Claim Forms & Downloads

Aditya Birla Sun Life Insurance Company Limited

Documents to be Submitted	Non-Early Claim	^Early Claim**
Claimant Statement Form	✓	✓
Death Certificate issued by Municipal Authority/ Gram Panchayat	✓	✓
Cancelled Cheque with pre-printed name/Bank Passbook with photograph (along with stamp and signature of the authorized signatory)/Online bank statement with transactions for last 3 months	✓	✓
Original Policy Document or Indemnity Bond in case Policy document is Lost	✓	✓
KYC Document of Claimant/Beneficiary/Nominee (ID Proof, Address Proof, Photograph and Relationship Proof).	✓	✓
Medical Attendant's Certificate, if any	❌	✓
Employer's Certificate (if employed)	❌	✓
Medical records (admission notes, discharge/ death summary, treatment records etc.	❌	✓
Additional Requirements for Accidental/Unnatural Death	Non-Early Claim	Early Claim
FIR & Final Police Closure Report	✓	✓
Post Mortem Report	✓	✓
Policy Inquest Report/Inquest Panchnama	✓	✓
Newspaper Cutting (if any)	✓	✓

Additional Requirements for below stated scenario:

1) Application to dispense for legal evidence to title (if the nominee has also expired)
2) Deed of Relinquishment (if Waiver of Premium applicable)
3) Copy of NRO/Indian Bank Account (if claimant is NRI/FNIO)
4) Banker's Certificate with details of new Karta (if HUF policy claim)
5) Outstanding loan account statement (if policy is assigned in favour of a financial institution, other than ABSLI)

^*Legally entitled beneficiaries for below stated scenario

1) Assignee, if the policy is assigned (to the extent of outstanding loan as on date of event)
2) Class I legal heir of the life insured, if nominee has pre-deceased the life insured
3) Class I legal heir of the nominee, if life insured has pre-deceased the nominee
4) Guardian/appointee, if the nominee is minor
5) Class I legal heir of nominee/entitled beneficiary as per WILL after the death of nominee, if it is a staggered payout claim

**Early Claim: Claim within 3 years from date of issue or reinstatement with COI.

Standard Documents: (For all death claims)

Appln to Dispense With Legal Evidence of Title

Certificate by Employer

Change Request Form Neft Updation for Staggered Payout Cases

Claimant Statement Form

Death Abroad Questionnaire

Deed of Relinquishment

Indemnity Bond for Claim Payout Where La and Nominee Expired

Indemnity Bond for Claim Payout Where Nominee is Unsound

Indemnity Bond for Loss of Policy Bond

Indemnity Bond Nominee is an Adopted Child

Indemnity Bond Where Nominees is Minor and Without Appointee

Indemnity Bond Where Nominees Name is Incorrect

Indemnity Bond Where There is No Nominee

Medical Attendant's Certificate (Death Claim)

Noc Format for Open Title Cases

In case of early claim: (Less than 36 months from date of policy issuance)

Medical Attendant Certificate

Employer's Certificate (In case Life Assured is Employed)

Change request form

RIDER CLAIM: Riders are the applicable benefits that will add value to the chosen plan.

Aditya Birla Sun Life Insurance Solutions offer the best and most comprehensive protection plans with a set of riders that you can add to the policy. You can choose the riders you require and customise the plan as per your preference. And all of this comes your way at a nominal cost.

NOTE: The option of including Riders as add on benefits is not provided for policies issued to NRI customers.

S.No.	Document Name	Critical Illness (CI) Rider / CI Plus / Waiver of Premium CI / Lady Rider	Accidental Dismemberment	Accidental Disability
1	Critical Illness Claimant's Statement with KYC - ID Proof / Relationship Proof	✓	❌	❌
2	Critical Illness Hospital Treatment Certificate	✓	❌	❌
3	Critical Illness Family Physician's Certificate	✓	❌	❌
4	Certificate by Employer	✓	❌	❌
5	Original Policy Document / Indemnity Bond (In case Original Policy document is lost)	✓	✓	✓
6	Medical Reports	✓	✓	✓
7	Claimant's Statement for Accidental Dismemberment Rider along with KYC - ID Proof / Relationship Proof	❌	✓	❌
8	Accidental Dismemberment Questionnaire to be Completed by Doctor	❌	✓	❌
9	Cancelled Cheque with NEFT details	❌	✓	✓
10	Claimant's Statement for Disability Claim along with KYC - ID Proof	❌	❌	✓
11	Medical Certificate for Disability	❌	❌	✓
12	Continuous Disability Statement	❌	❌	✓
13	Police Report	❌	❌	✓

Critical Illness (CI) Rider, CI Plus, Waiver of Premium CI, Lady Rider:

Critical Illness Claimant Form

Attending Physian's Certificate for Critical Illness Rider

Family Physician's Statement Critical Illness Rider

Certificate by Employer

Accidental Dismemberment:

Claimant's Statement for Accidental Dismemberment Rider

Certificate by Employer

Accidental Disability:

Claimant's Statement for Accidental Disability Rider

Medical Certificate for Disability

Continuous Disability Statement

Certificate by Employer

Cancershield:

Attending Physician Certificate-Cancer shield

Critical Illness Claimant Form

Critishield:

