Life Insurance Death Claim Form
1. Policy Information
Policy Number
Sum Assured
2. Deceased Insured's Details
Full Name
Date of Birth
Date of Death
Age at Death
Address
Cause of Death
3. Claimant's Details
Full Name
Relationship to Deceased
Address
Phone Number
Email
4. Bank Account Details (for Payment)
Account Holder Name
Bank Name
Account Number
IFSC / Routing Number
5. Declaration
I hereby declare that the information provided above is true and correct to the best of my knowledge.
Signature
Date