"Medical certificate stating cause of death","options":[],"required":true,"pdf_field":""},{"help":"Submit all relevant medical records.","type":"attachment","label":"Medical Records (Consultation notes, treatment records, admission notes, hospital indoor papers, discharge / death summary, investigation reports etc)","options":[],"required":true,"pdf_field":""},{"help":"Submit if applicable for unnatural death.","type":"attachment","label":"Copy of duly certified First Information Report /Inquest / Panchnama (translation mandatory in case vernacular language)","options":[],"required":false,"pdf_field":""},{"help":"Submit if applicable for unnatural death.","type":"attachment","label":"Copy of duly certified Post Mortem Report / Chemical Analysis Report (Viscera)","options":[],"required":false,"pdf_field":""},{"help":"Submit if applicable.","type":"attachment","label":"Medical Questionnaire / Physician Statement","options":[],"required":false,"pdf_field":""},{"help":"Submit if applicable.","type":"attachment","label":"Copy of Driving License if the Insured Person was driving the vehicle at the time of accident","options":[],"required":false,"pdf_field":""},{"help":"Attach any other relevant documents as needed.","type":"attachment","label":"Any other Document (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"Policy Details","fields":[{"help":"List all policy numbers related to the insured person.","type":"text","label":"Policy details - (Kindly provide all policy numbers incase if Insured Person had multiple policies)","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of the insured person.","type":"date","label":"Date of Birth:","options":[],"required":true,"pdf_field":""},{"help":"Specify your relationship to the insured person.","type":"text","label":"Relationship with Insured Person:","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Claimant","fields":[{"help":"Full name of the claimant.","type":"text","label":"Name (Full Name)","options":[],"required":true,"pdf_field":""},{"help":"If applicable, maiden name of claimant.","type":"text","label":"Maiden Name (Full Name)","options":[],"required":false,"pdf_field":""},{"help":"Provide current address matching address proof.","type":"text","label":"Communication Address (Current Address Should Match with the Address Proof Provided)","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of claimant.","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Landline number of claimant.","type":"phone","label":"Telephone","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of claimant.","type":"phone","label":"Mobile No","options":[],"required":true,"pdf_field":""},{"help":"Email address of claimant.","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Provide PAN number or Form 60 if PAN not available.","type":"text","label":"Claimant's PAN no. / Form 60","options":[],"required":false,"pdf_field":""},{"help":"Indicate if claimant is a politically exposed person.","type":"choice","label":"Politically Exposed Person","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select your capacity for making the claim.","type":"choice","label":"Capacity in which claim is made","options":["Nominee","Proposer","Appointee","Assignee","Legal Heir","Executor","Trustee","Employer","Others"],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Basic Details of Insured Person","fields":[{"help":"Full name of the insured person.","type":"text","label":"Name (Full Name) (Current)","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of insured person.","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select marital status of insured person.","type":"choice","label":"Marital Status","options":["Single","Married","Divorced","Widowed"],"required":false,"pdf_field":""},{"help":"Educational qualification of insured person.","type":"text","label":"Qualification","options":[],"required":false,"pdf_field":""},{"help":"Select occupation of insured person.","type":"choice","label":"Occupation","options":["Service","Self Employed","Homemaker","Student","Retired","Others (Please Specify)"],"required":false,"pdf_field":""},{"help":"State of residence of insured person.","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Postal code of insured person's address.","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Employment Details of Insured Person","fields":[{"help":"Name of last employer or business.","type":"text","label":"Last Business / Employer Name","options":[],"required":false,"pdf_field":""},{"help":"Address of last employer or business.","type":"text","label":"Address (With landmark)","options":[],"required":false,"pdf_field":""},{"help":"Describe nature of work.","type":"text","label":"Nature of Work","options":[],"required":false,"pdf_field":""},{"help":"Last designation held.","type":"text","label":"Designation","options":[],"required":false,"pdf_field":""},{"help":"Date of last working day.","type":"date","label":"Last Working Day","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Bank Account Details of Claimant","fields":[{"help":"Bank account number for claim payment.","type":"text","label":"Account No.","options":[],"required":true,"pdf_field":""},{"help":"Name of bank where account is held.","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Branch details of bank account.","type":"text","label":"Branch Name & Address","options":[],"required":false,"pdf_field":""},{"help":"IFSC code of bank branch.","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Type of bank account.","type":"choice","label":"Account type","options":["Savings","Current","NRO"],"required":true,"pdf_field":""},{"help":"Consent for electronic payment.","type":"yes-no","label":"I Hereby Give My Consent To Direct Credit / NEFT / RTGS Claim Amount In My Account","options":["NO","YES"],"required":true,"pdf_field":""},{"help":"Select preferred payment option.","type":"choice","label":"Payment Option Details","options":["Lump Sum","Installment (Applicable as per product features)"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Death of Insured Person","fields":[{"help":"Date when insured person died.","type":"date","label":"Date of Death","options":[],"required":true,"pdf_field":""},{"help":"Time of death if known.","type":"text","label":"Time of Death","options":[],"required":false,"pdf_field":""},{"help":"Specify