Claim Form for Staged Critishield Benefit

Critical Illness Claimant Form

S.No.	Document Name	Employer – Employee policy	EDLI Policy	Affinity Policy	Affinity Policy – Borrower Lender Policy	In case of Unnatural Death
1	Copy of Death Certificate issued by Municipal Authority / Gram Panchayat	✓	✓	✓	❌	❌
2	Death Claim Form	✓	✓	✓	❌	❌
3	Claimant's statement along with KYC – ID Proof / Relationship Proof	❌	❌	✓	❌	❌
4	Medical Attendant's Certificate	❌	❌	❌	✓	❌
5	Cancelled cheque with NEFT details	❌	❌	❌	✓	❌
6	Certificate of Insurability	❌	❌	❌	✓	❌
7	Employer's Certificate – In case Life Assured is employed	❌	❌	❌	✓	❌
8	Age Proof	❌	❌	❌	✓	❌
9	Loan Account's Statement	❌	❌	❌	✓	❌
10	First Information Report	❌	❌	❌	❌	✓
11	Post Mortem Report	❌	❌	❌	❌	✓

Standard Documents: (Based on scheme type)

Group Death Claim Form (GTI)

Group Death Claim Form (EDLI)

Affinity Claim Form

Group Death Claim Form For ABSLI_AMC

Group Death Claim Form (IIB)

Death Claim Form 1000 FSG

Claim form for Death Benefit under Group Term Life Insurance Scheme (SBI Housing)

Group Claim - Death - Aditya Birla Payment Bank - Death Claim Form

IDEA Cellular Limited - Death Claim Form

Affinity Policy: Borrower Lender Policy:

Medical Attedant's Certificate

S.No.	Document Name	Critical Illness	Accidental Dismemberment	Accelerated Terminal Illness
1	Dismemberment Rider Claim Form	❌	✓	❌
2	Claimant's Statement for Accidental Dismemberment Rider	❌	✓	❌
3	Accidental Dismemberment questionnaire to be completed by Doctor	❌	✓	❌
4	Cancelled cheque with NEFT details	✓	✓	✓
5	First Information Report	❌	✓	❌
6	Final Police Report	❌	✓	❌
7	Medical Reports	✓	✓	✓
8	Critical Illness Rider Claim Form	✓	❌	❌
9	Critical Illness Claimant Statement	✓	❌	❌
10	Critical Illness Rider questionnaire to be completed by Doctor	✓	❌	❌
11	Accelerated Terminal Illness Rider Claim Form	❌	❌	✓
12	Accelerated Terminal Illness Claimant Statement	❌	❌	✓
13	Accelerated Terminal Illness Rider questionnaire to be completed by Doctor	❌	❌	✓

Accidental Dismemberment:

Dismemberment Rider Claim Form

Dismemberment Group Rider Claim Form

Group Rider Dismemberement Doctor's Questionnaire

Critical Illness:

CI Rider Claim Form

Critical Illness Rider Claimant Statement Form

Attending Physians Certificate for Critical Illness Rider

Critical Illness Rider Family Physian Certificate

Accelerated Terminal Illness:

Accelerated Terminal Illness Premier Rider Claim

Accelerated Terminal Illness Premier Rider Claimant Statement

Attending Physician's Accelerated Terminal Illness Premier Rider

Family Physician Certificate Accelerated TIPR

Disability:

Group Claimants Statement For Disability Claim

Group Continuous Disability Statement

Group Medical Certificate For Disability

Group PMA For Disability Claims

S.No.	Document Name	Accidental Dismemberment
1	Copy of Death Certificate issued by Municipal Authority / Gram Panchayat	✓
2	Death Claim Form	✓

Downloads:

Death Claim Form

S.No.	Document Name	Reimbursement Claims	Preauthorisation Claims	Hospital Care & Surgical Care Rider Claims
1	Claimant Statement duly filled by Policy holder / Nominee	✓	❌	✓
2	Hospital Treatment Certificate duly filled by Treating Doctor of the hospital	✓	❌	✓
3	Copy of Discharge Card / Death Summary duly attested by the hospital authority	✓	❌	✓
4	Main Hospital bill with Bill Number & detailed break up	✓	❌	✓
5	Laboratory reports	✓	❌	✓
6	Cashless / Pre Authorisation request form	❌	✓	❌

Hospital care, Surgical Care, Health Plans reimbursment claim:

Claim Form - Part A

Claim Form - Part B

Pre - authorisation Claim:

Preauthorization Request Form

Claim Forms & Downloads

Individual Claim

Standard Documents: (For all death claims)

In case of early claim: (Less than 36 months from date of policy issuance)

Change request form

Critical Illness (CI) Rider, CI Plus, Waiver of Premium CI, Lady Rider:

Accidental Dismemberment:

Accidental Disability:

Cancershield:

Critishield:

Group Claim

Standard Documents: (Based on scheme type)

Affinity Policy: Borrower Lender Policy:

Accidental Dismemberment:

Critical Illness:

Accelerated Terminal Illness:

Disability:

Social Claim

Downloads:

Health Claim

Hospital care, Surgical Care, Health Plans reimbursment claim:

Pre - authorisation Claim:

Claim Forms & Downloads

Individual Claim

List of required documents

Standard Documents: (For all death claims)

In case of early claim: (Less than 36 months from date of policy issuance)

Change request form

List of required documents

Critical Illness (CI) Rider, CI Plus, Waiver of Premium CI, Lady Rider:

Accidental Dismemberment:

Accidental Disability:

Cancershield:

Critishield:

Group Claim

List of required documents

Standard Documents: (Based on scheme type)

Affinity Policy: Borrower Lender Policy:

List of required documents

Accidental Dismemberment:

Critical Illness:

Accelerated Terminal Illness:

Disability:

Social Claim

List of required documents

Downloads:

Health Claim

List of required documents

Hospital care, Surgical Care, Health Plans reimbursment claim:

Pre - authorisation Claim: