Kaagazaat

Personal Accident Claim Letter

At a glance

Price: Free, always.
Stamp duty: Punjab and Chandigarh: no stamp duty is payable.
Registration: Punjab and Chandigarh: not registrable.
Witnesses: Punjab and Chandigarh: no witness is needed.

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Free, always.

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Guided questions, full draft on screen, download in Word.

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Also called

PA policy claim
personal accident insurance claim
accidental death claim
accidental disability claim
owner-driver personal accident claim
group personal accident claim
दुर्घटना बीमा दावा पत्र
व्यक्तिगत दुर्घटना दावा

When you need it

Use this when a person insured under a personal accident policy or cover has died, been permanently or temporarily disabled, or been injured in an accident, and you want the insurer to pay the benefit. It works for a stand-alone personal accident policy, a personal accident cover that comes with a motor policy for the owner-driver, and a group cover through an employer, bank or society.

The insured person writes it, or the nominee or legal heir does if the insured person has died. It gives the policy, the accident, the result of it, the police position, the amount claimed and where to pay, and asks the insurer to register the claim and give written reasons for any deduction or rejection. Tell the insurer at once, by phone or email, and send this letter soon after; a late claim may be questioned. Papers usually asked for: the claim form, policy copy, FIR and post-mortem report where there is a death or a police case, the hospital records and bills, the disability certificate from a medical board or doctor, identity proof, the nominee's or heir's proof of relationship, and a cancelled cheque. Read the policy for what it pays for each result, the time within which a claim must be made, and what it excludes. Not a claim for illness or hospital bills under a health policy — use the Health Insurance Claim Letter. Not a compensation case against the driver and owner of a vehicle — use the Motor Accident Claim Petition. Not a life insurance claim for a death that was not an accident — use the insurer's own claim form.

Whether you can fill this in here

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You can fill this one in on this site, and read the whole draft on screen before you decide anything about it. It is a carefully drafted template; it is not advice about your own facts.

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See stamp duty, registration and witnesses

What follows is written for Punjab and Chandigarh. It states the position there rather than describing how it varies, so the amounts below are the ones that apply — worth confirming at the sub-registrar’s office, because rates change. If the property is anywhere else in India, none of this is yours.

Stamp duty

Punjab and Chandigarh: no stamp duty is payable. A letter asking an insurer to perform its own contract creates, transfers or ends no right, so it is not a chargeable instrument under the Indian Stamp Act, 1899. Plain paper is enough.

Registration

Punjab and Chandigarh: not registrable. It touches no immovable property, so section 17 of the Registration Act, 1908 does not reach it. Keep proof of the day it was lodged: the stamped copy, the email delivery receipt or the post receipt.

Notarisation

Punjab and Chandigarh: no notarisation is needed. If the insurer asks for a sworn statement, it will say which of its papers it wants sworn. A nominee or legal heir may be asked for a sworn statement or an indemnity; ask the insurer which papers it wants sworn.

Witnesses

Punjab and Chandigarh: no witness is needed. The signatory signs alone.

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Sample preview — placeholder answers, not your data

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PERSONAL ACCIDENT CLAIM LETTER

A claim under a personal accident policy or cover for death, disability or injury caused by an accident.

Date: 1 April 2026, at Ludhiana

TO:
The Claims Manager
ABC General Insurance Company Limited
Regional Office, SCO 25, Sector 17-E, Chandigarh 160017

FROM:
Harjinder Singh Gill
House No. 412, Sector 38-A, Chandigarh 160036
Phone: 98765 43210
Email: harjinder.gill@example.com

SUBJECT: Personal accident claim under policy no. P/141234/01/2026/003318 for Harjinder Singh Gill

Sir / Madam,

1. THE POLICY AND THE INSURED PERSON

1.1 I write as the insured person. The insured person is Harjinder Singh Gill, who is covered with you under a personal accident policy, policy no. P/141234/01/2026/003318. The sum insured for personal accident is ₹10,00,000 (Rupees Ten Lakh only).

2. THE ACCIDENT AND ITS RESULT

2.1 On 2 April 2026 the insured person met with an accident at the Chandigarh-Kharar road near Sector 66, Mohali. He was riding his motorcycle home from work when a car coming from the opposite side hit him.

2.2 The accident resulted in the death of the insured person. Fracture of the left leg, treated at Fortis Hospital, Mohali from 2 to 9 September 2026. The doctor has certified a temporary disability for three months.

2.3 The police were told, and the reference is FIR No. 214 of 2026, Police Station Phase 8, Mohali.

2.4 I first told you of the accident on 3 April 2026. The claim number is PA/2026/004417.

3. WHAT I ASK YOU TO DO

3.1 Please register this claim, give me the claim number in writing, send me your claim form, and tell me in one list every paper you still need, with the name and number of the officer handling the claim.

3.2 Please pay the benefit that the policy gives for this result, which I put at ₹10,00,000 (Rupees Ten Lakh only), and tell me in writing how it is worked out.

3.3 If you reduce or reject any part of the claim, please give me each deduction or reason in writing, with the clause of the policy you rely on.

4. WHERE TO PAY

4.1 Please pay any amount due by transfer to the account held by Harjinder Singh Gill with HDFC Bank, Sector 40, Chandigarh, account ending 3391. I will give the full account number on your own form, not in this letter.

5. WHAT I CONFIRM

5.1 What I have written is true to the best of my knowledge, and I have kept back no fact that you would reasonably want to know. I will give you the papers listed below and any further paper you reasonably ask for.

6. PAPERS ENCLOSED

1. Claim form. 2. Policy copy. 3. FIR and post-mortem report, where there is one. 4. Hospital records and bills. 5. Disability certificate. 6. Identity proof and proof of relationship. 7. Cancelled cheque.

Yours faithfully,

_________________________
Harjinder Singh Gill
Claimant
House No. 412, Sector 38-A, Chandigarh 160036
Date: 1 April 2026

Questions about this document

Does the Personal Accident Claim Letter need stamp paper or stamp duty in Punjab and Chandigarh?

Punjab and Chandigarh: no stamp duty is payable.

See the full position on stamp duty, registration and witnesses

Does the Personal Accident Claim Letter need registration in Punjab and Chandigarh?

Punjab and Chandigarh: not registrable.

See the full position on stamp duty, registration and witnesses

What does the Personal Accident Claim Letter cost on Kaagazaat?

Free, always.

Does the Personal Accident Claim Letter need witnesses?

Punjab and Chandigarh: no witness is needed.

See the full position on stamp duty, registration and witnesses

Often needed with this document

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