Settlement

Date of Account Relationship Nominees Alternate Contact Details of Organization Organization Organisation Last Document Claim Branch Policy
No. Month Date of Accident Date of Demise Insured Name Claim No Account No Band Organisation Nature of loss Location of Accident Details of Accident Accident Type Sum Insured Add On Amount Final settlement Status Claim Main Status Date of payment Remarks Follow Up Remark Pending Documents Insured Address State City LHO Nominee Name Nominee Contact Nominees Account Details Branch Code Date/Inadmissible FORSE NO. Reason
Intimation Name of Nominee Email No Organisation Email Contact No Detail Submission Date Settlement TAT Details Number
date

1.Aadhar & Pan Card Copy of

Nominee,2.Attested Copy of
Death Certificate,3.Attested Copy
NOK FROM DISTRICT SAINIK of Post Mortem Report,4.Attested
BOARD, LAB REPORTS, Copy of FIR Report,5.Original
ADMISSION PAPERS, DISCHARGE SUMMARY cancelled cheque/ Copy of First
580000/48 Documents INDOOR CASE PAPERS - RECEIVED 17-05-2025 leaf of the Claimant´s Bank hemendragangw
SINGRA MODH MILK VILL- TIRAA, MILAK, 580000/48/20 Claim
1 Apr'25 04-Apr-25 12-Aug-24 17-Sep-24 JAI PRAKASH /2026/000 11587720451 DSP Veteran Protection Army Accidental Death only ROAD ACCIDENT Road Accident 3000000 0 Pending from Outstanding DAY-TO-DAY NOTES ALL account,6.NEFT details of the Rampur LUCKNOW JAMUNA DEVI 9627964756 [email protected] 9719578126 RETIRED 584 584
RAMPUR UP RAMPUR, U.P, -243701 25/152 Withdrawn
01173 client AND DEATH SUMMERY ANNEXURS,DC,FIR,PM,KYC,B claimant certified by the om
REQUIRED 17-05-2025 ANK STATEMENT, PENNSION Claimant´s Bank Annexure
SLIP RECEIVED - 11.4.2025 7,7.Letter from the Bank´s Branch
VG Manager on Bank´s Letter Head
Annexure 6,8.Completely filled
claim form Annexure 5,9.Claim
Intimation form (Annexure 4)

CLAIM PAID ON 31-12-24

CLAIM IN PROCESS 05-12-
2024 SM S/O OMKAR SINGH,
580000/48 YAMUNA ATTESTED COPY OF BAHADURPUR, PO- PUSHPENDRAI
CLAIM PAID ON 31-12- VIRENDRA 580000/48/20
2 Apr'24 16-Apr-24 10-Feb-24 10-Feb-24 MORDHAWAJ SINGH /2025/000 33643005877 PSP II Ultra Platinum Police Accidental Death only EXPRESSWAY MILE ROAD ACCIDENT Road Accident 7500000 7500000 Paid Settled 31-12-2024 00:00 VISCERA REPORT KARAB, BAHADURPUR Uttar Pradesh Kanpur LUCKNOW 9457851818 NARMY1@GM 9412803820 36714683725 UP POLICE 61629 05-Dec-24 31-12-2024 00:00 26 61629
24 SINGH 24/1521
05510 STONE 115 REQUIRED - 22.4.2024. MATHURA, UTTAR AIL.COM
ALL DOCUMENTS RECEIVED PRADESH -281204
EXCEPT VISCERA REPORT -
22.4.2024.VG

