{"id":661,"title":"Death Claim Form - Individual","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/Death_Claim_Form-Individual-Version_Updated.pdf","sha256":"44d66f8f8a80f79162413d985d95e129e9c4bf70e35305a8a001458e9b6ab8a3","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for notifying and claiming death benefits under individual life insurance policies. 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 an intimation of claim and not admittance of claim by the company.","The company may call for additional information or documents as necessary.","The claimant should not pay any fees for claim processing to any agency or person.","If claimant signs in vernacular language or uses thumb impression, scribe details must be filled.","Current address should match the address proof provided."],"title":"Death Claim Form - Individual","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: 8th 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":"Mandatory Documents and Instructions","fields":[{"help":"Attach the completed claim intimation form.","type":"attachment","label":"Duly filled Death Claim Intimation Form","options":[],"required":true,"pdf_field":""},{"help":"Attach original policy documents.","type":"attachment","label":"Original Policy Documents","options":[],"required":true,"pdf_field":""},{"help":"Attach claimant's photo, address proof, and photo ID.","type":"attachment","label":"Claimant’s Photograph, Current Address Proof and Photo ID Proof","options":[],"required":true,"pdf_field":""},{"help":"Attach copy; original to be presented at branch for verification.","type":"attachment","label":"Copy of Death Certificate issued by municipality or equivalent authority","options":[],"required":true,"pdf_field":""},{"help":"Attach if Aadhaar is submitted.","type":"attachment","label":"Aadhaar Consent Form (In case Aadhaar is submitted)","options":[],"required":false,"pdf_field":""},{"help":"Attach bank document showing 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":"Attach medical certificate.","type":"attachment","label":"Medical certificate stating cause of death","options":[],"required":true,"pdf_field":""},{"help":"Attach 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":"Attach if applicable.","type":"attachment","label":"Copy of duly certified First Information Report /Inquest / Panchnama (translation mandatory in case vernacular language)","options":[],"required":false,"pdf_field":""},{"help":"Attach if applicable.","type":"attachment","label":"Copy of duly certified Post Mortem Report / Chemical Analysis Report (Viscera)","options":[],"required":false,"pdf_field":""},{"help":"Attach if applicable.","type":"attachment","label":"Medical Questionnaire / Physician Statement","options":[],"required":false,"pdf_field":""},{"help":"Attach 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.","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":"Enter 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":"Claimant Details","fields":[{"help":"Enter claimant's full name.","type":"text","label":"Name (Full Name)","options":[],"required":true,"pdf_field":""},{"help":"Enter maiden name if applicable.","type":"text","label":"Maiden Name (Full Name)","options":[],"required":false,"pdf_field":""},{"help":"Enter 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":"Enter claimant's date of birth.","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Select marital status.","type":"choice","label":"Marital Status","options":["Single","Married","Divorced","Widowed"],"required":false,"pdf_field":""},{"help":"Enter educational qualification.","type":"text","label":"Qualification","options":[],"required":false,"pdf_field":""},{"help":"Select occupation and specify if others.","type":"choice","label":"Occupation","options":["Service","Self Employed","Homemaker","Student","Retired","Others (Please Specify)"],"required":false,"pdf_field":""},{"help":"Enter telephone number.","type":"phone","label":"Telephone","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number.","type":"phone","label":"Mobile No","options":[],"required":false,"pdf_field":""},{"help":"Enter email address.","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN number or Form 60 details.","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":"Bank Account Details of Claimant","fields":[{"help":"Enter bank account number.","type":"text","label":"Account No.","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name.","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Enter branch name and address.","type":"text","label":"Branch Name & Address","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code of the branch.","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter name of the bank account holder.","type":"text","label":"Bank Account Holder Name","options":[],"required":true,"pdf_field":""},{"help":"Select account type.","type":"choice","label":"Account type","options":["Savings","Current","NRO"],"required":true,"pdf_field":""},{"help":"Give 