Senior Citizen Life Insurance Death Claim Form
Deceased Policyholder Details
Policy Number
Full Name of Deceased
Date of Birth
Date of Death
Address
Cause of Death
Claimant Details
Claimant's Name
Relationship to Deceased
Claimant's Address
Contact Number
Email Address
Bank Details for Payout
Bank Name
Account Holder's Name
Account Number
IFSC/Branch Code
Declaration & Signature
Declaration
Claimant's Signature
Date