Claims Forms

Death claim application form (Form 'A')

Attending physician's statement (Form 'C')

Employer certificate (Form 'E')

NEFT mandate form

* Click here for claim forms in regional languages.

Rider Claims

• Dreaded Disease rider/Critical Illness benefit
• Dread disease/critical illness benefit form (Form 'AA')
• Attending physician’s statement for dread disease/critical illness benefit (Form ’DD’)
• Disability benefits (Personal Accident benefit/Premium waiver/Payer Rider disability)
  • Disability benefit claim form (Form ‘DA’)
  • Attending physician’s statement - disability claim form (Form 'TD')
• Terminal illness benefits
  • Terminal illness claim form (Form 'TA')
  • Attending physician's statement form (Form 'TC')

Life Line Series Claims Forms

• Medicash, Medicash Plus, and Health Family Floater
  • Authorization letter Request Note
  • Claim reimbursement form for Medicash and Medicash plus (Form 'MA')
• Wellness and Wellness Plus
  • Wellness and wellness plus claim form (Form 'WA')
  • APS for wellness and wellness plus claim form (Form 'WD')
• Safety net
  • Death benefits (Including accidental death benefits)
    • Death claim application form (Form 'A')
    • Attending physician's statement (Form 'C')
    • Employer Certificate (Form 'E')
    • NEFT mandate form
  • Accelerated critical illness benefits:
    • Dread disease / critical illness benefit form (Form 'AA')
    • Attending physician’s statement for dread disease / critical illness benefit (Form 'DD')
  • Additional total permanent disability benefit:
    • Disability benefit claim form (Form 'DA')
    • Attending physician's statement - disability claim form (Form ‘TD’)

Claimant statement - Lender borrower scheme

Claimant statement - Non-Lender borrower scheme

Claimant's statement - GTL employer-employee

Claimant's statement - EDLI

Claimant's statement - gratuity

Attending physician's statement - Form 'C'

Pradhan Mantri Jeevan Jyoti Bima Yojana

Cancer Insurance claim form - Form CA

NEFT form