{"id":662,"title":"DEATH CLAIM INTIMATION FORM INDIVIDUAL POLICY CLAIMS","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_Intimation_Form_All1.pdf","sha256":"995c5e78ef94b82908cec38f917d13f08ed898b0f4356f31e5c1a799920c3c64","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for intimating a death claim under individual life insurance policies. It is to be filled by the policyholder, nominee, assignee, or legal heirs of the deceased insured person.","notes":["Affix claimant's photograph with signature across the photograph.","Every field should be properly, correctly and completely filled up.","Submit original policy documents and original death certificate issued by municipality or equivalent authority.","Current address of claimant should match the address proof provided.","Attach all supporting medical and legal documents as applicable.","This intimation is not admittance of the claim by the Company.","Use block letters where applicable.","If claimant signs in vernacular language or thumb impression, scribe details must be filled.","The Company reserves the right to call for any additional information or documents as deemed necessary.","Do not pay any fees for claim processing to any person or agency."],"title":"DEATH CLAIM INTIMATION FORM INDIVIDUAL POLICY CLAIMS","submit":{"to":"nearest branch or Claims Department, 7th Floor, Zone -2 Kotak Infiniti, Building no. 21, Infinity Park, Off Western Express Highway, General A K Vaidya Marg, Malad (E), Mumbai – 400 097","how":"in person or by post","address":"7th Floor, Zone -2 Kotak Infiniti, Building no. 21, Infinity Park, Off Western Express Highway, General A K Vaidya Marg, Malad (E), Mumbai – 400 097"},"purpose":"claim","sections":[{"title":"Policy Details and Documents to be Submitted","fields":[{"help":"List all policy numbers of the insured person if multiple policies exist.","type":"text","label":"Policy Details (Kindly provide all policy numbers incase if Insured Person had multiple policies)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if each mandatory and supporting document is submitted (Yes/No).","type":"table","label":"Documents to be submitted","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Details of Claimant","fields":[{"help":"","type":"text","label":"Name (Full Name)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Maiden Name (Full Name)","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Tick the document submitted as address proof","type":"choice","label":"Kindly tick the address proof submitted","options":["Passport","Voter Identity Card","Driving License","Electricity Bill","Ration card","Bank Statement /Passbook updated till the previous month","Aadhar Card","Valid Lease Agreement with rent receipt of recent 3 months","Telephone Bill","Any other (Kindly Specify)"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Include STD code","type":"phone","label":"Telephone STD Landline","options":[],"required":false,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with Insured Person","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"EMAIL ID","options":[],"required":false,"pdf_field":""},{"help":"Provide bank name, branch name & address, account number, IFSC code","type":"text","label":"Bank A/c Details","options":[],"required":true,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"I HEREBY GIVE MY CONSENT TO DIRECT CREDIT / NEFT / RTGS CLAIM AMOUNT IN MY ACCOUNT","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Payment Option Details","fields":[{"help":"Tick the applicable payment option","type":"choice","label":"Kotak Smart Advantage Plan (107L043V01) / Kotak Head start Future Protect (107L037V01/ 107L038V01) / Kotak Long Life Secured Plus (107L044V01) (Please tick as applicable)**","options":["Lump Sum","Installment"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Basic Details of Insured Person","fields":[{"help":"","type":"text","label":"Name (Full Name)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Maiden Name (Full Name)","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Qualification","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable and specify if others","type":"choice","label":"Employed","options":["Self Employed","Others (Specify)"],"required":false,"pdf_field":""},{"help":"Annual income","type":"number","label":"Income","options":[],"required":false,"pdf_field":""},{"help":"Permanent address of insured","type":"text","label":"Address: (PERMANENT)","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Employment Details of Insured Person","fields":[{"help":"","type":"text","label":"Last Business / Employer Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address (With landmark)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature Of Work","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Designation","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Last Working Day","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"EMAIL ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Contact No (Landline / Mobile)","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Death of Insured Person","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Death","options":[],"required":true,"pdf_field":""},{"help":"Provide time 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":"Tick the applicable type","type":"choice","label":"Type of Death (PLEASE TICK)","options":["NATURAL","ACCIDENTAL","SUICIDE","MURDER","OTHERS"],"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 name and contact details","type":"text","label":"Doctor / Hospital Contacted at the time of Death","options":[],"required":false,"pdf_field":""},{"help":"Duration of symptoms","type":"text","label":"How Long was the Insured Person suffering from these symptoms","options":[],"required":false,"pdf_field":""},{"help":"Provide details","type":"text","label":"Details of Doctor / Hospital Contacted first","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Unnatural Death (if applicable)","fields":[{"help":"Elaborate specific unnatural claim event (e.g. accident, burns)","type":"text","label":"Details of Unnatural Death","options":[],"required":false,"pdf_field":""},{"help":"Provide details","type":"text","label":"Details of the Doctor / Hospital contacted","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Past History of Health / Habits of Insured Person","fields":[{"help":"Tick all applicable conditions or habits","type":"checkbox","label":"Nature of medical condition / habit (Please tick the relevant box)","options":["Hypertension","Diabetes","Heart Disease","Liver Disease","Kidney Disease","Cancer","Respiratory Disease","Any other ailments / disorder/surgery /hospitalisation","Alcohol","Smoking","Tobacco","Narcotics in any form"],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Family Physician","fields":[{"help":"","type":"text","label":"Name of Clinic / Hospital","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Include STD code","type":"phone","label":"Telephone STD Landline","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"EMAIL ID","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Particulars of Other Life Insurance Policies","fields":[{"help":"Provide details of every other life insurance policy","type":"text","label":"Name of the Company","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Risk Commencement Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Assured","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable status","type":"choice","label":"Status of Claim (Paid / Rejected / Pending)","options":["Paid","Rejected","Pending"],"required":false,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":["Valid claim intimation 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","Original Death Certificate issued by municipality or equivalent authority","Claimant’s Photograph, Current Address Proof and Photo ID Proof","Copy of bank passbook/statement of the claimant bearing IFSC Code","Medical certificate stating cause of death (for Natural Death)","Medical Records (Consultation notes, treatment records, admission notes, hospital indoor papers, discharge / death summary, investigation reports etc) (for Natural Death)","Medical Questionnaire / Physician Statement (for Natural Death)","Copy of duly certified First Information Report /Inquest / Panchnama (translation mandatory in case vernacular language) (for Unnatural Death)","Copy of duly certified Post Mortem Report / Chemical Analysis Report (Viscera) (for Unnatural Death)","Copy of Driving License if the Insured Person was driving the vehicle at the time of accident (for Unnatural Death)","Settlement Option Form as applicable","Any other Document (Please specify)"],"declarations":["I authorize any physician, hospital or authority to divulge information regarding the deceased’s health to Kotak Mahindra Life Insurance Company Limited or its representatives.","I declare that the statements made in this form are true and complete and understand that incorrect or incomplete information may affect claim settlement.","I agree to assist the Company in Claims Investigation.","I understand that submitting this form does not admit liability or waive any rights of the Company.","I will not pay any charges/fees for claim processing to any agency or person as the Company does not charge any fees for claims process.","I authorize the Company and its representatives to contact me via calls, SMS, emails or personal visits for claim related enquiries.","I undertake not to lodge complaints for violation of TRAI guidelines on unsolicited calls/SMS from the Company or its representatives."],"dropped_labels":15},"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/662-death-claim-intimation-form-individual-policy-claims"}