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Life Claim Forms

    Please refer the table below for the list of documents to be submitted to intimate death or rider claim. You can submit these documents at the nearest ICICI Prudential Life Insurance Co. branch or send it directly to Life Claims Cell, ICICI Prudential Life Insurance Company Ltd, BSEL tech, C- wing, 1st floor, Vashi, Navi Mumbai – 400703

    A) For Zero Death Benefit /Investment Plan / Paid Up Policies

    • Original Policy Document
    • Claimant's Photo Identity and Address Proof List of Photo ID and AddressProofs 
    • Copy of Death Certificate by Local Authority
    • Death claimant Statement cum Intimation forms

    B) For all other plans

    Death

    Claim

    Illness/

    Surgery

    Claim

    Disability

    Claim

    Original Policy Document, Claimant Photo Identity and Address Proof

     

       

      

    Claimant Statement cum Intimation forms

    DeathRider

    (Download Form)

     

      

      

    Copy of Death Certificate by Local Authority

     

         -

         -

    Copy of Medico-Legal cause of Death Certificate

     

         -

          -

    Medical Records (Admission Notes, Discharge Summary, Test Reports etc)

     

       

      

    Usual/ Family Doctor Certificate 

    (Download Form)

     

       

        

    Medical Attendant's/ Hospital Certificate

    (Download Form)  

     

         -

        

    Employer Certificate for Salaried Individuals 

    (Download Form) 

     

         -

       

    Post Mortem Report (if conducted)

     

         -

          -

    FIR/ Police Report (if case filed with Police)

     

         -

      

    Panchnama/ Inquest Report (if case filed with Police)

     

         -

      

    Copy of Driving License if Life Assured was driving the vehicle
    (Applicable if “Accident and Disability Benefit Rider” is opted)

     

         -

       

    Other Treating Doctor/ Hospital Formats  (contact nearest branch)

          -

        

            -