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":"Basic Details of Insured Person","fields":[{"help":"Enter full name of the insured person.","type":"text","label":"Name (Full Name) (Current)","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth of the insured person.","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select marital status.","type":"choice","label":"Marital Status","options":["Single","Married","Divorced","Widowed"],"required":false,"pdf_field":""},{"help":"Enter state of residence.","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter postal pin code.","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Employment Details of Insured Person","fields":[{"help":"Enter last employer or business name.","type":"text","label":"Last Business / Employer Name","options":[],"required":false,"pdf_field":""},{"help":"Enter employer/business address with landmark.","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":"Enter last designation held.","type":"text","label":"Designation","options":[],"required":false,"pdf_field":""},{"help":"Enter last working day date.","type":"date","label":"Last Working Day","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Death of Insured Person","fields":[{"help":"Enter date of death.","type":"date","label":"Date of Death","options":[],"required":true,"pdf_field":""},{"help":"Enter 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 event leading to death.","type":"text","label":"Cause of Death and Event Leading to Death","options":[],"required":true,"pdf_field":""},{"help":"Provide contact details of doctor or hospital.","type":"text","label":"Doctor / Hospital Contacted at the time of Death","options":[],"required":false,"pdf_field":""},{"help":"Provide details of first medical contact.","type":"text","label":"Details of Doctor / Hospital Contacted first","options":[],"required":false,"pdf_field":""},{"help":"Elaborate unnatural death details if applicable.","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":""},{"help":"Enter clinic or hospital name.","type":"text","label":"Name of Clinic / Hospital","options":[],"required":false,"pdf_field":""},{"help":"Enter duration or first diagnosis date.","type":"text","label":"Duration / First Date of Diagnosis","options":[],"required":false,"pdf_field":""},{"help":"Provide family physician details.","type":"text","label":"Details of Family Physician","options":[],"required":false,"pdf_field":""},{"help":"Provide company name, policy no, risk commencement date, sum assured, and claim status (Paid / Rejected / Pending) for each policy.","type":"table","label":"Particulars of Other Life Insurance Policies (Please mention details of every policy here)","options":[],"required":false,"pdf_field":""},{"help":"Tick relevant medical conditions or habits.","type":"checkbox","label":"Details of Past History of Health / Habits of Insured Person","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":""}],"filled_by":"claimant"},{"title":"Authorisation and Declaration","fields":[{"help":"Authorise physicians, hospitals, and authorities to share medical information with the insurer.","type":"text","label":"Authorisation","options":[],"required":true,"pdf_field":""},{"help":"Declare understanding of tax liabilities and claim conditions.","type":"text","label":"Declaration","options":[],"required":true,"pdf_field":""},{"help":"Sign or affix thumb impression.","type":"signature","label":"Signature / Thumb Impression of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Witness and Scribe Details","fields":[{"help":"Enter full name of witness.","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Enter address of witness.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter contact number of witness.","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship to claimant.","type":"text","label":"Relationship with claimant","options":[],"required":false,"pdf_field":""},{"help":"Enter scribe's full name if applicable.","type":"text","label":"Full Name of the Scribe","options":[],"required":false,"pdf_field":""},{"help":"Enter scribe's address.","type":"text","label":"Complete Address","options":[],"required":false,"pdf_field":""}],"filled_by":"witness / scribe"},{"title":"Authorisation to Company Representatives to Contact the Claimant & Family","fields":[{"help":"Enter mobile number for contact.","type":"phone","label":"Mobile number","options":[],"required":true,"pdf_field":""},{"help":"Enter landline number if any.","type":"phone","label":"Landline","options":[],"required":false,"pdf_field":""},{"help":"Enter email for contact.","type":"email","label":"Email ID","options":[],"required":false,"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 share medical information regarding the deceased with Kotak Mahindra Life Insurance Company Limited.","I authorize the company and its representatives to contact me for claim related enquiries and will not lodge complaints for such communications."],"dropped_labels":3},"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/661-death-claim-form-individual"}