CLAIM PAID ON 30-1-25

CLAIM IN PROCESS, 24-12-
24,SM
CBS SS FOR A/C
CONVERSION DATE,
MAYAVANI HOSPITAL 3 GRENDIERS
580000/48 E-49 HIGHWAY DISTT- VIKASHCHOU
PAPERS, VISCERA REPORT SAVITRI REGT 580000/48/20
3 Apr'24 19-Apr-24 22-Feb-24 23-Feb-24 ACHAL SINGH /2025/000 33213778611 DSP Veteran Protection Army Accidental Death only VATSALYGAM ROAD ACCIDENT Road Accident 3000000 3000000 Paid Settled 30-01-2025 00:00 CLAIM PAID ON 30-1-25 MATHURA STATE-UTTAR Uttar Pradesh Mathura LUCKNOW 8533907325 DHARY2611@ 32200262814 8307 24-Dec-24 30-01-2025 00:00 37 8307 450498P
REQUIRED ( QUERY BY CHAUDHARY CENTRE, 24/1521
06609 PRADESH -281006 GMAIL.COM
OICL), REQUIRED, 27-8-24,SM JABALPUR
CLAIM IN PROCESS, 6-8-
24,SM
ALL DOCUMENTS RECEIVED
EXCEPT MEDICAL RECORDS -
24.4.2024.VG

1.Aadhar & Pan Card Copy of

Nominee,2.Attested Copy of
Death Certificate,3.Attested Copy
of Post Mortem Report,4.Attested
ATTESTED COMPLETE Copy of FIR Report,5.Original
511 ARMY
POST MORTERM ALL ANNEXURES, DC, FIR, cancelled cheque/ Copy of First
VILL- BAGHAWAR, PO- SERVICE Consent
580000/48 BRUST OF TYRE Documents REPORT, EMPLOYEE ID BANK STATEMENT, NOMINEE leaf of the Claimant´s Bank KAVITA
RAUNPAR, TEH- SEGRI, ksingh4184@g CORPS [email protected] SBI.08448@S 580000/48/20 awaited
4 Apr'25 30-Apr-25 08-Feb-25 08-Feb-25 RAJESH PATEL /2026/000 20425483794 DSP Super Platinum Army Accidental Death only MALVAN AND TOPPLING OF Road Accident 10000000 0 Pending from Outstanding CARD AS EMPLOYMENT BANK DETAILS, NOMINEE account,6.NEFT details of the Uttar Pradesh Azamgarh LUCKNOW JAIKESH 9689264184
DIST-AZAMGARH, UP - mail.com BATTALION, O.IN BI.CO.IN 25/152 from
10749 VEHICLE client PROOF, PAN CARD OF AADHAR CARD RECEIVED 03- claimant certified by the SINGH
276122 AHMEDABAD insured
NOMINEE REQUIRED 03- 05-2025 SRM Claimant´s Bank Annexure
GUJRAT
05-2025 7,7.Letter from the Bank´s Branch
Manager on Bank´s Letter Head
Annexure 6,8.Completely filled
claim form Annexure 5,9.Claim
Intimation form (Annexure 4)

CLAIM PAID ON 13-6-25(AS

PER OICL NEFT) 151 BTN CRPF,
CLAIM IN PROCESS 03-06- VILL:
2025 SRM SATYANARAYA
BANK STATEMENT RECD, 28- NPURAM,CHA
VPO- HANUMANGRAH
580000/48 5-25,BT RLA
CLAIM PAID ON 13-6- DISTT- CHANDAULI singhasha5504 hq151bncrpf@gm [email protected] SBI.10888@S 580000/48/20
5 Feb'25 14-Feb-25 22-Dec-24 23-Dec-24 RITESH KUMAR SINGH /2025/001 30349457059 CAPSP Super Platinum CRPF Accidental Death only NEAR BAULA ROAD ACCIDENT Road Accident 5000000 5000000 Paid Settled 13-06-2025 00:00 Uttar Pradesh Chandauli LUCKNOW ASHA SINGH 7982265242 30349457059 MANDAL,BHAD 03-Jun-25 13-06-2025 00:00 10
25(AS PER OICL NEFT) STATE- UTTAR PRADESH @gmail.com ail.com O.IN BI.CO.IN 25/152
38321 ANNEXURE 6, NOMINEE SBI RADRI
232105
BANK DETAILS, RECEIVED 14- KOTHAGUDEM
05-2025 SRM , DIST:
ANNEXURES, ATTESTED TELANGANA,PI
FIR,PM,DC, KYC, ID CARD N507140
RECEIVED, 17-2-25,SM

