Kerala Gramin Bank PMSBY Claim Form

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Kerala Gramin Bank PMSBY Claim Form

This is an application form for the Pradhan Mantri Suraksha Bima Yojana Claim Form issued by the Kerala Gramin Bank and this form can be downloaded from the bank’s official website, or it can be directly downloaded from the link given below.

Details to be Mentioned in Kerala Gramin Bank PMSBY Claim Form

  • Name of the Account holder
  • Full address of the Insured
  • Name and address of the Bank Branch
  • Savings Bank Account Number
  • Contact details of insured (if available)
  • Details of Nominee
  • Details of Accident
  • Name address and contact details of Hospital/ attending Doctors
  • And any other details

Documents Required

Documents to be submitted in support of the Claim:

  • In case of Death: Original FIR/ Panchnama, Post Mortem Report and Death Certificate.
  • In case of Permanent Disablement: Original FIR/ Panchnama and Disability Certificate from Civil Surgeon.
  • Discharge voucher

PMSBY Claim Procedure

  • Immediately after the occurrence of an accident that may give rise to a claim under the policy, the insured or the nominee (in case of death of the insured) shall contact the bank branch where the insured person held the underlying Bank Account from which the premium for the policy was auto debited and submit a duly completed claim form
  • The claim form may be obtained from the above bank branch or any other designated source like insurance company branches, hospitals, PHCs, BCs, insurance agents, etc., including from designated websites. The insurance companies concerned shall ensure the wide availability of forms at all such locations. Supply of the form shall not be denied to any person requesting the same.
  • The Claim form shall be completed by the insured or, as the case may be,by the nominee and submitted to the above bank branch preferably within 30 days of the occurrence of the accident giving rise to the claim under the policy
  • The Claim form shall be supported, in case of death of the insured, by the Original FIR/ Panchnama, Post Mortem Report, and Death Certificate and in case of permanent disablement, by Original FIR/ Panchnama and a Disability Certificate issued by a Civil Surgeon. A discharge certificate in the enclosed format shall also be submitted by the claimant/nominee.
  • The authorized official of the Bank shall check the account / auto-debit particulars and verify the account details, nomination, debiting of premium/remittance to the insurer and certify the correctness of the information given in the claim form, and forward the case to the insurance company concerned within 30 days of the submission of the claim.
  • An insurer will verify and confirm that premium has been remitted for the insured and the insured is included in the list of insured persons in the master policy.

Download the Kerala Gramin Bank PMSBY Claim Form PDF using the link given below or an alternative link for more details.

2nd Page of Kerala Gramin Bank PMSBY Claim Form PDF
Kerala Gramin Bank PMSBY Claim Form

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