Name of Account Holder(Insured person)
Full Address of Account Holder (Insured person
Name and address of Post Office and SOL ID where account stands
Savings Account Number:
Contact details of Account Holder (if available)
(i) Mobile/Phone number
(ii) Aadhar Number
(iii) e mail ID
Details of nominee (in case of death of Account holder):-
E mail ID(if any)
Aadhar Number (if any)
Bank or Post Office Account Details
Bank or Post Office name
IFSC Code or SOL ID
Detail of Accident
a) Day, Date and time of accident
b) Place of accident
c) Nature of accident
d) Details of injury
e) Cause of Death
Name , Address and contact details of Hospital/Attending Doctor
State where and when a Medical or other person from company can visit the insured
Documents to be submitted with claim:-
a) In case of death:-Original FIR/Panchnama, Post Mortem report and Death Certificate
b) In case of permanent disability: Original FIR/Panchanama and Disability Certificate from Civil Surgeon.
Table of benefit
Sum Insured (In Rs.)
Total and irrecoverable loss of both eyes or loss of use of both hands or feet or loss of sight of one eye and loss of use of hand or foot.
Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot
- Nominee should approach CBS Post Office where the depositor was having the ‘Savings Bank Account’ through which he / she was covered under PMSBY and collect Claim Form, and Discharge receipt, from the Post Office.
- Depositor should approach CBS Post Office where the depositor was having the ‘Savings Bank Account’ through which he / she was covered under PMSBY and collect Claim Form, and Discharge receipt, from the Post Office.
- Upon receipt of claim form and discharge certificate alongwith documents mentioned above, the Post Office should check whether the cover for the said member was in-force on the date of his death, i.e., whether the premium for the said cover was deducted from account prior to the Member’s death.
- Post Office to verify the Claim Form & the nominee details from the relevant Finacle menu through which enrolment was made and to fill in the relevant columns of the Claim form.
- Post Office should ensure that following documents are attached with claim form:-