CLAIM PAID - 20.3.2025

CLAIM IN PROCESS -
27.2.2025 VG
FILE GIVEN FOR MEDICAL
OPINION - 21.2.2025
CLAIM IN PROCESS, 7-2-
25,SM
580000/48 HIT BY AN SELF ATTESTED FIR, bhardwajsandee
NEAR SHIKARPUR GIRDHAR PUR NABADA [email protected] SBI.03641@S 580000/48/20
6 Jan'25 09-Jan-25 24-Nov-24 24-Nov-24 SANJAY SHARMA /2025/001 30171656622 PSP II Ultra Platinum Police Accidental Death only UNKNOWN Road Accident 7500000 7500000 Paid Settled 20-03-2025 00:00 CLAIM PAID - 20.3.2025 POSTMORTEM, DEATH Uttar Pradesh Bulandshahr LUCKNOW RAKESH 8954618567 [email protected] 30171656622 UP POLICE 0 27-Feb-25 20-03-2025 00:00 21 311
TIRAHA GULAOTHI B.SHAHR O.IN BI.CO.IN 25/152
24665 VEHICLE CERTIFICATE. EMPLOYMENT m
PROOF. RECEIVED. KB 23-01-
2025

ALL ANNEXURES, BANK

STATEMENT, SELF
ATTESTED FIR, PMR, DC
RECEIVED. KB 16-01-2025

CLAIM PAID - 25.2.2025

CLAIM IN PROCESS 06-02-
2025 SRM 1 SIGNAL BN
580000/48 BANK STATEMENT (SEP TP CRPF,
FRONT OF PAC GATE GTB NAGAR ALLHABAD bkhanam440@g 580000/48/20
7 Dec'24 31-Dec-24 20-Nov-24 20-Nov-24 KHUSHNOOD HASAN /2025/001 30259022607 CAPSP Super Platinum CRPF Accidental Death only ROAD ACCIDENT Road Accident 5000000 5000000 Paid Settled 25-02-2025 00:00 CLAIM PAID - 25.2.2025 NOV 24) REQUIRED, 31-12-24 Uttar Pradesh LUCKNOW AJRA FATMA 6388755415 30259022607 JHARODA 6388755415 11511 06-Feb-25 25-02-2025 00:00 19 11511 55164404
PRYAGRAJ UP-211016 mail.com 25/152
20654 ANNEXURES, ATTESTED KALAN, NEW
FIR,PM,DC,KYC, ID CARD, DELHI 110072
PAYSLIP RECEIVED, 31-12-
24,SM
CLAIM PAID - 28.4.2025
CLAIM IN PROCESS, 20-3-
25,BT

ATTESTED FIR COPY,

DETAILED FIR WITH
COMPLETE INCIDENCE
NEAR SHAHID UDYAN,
REPORT, NOK CERTIFICATE CRPF
580000/48 PARASHIDUBEY
NEAR MILITARY CAMP FROM UNIT RECD, 19-3-25,BT RAGINI raginidwivedi690 CHAKIYA, [email protected] [email protected] sbi.00170@sb 580000/48/20
8 Jan'25 30-Jan-25 07-Dec-24 07-Dec-24 SARVESH PRAKASH DWIVEDI /2025/001 30354100317 CAPSP Super Platinum CRPF Accidental Death only ROAD ACCIDENT Road Accident 5000000 5000000 Paid Settled 28-04-2025 00:00 CLAIM PAID - 28.4.2025 ROBERTSGANJ, Uttar Pradesh Robertsganj LUCKNOW 6394843070 30354100317 7307456662 20-Mar-25 28-04-2025 00:00 39 60722704
KARANPUR CHAUKI DWIVEDI [email protected] CHANDAULI v.in n i.co.in 25/152
31926 SONBHADRA, UTTAR
3 MONTHS BANK UP 232103
PRADESH 231216
STATEMENT PRIOR TO
ACCIDENT, INQUEST
PANCHNAMA, PMR, GD
RECEIVED. KB 05-03-25
ANNEXURES, PMR, NOMINEE
KYC, EMPLOYMENT PROOF
RECEIVED. KB 31-01-2025
3 MONTHS BANK
STATEMENT PRIOR TO
ACCIDENT REQUIRED. (
NOMINEE URMILA DEVI
ADHAAR CARD, PAN CARD,
580000/48 Documents 3 MONTHS BANK BANK DETAILS RECEIVED ) 683/1, AVAS VIKAS
shailendrid24@ 163bn CRPF COL63BN@CRP [email protected] SBI.11637@S 580000/48/20 Claim
9 Jan'25 10-Jan-25 17-Dec-24 17-Dec-24 KAMLESH KUMAR /2025/001 32206313650 CAPSP Super Platinum CRPF Accidental Death only NA RTA Road Accident 5000000 0 Pending from Outstanding STATEMENT PRIOR TO 09-05-2025 SJ COLONY AGRA, Uttar Pradesh Agra LUCKNOW SHAILENDRI 6395599074 6395599074 9419043568 115183678CT
gmail.com KULGAM J&K F.GOV.IN O.IN BI.CO.IN 25/152 intimated
23382 client ACCIDENT 09-05-2025 SIKANDRA ,UP - 282007