place of death.","type":"text","label":"Place of Death (Hospital, Home, Any other place)","options":[],"required":true,"pdf_field":""},{"help":"Describe cause and circumstances of death.","type":"text","label":"Cause of Death and Event Leading to Death","options":[],"required":true,"pdf_field":""},{"help":"Name of doctor or hospital contacted at death.","type":"text","label":"Doctor / Hospital Contacted at the time of Death","options":[],"required":false,"pdf_field":""},{"help":"Name and details of first medical contact.","type":"text","label":"Details of Doctor / Hospital Contacted first","options":[],"required":false,"pdf_field":""},{"help":"Provide details if death was unnatural (accident, suicide, etc).","type":"text","label":"Details of Unnatural Death","options":[],"required":false,"pdf_field":""},{"help":"Select type of death.","type":"choice","label":"Type of Death (please tick)","options":["Natural","Accidental","Suicide","Murder","Others"],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Past History of Health / Habits of Insured Person","fields":[{"help":"Tick all applicable medical conditions or habits.","type":"checkbox","label":"Nature of medical condition/ habit (Please tick the relevant box)","options":["Kidney Disease","Cancer","Respiratory Disease","Hypertension","Diabetes","Heart Disease","Liver Disease","Alcohol","Smoking","Tobacco","Narcotics in any form","Any other ailments / disorder / surgery / hospitalisation"],"required":false,"pdf_field":""},{"help":"Name of clinic or hospital where treated.","type":"text","label":"Name of Clinic / Hospital","options":[],"required":false,"pdf_field":""},{"help":"Duration or date when condition was first diagnosed.","type":"text","label":"Duration / First Date of Diagnosis","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Family Physician","fields":[{"help":"Name of family physician.","type":"text","label":"Name","options":[],"required":false,"pdf_field":""},{"help":"Address of family physician.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Phone number of family physician.","type":"phone","label":"Telephone","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of family physician.","type":"phone","label":"Mobile No","options":[],"required":false,"pdf_field":""},{"help":"Email of family physician.","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Particulars of Other Life Insurance Policies","fields":[{"help":"Name of other insurer.","type":"text","label":"Name of the Company","options":[],"required":false,"pdf_field":""},{"help":"Policy number of other insurance.","type":"text","label":"Policy No","options":[],"required":false,"pdf_field":""},{"help":"Start date of risk for other policy.","type":"date","label":"Risk Commencement Date","options":[],"required":false,"pdf_field":""},{"help":"Sum assured under other policy.","type":"amount","label":"Sum Assured","options":[],"required":false,"pdf_field":""},{"help":"Status of claim under other policy.","type":"choice","label":"Status of Claim (Paid / Rejected / Pending)","options":["Paid","Rejected","Pending"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Witness Details","fields":[{"help":"Full name of witness.","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Address of witness.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Phone number of witness.","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Relationship of witness to claimant.","type":"text","label":"Relationship with claimant","options":[],"required":false,"pdf_field":""},{"help":"Witness signature.","type":"signature","label":"Signature / of the Witness","options":[],"required":true,"pdf_field":""}],"filled_by":"witness"},{"title":"Scribe Details","fields":[{"help":"Name of scribe if claimant signed in vernacular or thumb impression.","type":"text","label":"Full Name of the Scribe","options":[],"required":false,"pdf_field":""},{"help":"Address of scribe.","type":"text","label":"Complete Address","options":[],"required":false,"pdf_field":""},{"help":"Scribe signature.","type":"signature","label":"Signature of Scribe","options":[],"required":false,"pdf_field":""}],"filled_by":"scribe"},{"title":"Authorisation to Company Representatives to Contact the Claimant & Family","fields":[{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":["Submit original Death Certificate at branch for verification","NAV shall be provided as on the Date of Valid Claim intimation if submitted up to 3 pm or the next working day of the valid claim intimation date"],"applies_to":"All Death Claims – Death of the Life Insured or Death of the Policyholder, where Waiver of Premiums rider has been opted for.","attachments":["Duly filled Death Claim Intimation Form","Original Policy Documents","Claimant’s Photograph, Current Address Proof and Photo ID Proof","Copy of Death Certificate issued by municipality or equivalent authority","Aadhaar Consent Form (In case Aadhaar is submitted)","Copy of Bank Passbook/Copy of Cancelled Cheque/Bank Statement of the claimant bearing Account Number, IFSC code and Beneficiary’s name","Medical certificate stating cause of death","Medical Records (Consultation notes, treatment records, admission notes, hospital indoor papers, discharge / death summary, investigation reports etc)","Copy of duly certified First Information Report /Inquest / Panchnama (translation mandatory in case vernacular language)","Copy of duly certified Post Mortem Report / Chemical Analysis Report (Viscera)","Medical Questionnaire / Physician Statement","Copy of Driving License if the Insured Person was driving the vehicle at the time of accident","Any other Document (Please specify)"],"declarations":["I will bear any tax liability on account of taking the full refund instead of purchasing an annuity","I authorize any physician, hospital or authority to disclose medical information about the deceased to Kotak Mahindra Life Insurance Company Limited","I declare that all information provided is true and correct to the best of my knowledge","I authorize the company and its representatives to contact me and my family for claim related enquiries and will not lodge complaints for such communications"],"dropped_labels":5},"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/660-individual-death-claim-form"}