‘IFFCO-Tokio Personal Accident Insurance Claim Form’ PDF Quick download link is given at the bottom of this article. You can see the PDF demo, size of the PDF, page numbers, and direct download Free PDF of ‘IFFCO-Tokio Personal Accident Insurance Claim Form’ using the download button.
IFFCO-Tokio Personal Accident Insurance Claim Form PDF Free Download
IFFCO-Tokio Personal Accident Insurance Claim Form
Policy No.
Name of Claimant (in full)
[If more than one, state the names of all]
Full Postal Address
Relationship of Claimant with the deceased
State the nature of the title under which the Claimant is claiming the
amount
Particulars of the Insured Person who died in the accident
Name (in full)
Last full Postal Address
Last Occupation
Age at the time of the accident
When did the accident happen? (Give the date and exact time)
Where did the accident happen?
Give a full description of the accident, its cause, and injuries
sustained
State date, time, and place of death
On what date did the claimant receive information in regard
to the accident and from whom?
Give the names and addresses of two persons who
witnessed the accident
Was the deceased free from infirmity at the time of
the accident? If not, give particulars.
Was the deceased under the influence of drugs or drinking at
the time of the accident?
Is the Claimant satisfied that the death was directly due to
the accident?
Give the names and addresses of the Hospital, Clinic or
| Language | English |
| No. of Pages | 2 |
| PDF Size | 0.05 MB |
| Category | General |
| Source/Credits | – |
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IFFCO-Tokio Personal Accident Insurance Claim Form PDF Free Download