ALL ANNEXURES, FIR, PMR,

DC RECEIVED. KYC OF
SHAILENDRI RECEIVED. KB
17-01-2025

CLAIM PAID - 29.4.2025

CLAIM IN PROCESS 07-03-
2025 SRM 194 BN, RAF,
580000/48 VPO-BARODA
KAVI NAGAR ALL ANNEXURES, DC, FIR, CRPF, 580000/48/20
10 Mar'25 03-Mar-25 12-Dec-24 12-Dec-24 NEERAJ KUMAR /2025/001 34555949498 CAPSP Super Platinum CRPF Accidental Death only ROAD ACCIDENT Road Accident 5000000 5000000 Paid Settled 29-04-2025 00:00 CLAIM PAID - 29.4.2025 ,BULANDSHAHR UP- Uttar Pradesh LUCKNOW JYOTI 8218524759 34555949498 8826918194 624 07-Mar-25 29-04-2025 00:00 53 624 155301348
GHAZIABAD PMR, EMPLOYMENT PROOF, BAWANA, NEW 25/152
45685 203202
BANK STATEMENT, KYC, DELHI
BANK PASSBOOK RECEIVED
07.03.2025

CLAIM PAID - 27.9.2024

CLAIM IN PROCESS –
20.09.2024.VG

ALL DOCUMENTS REQUIRED

580000/48 EXCEPT EMPLOYMENT 35 BATILIYA ,SAL 7380433925har
580000/48/20
11 Mar'24 06-Mar-24 11-Jan-24 11-Jan-24 MAHARAJ SINGH /2024/000 30174027689 CAPSP Super Platinum CRPF Accidental Death only BIJAPUR KALPI JALAN RTA Road Accident 5000000 5000000 Paid Settled 27-09-2024 00:00 CLAIM PAID - 27.9.2024 PROOF & KYC, 11-9-24 COLONY BHIND MP PIN- Madhya Pradesh Jalaun BHOPAL KUNTI DEVI 9473697340 [email protected] 42652420512 32 BN CRPF, 16722 20-Sep-24 27-09-2024 00:00 7 16722 961350641
24/1521
87031 477105 m
ENQUIRY LETTER RECEIVED,
11-9-24,SM
ANNEXURE 4, KYC, ID CARD
& PHOTOCOPY OF FIR,PM
RECEIVED, 18-3-24,SM

