Free form template · Word

Life Insurance Nomination Form

A life insurance nomination form names who should receive the sum assured under the employer's term life policy if the employee dies while covered. It records the cover basis, such as a multiple of CTC, and is kept with HR so the death claim can be filed without dispute.

Editable Word (.docx)
Made for India
14 fill-in fields highlighted
Free, no sign-up

Download Word (.docx) — free

Preview of the form

[Highlighted] = fill in

[Company Logo][Company Name]

LIFE INSURANCE NOMINATION FORM

Company:: [Company Name]
Policy:: Group Term Life, No. [Policy Number]
Insurer:: [Insurer Name]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Designation
Date of Birth
Date of Joining
Cover Basis	[Number] x Annual CTC / Flat ₹[Amount]
Current Sum Assured: ₹[Amount]

Nominees

Nominee Name	Relationship	Age	Address	Share (%)
[Nominee Name]	[Relationship]	[Age]	[Address]	[%]
[Nominee Name]	[Relationship]	[Age]	[Address]	[%]
[Nominee Name]	[Relationship]	[Age]	[Address]	[%]

Appointee for Minor Nominee

Appointee Name
Relationship
Address
Consent Signature of Appointee

Important

This nomination applies only to the company's group term life policy named above.
PF, EPS and EDLI nominations must be filed separately with EPFO.
Gratuity nomination is made in the separate gratuity nomination form.
A fresh form must be submitted to change nominees; the latest acknowledged form prevails.

Declaration

I nominate the person(s) above to receive the sum assured payable on my death under the group term life policy, in the shares stated, and cancel any earlier nomination for this policy.

Employee
[Employee Name]
Date: [Date]

Witness 1
[Witness Name]

Witness 2
[Witness Name]

HR Acknowledgement
[HR Name]
Date: [Date]

Download Word (.docx) — free

What this template includes

Cover basis and amount so the employee understands the benefit
Nominee list with percentage shares
Minor appointee section
Statement that this does not replace PF, EPS or EDLI nominations
Two witnesses
HR acknowledgement with date

When to use it

When the company introduces group term life cover
For new joiners whose cover starts from joining
When an employee's cover amount rises after a promotion or revision
When the existing nomination is incomplete or unsigned

How to customise this template

1State your cover formula, for example [Number] times annual CTC, or a flat ₹[Amount]
2Add any age or grade-based cover differences
3Mention whether voluntary additional life cover is offered
4Keep or remove the EDLI reference based on your setup

HR tips

Remind employees that EDLI under EPFO uses the PF nomination, not this form
Collect nominations at joining, not after an incident
Ask for full nominee names exactly as on ID documents
Provide a copy to the employee for their family's records

For HR & hiring managers

Experienced and fresher candidates across India — blue, grey and white collar. Post a job in 5 minutes and start receiving applications.

Post a job free See plans

Post in 5 minutesDescribe the role in one line — we write the job description.
Verified applicantsEvery applicant has a verified mobile number.
Resume databaseSearch experienced candidates by skill, city and experience.

Frequently asked questions

Is EDLI nominee the same as group term life nominee?+

No. EDLI is linked to your PF nomination with EPFO. The company's group term life policy uses its own nomination form.

How much life cover does a company term policy give?+

It varies by employer, often a flat amount or a multiple of annual CTC. Your HR policy or benefits statement will state it.

Does life cover continue after I leave the company?+

Group cover usually ends on the last working day, though some insurers offer conversion to an individual policy.

All 50 employee benefits & insurance →

[Company Logo][Company Name]

GROUP INSURANCE NOMINATION FORM

Company:: [Company Name]
Policy:: Group Term Life / Group Personal Accident
Insurer:: [Insurer Name]
Policy No.:: [Policy Number]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Designation
Department
Date of Birth
Date of Joining
Marital Status

Nominee Details

Nominee Name	Relationship	Date of Birth	Address and Mobile	Share (%)
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
Total				100%

Appointee (only if a nominee is a minor)