1.Aadhar & Pan Card Copy of

Nominee,2.Attested Copy of
DEATH SUMMARY, LAB Death Certificate,3.Attested Copy
REPORTS, MEDICAL of Post Mortem Report,4.Attested
PRESCRIPTIONS RECEIVED. Copy of FIR Report,5.Original
KB 16-06-2025 cancelled cheque/ Copy of First
580000/48 Documents INDOOR CASE PAPERS, ALL DOCUMENTS RECEIVED leaf of the Claimant´s Bank
MEMADA, PITHANPUR, VANDANA 580000/48/20 Claim
12 Mar'25 24-Mar-25 04-Nov-24 16-Dec-24 VIJAY KUMAR PANDEY /2025/001 30831578788 DSP Super Platinum Army Accidental Death only ANANGPUR ROAD ACCIDENT Road Accident 5000000 0 Pending from Outstanding ADMISSION NOTES EXCEPT HOSPITAL PAPERS account,6.NEFT details of the Uttar Pradesh LUCKNOW 7800196469 11597 11597 JC-2480798
UTTAR PRADESH 207246 KUMARI 25/152 Withdrawn
53120 client REQUIRED 16-06-2025 07-05-2025 SRM claimant certified by the
ALL ANNEXURES, DC, PMR, Claimant´s Bank Annexure
FIR, NOMINEE KYC, NOMINEE 7,7.Letter from the Bank´s Branch
BANK DETAILS RECEIVED 27- Manager on Bank´s Letter Head
03-2025 SRM Annexure 6,8.Completely filled
claim form Annexure 5,9.Claim
Intimation form (Annexure 4)

EXAMINATION REPORT
RECEIVED- 24-6-25 YP
1.Aadhar & Pan Card Copy of
200 RS STAMP PAPER NOC
Nominee,2.Attested Copy of
WITH LEGAL HEIR, INDOOR
Death Certificate,3.Attested Copy
CASE PAPERS, DEATH
of Post Mortem Report,4.Attested
VISCERA REPORT WITH SUMMARY, RECEIVED -
Copy of FIR Report,5.Original
ENDORSE POST 22.5.2025 VG
cancelled cheque/ Copy of First
MORTERM REPORT NEXT OF KIN
580000/48 Documents leaf of the Claimant´s Bank
KASVA CHHATARI WITH FINAL CAUSE OF CERTIFICATE/200 RS STAMP USHA 580000/48/20 Delayed
13 Mar'25 27-Mar-25 13-Jan-25 18-Jan-25 JITENDRA SINGH BHAGAUR /2025/001 35087687865 PSP II Ultra Platinum Police Accidental Death only ROAD ACCIDENT Road Accident 7500000 0 Pending from Outstanding account,6.NEFT details of the LUCKNOW 9258632688 7983127141 11506 11506
NAGLIYA DEATH, BANK PAPER NOC WITH LEGAL FAUJADAR 25/152 intimation
54965 client claimant certified by the
STATEMENT (NOV 24 - HEIR, VISCERA REPORT
Claimant´s Bank Annexure
JAN 25) REQUIRED WITH ENDORSE POST
7,7.Letter from the Bank´s Branch
24.6.2025 MORTERM REPORT WITH
Manager on Bank´s Letter Head
FINAL CAUSE OF DEATH,
Annexure 6,8.Completely filled
INDOOR CASE PAPERS,
claim form Annexure 5,9.Claim
DEATH SUMMARY,
Intimation form (Annexure 4)
EMPLOYMENT PROOF, BANK
STATEMENT (NOV 24 - JAN
FSL REPORT REQUIRED -
28.1.2025 VG
FILE GIVEN FOR
TRANSLATION - 22.1.2025 VG
REVISED ANNEXURE 6 WITH
CORRECT SUM INSURED (40
LACS) & NOMINEE SBI BANK
DETAILS REQUIRED, 31-12-
580000/48 Documents RAJKIYA ADARSH
FSL REPORT 24 PALLAVI RAILWAY 580000/48/20 Delayed
14 Nov'24 06-Nov-24 19-Jul-24 19-Jul-24 VARUN KUMAR /2025/000 20346374565 CGSP Elite Central Govt Accidental Death only NANA RAJKOT ROAD ACCIDENT Road Accident 4000000 0 Pending from Outstanding COLONY NEAR 23 PAC Uttar Pradesh Moradabad LUCKNOW 7668051501 7227933328 9724047291 4215 22-Jan-25 4215 2CTL
REQUIRED - 28.1.2025 NOK, KYC, BOB BANK SINGH TRACHMAN 25/152 intimation
99006 client MORADABAD
DETAILS RECEIVED, 31-12-
24,SM
NOK / LEGEL HEIR
CERTIFICATE ALONG WITH
NEFT & KYC OF NOMINEE
REQUIRED, REVISED
ANNEXURE 6 WITH
CORRECT SUM INSURED (40