Form · Word

Group Insurance Nomination Form

Download .docx

[Company Logo][Company Name]
HEALTH INSURANCE CLAIM SUBMISSION FORM (INTERNAL)
Company:
[Company Name]
Insurer / TPA:
[Insurer Name] / [TPA Name]
Policy No.:
[Policy Number]
Internal Claim Ref.:
[Reference Number]
Date of Submission:
[Date]
Important: This form helps HR process your claim. The insurer's or TPA's official claim form must also be completed, signed and attached where required.
1. Employee Details
Employee Name
Employee ID
Department
Mobile Number
Email ID
2. Patient Details
Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)
Form · Word
Health Insurance Claim Form
Download .docx
[Company Logo][Company Name]
INSURANCE CLAIM ASSISTANCE REQUEST
Company:
[Company Name]
Request No.:
[Reference Number]
Date:
[Date]
Priority:
Urgent (in hospital) / Normal
Employee and Policy
Employee Name
Employee ID
Department
Mobile Number
Policy Type: Group Health / Group Personal Accident / Group Term Life
Patient / Insured Member Name
TPA / Insurer Claim Number
Nature of Assistance Needed
- Cashless approval pending
- Reimbursement claim delayed
- Claim rejected, request review
- Claim partly settled / deductions unclear
- Document query from TPA
- Other: [Details]
Claim Summary
Form · Word
Insurance Claim Assistance Form
Download .docx

Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)

[Company Logo][Company Name]

EMPLOYEE INSURANCE DETAILS FORM

Company:: [Company Name]
Record Date:: [Date]
Last Updated:: [DD/MM/YYYY]

Employee Information

Employee Name
Employee ID
Designation
Department
Work Location
Date of Joining
Mobile Number

Coverage Summary

Cover	Insurer	Policy No.	Member / E-card ID	Sum Insured (₹)	Valid Till
Group Mediclaim	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Group Term Life	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Group Personal Accident	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Voluntary Top-up	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]

Statutory Coverage

Form · Word

Employee Insurance Details Form

Download .docx

[Company Logo][Company Name]
INSURANCE BENEFICIARY DESIGNATION / CHANGE FORM
Company:
[Company Name]
Form Ref.:
[Reference Number]
Date:
[Date]
Effective From:
[DD/MM/YYYY]
Employee Details
Employee Name
Employee ID
Department
Designation
Mobile Number
Policies Affected
- Group Term Life, Policy No. [Policy Number]
- Group Personal Accident, Policy No. [Policy Number]
- Voluntary Life Cover, Policy No. [Policy Number]
Type of Request
Form · Word
Insurance Beneficiary Form
Download .docx
Form · Word
Employee Insurance Correction Form
Download .docx
[Company Logo][Company Name]
PERSONAL ACCIDENT CLAIM FORM (INTERNAL)
Company:
[Company Name]
GPA Policy No.:
[Policy Number]
Insurer:
[Insurer Name]
Internal Ref.:
[Reference Number]
Date:
[Date]
This form supports HR in filing the claim. The insurer's official claim form must also be completed and signed by the insured or claimant.
1. Insured Employee
Employee Name
Employee ID
Designation
Department
Date of Birth
2. Claimant (if not the employee)
Claimant Name
Relationship to Employee
Nominee as per records: Yes / No
Mobile Number
Address
Form · Word
Accident Insurance Claim Form
Download .docx
[Company Logo][Company Name]
EMPLOYEE BENEFITS ENROLLMENT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date of Submission:
[Date]
Enrollment Deadline:
[DD/MM/YYYY]
Please complete all sections within the enrollment window and return this form to [HR Name], Human Resources. Benefits will be activated only after HR verification.
Section A: Employee Details
Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)
Section B: Statutory Benefits
UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No
Form · Word
Employee Benefits Enrollment Form
Download .docx

Member Name (as currently on e-card)
Relationship
E-card / Member ID

Claimant Name
Relationship to Employee
Nominee as per records: Yes / No
Mobile Number
Address

Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)

UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No

Life Insurance Nomination Form

Preview of the form

Employee Details

Nominees

Appointee for Minor Nominee

Important

Declaration

What this template includes

When to use it

How to customise this template

HR tips

Hire top talent from BetterJobs

Frequently asked questions

Related HR templates