Investigation Report (Death Claim)

CONTRACT DETAILS

Claim Number Policy Issued

Policy Number Date of Death Sum Insured Duration
No. Date

INVESTIGATOR PARTICULARS

Investigation Report Time Taken

Investigation Agency Name Contact Number
Assignment date Submission date (TAT)
Delver 9211182666 06/07/2023 16/08/2023 41 Days
194/2 Third floor Madhuban Apartment, ward No. 02 Mehraulli New Delhi-
Investigation Agency Address
110030

Decision Negative

CASE DETAILS

Name of Life Assured XYZ

Name of Claimant Rachna Singh

Claimant Relationship with LA Wife

Address Of the Claimant ABC

Relationship proof Adhar card

Date of Death & Timing 26/04/2023

Cause of Death Not given

Advisor Relationship with life

Not Confirmed
assured / claimant
Findings if the customer’s area is
fraud prone (Give details) for Not confirmed as such
life insurance
 PROPOSAL VERIFICATION
(Personal Details of the Insured’s (Age, Income, Reason & Occupation – Nature of Duties)

Evidence received
Details As per Proposal Form As per Investigation
(YES/NO)
Age 48 48 Yes

Income Not given Not provided by the claimant No

Staying lodge Running by Name
Occupation Not given Hotel Vikram Near Kota railway No
Station

Existing insurance Not mentioned Not Confirmed No

Others (if any) None None None

Note: - If the answer is yes to any of the above then mention details in evidence procured and should be authenticated
by concerned issuing authority.

FAMILY HISTORY:

Sr. Relation with

Name of Member Age Occupation Income KYC Proof
No. insured
NA Pan and Adhar
1 Rachna Singh Wife 46 House wife

2 Ishita Singh Daughter 21 Student NA Not Provided

3 Bhavya Singh Daughter 14 Student NA Not Provided

4 Saibala Singh Mother 66 Dependent NA Not Provided

In private Job Not provided Not Provided
5 Pankaj Singh Brother 45
in Delhi

OTHER POLICY DETAILS & FAMILY INSURANCE DETAILS:- Not Confirmed

Basic Sum
Name of Life Name of Contract / Policy status
Assured RCD
Assured / Proposer Company Proposal no ( In-force / Lapsed /Applied )
years
 NA NA NA NA NA NA

VICINITY CHECK
(Inference made with Relatives, neighbors, workplace and hospitals)

Name of the person / Relation with

Sr. No. Contact No Address
Company insured
1 Pawan Kumar Singh Neighbor 9650791731 Near the locality of the LA
2 Ratna Neighbor 8130454636 Near the locality of the LA
3 Ranu Singh Neighbor 8470845271 Near the locality of the LA
4 Anil Neighbor Not provided Near the locality of the LA

Sr. No. Name of the hospital Contact No Address

Maharao Bhim Singh Govt.
1 NA Kota
hospital
Govt. Medical college and Kota
2 NA
hospital Kota
Ram Krishna Multi specialty Kota
3 NA
Hospital
4 Sudha Hospital 0744-2790002 Kota

5 Sir Ganga Ram hospital 011-25750000 Delhi

6 Rajiv Gandhi cancer hospital 011-47072222 Delhi

7 Mahatma Gandhi hospital 0141-2770677 Jaipur

DISCREET CHECK – FINDINGS

We visited at the given address which falls at main town near Kota Railway station which is residential and
commercial area and there on visit we met some people there who verbally confirmed that LA was approx 45-50 years
old married person and he used to run a residential hotel by Name Vikrant palace which is his parental hotel and in
current day it is still running but the condition of hotel is not good. They verbally confirmed that LA had been ill for
last 4-5 years prior to death as he had been suffering from some critical diseases and he was almost paralyzed for last
3-4 years as he had difficulties in standing and walking for which he had taken treatment at Kota, Jaipur and Delhi in
several hospitals but majorly he was treated in Delhi and probably he was diagnosed of cancer for last 2-3 years and he
remained always out of Kota for treatment and last time he was admitted in some governme4nt hospital of Jaipur
where he died on 26/04/2023 and his dead body was brought to Kota for cremation and they confirmed verbally also
that family of the LA mostly live out of Kota and for further information they told us to call and meet the family of the
LA.
We visited the house of the LA and in our first visit house found locked so further we called the claimant after
collecting death summary from last treating hospital (Mahatma Gandhi hospital, Jaipur) and there we found that LA
had been suffering from cancer and had some other pre policy and post policy medical history so we requested the
claimant to share the biopsy report than she confirmed verbally that she has some more medical paper with her In
Jaipur so we requested her to share all the medical papers available with her and she shared all the medical docs
available with her. We requested her to provide all the KYC docs, income and occupation proof of the LA than she
confirmed that those all documents like KYC and other docs are at Kota and when she will reach there than we can
collect from her so after a long period she reached her home at Kota and we met her and observed that LA had good
maintained house. Claimant assisted us in the investigation and confirmed verbally that LA used to run residential
hotel by name Vikrant palace at Station road Kota and he had good income. He was physically fit and fine but in
starting of 2020 he had pain in his waist so he had difficulties in walking so he had taken treatment from here and there
but he didn’t get relief and day by day his condition was deteriorating so further LA’s brother who is working in Delhi
called him for treatment and he was treated at Sir Ganga Ram hospital and he was admit there and there several tests
were conducted and he was diagnosed of cancer sop further he was taking treatment from Rajiv Gandhi cancer
hospital Delhi and for a long period his treatment continued but since then he was bed ridden. He was further brought
to Jaipur and there his treatment continued from different hospitals but day by day his condition was getting critical
and in this sequences on 24/04/2023 he was admitted at mahatma Gandhi hospital Jaipur and there he was declared
dead on 26/04/2023 in early morning hour so on the same day his dead body was brought to Kota and his cremation
was done. She confirmed verbally that whatever medical documents she had she has already shared than we asked her
LA had history of Old CVA before 2020 also so where are all the documents than she confirmed verbally that during
treatment they had missed some medical docs during going here and there and besides the given documents she has
not any medical documents and she bursts in to tears stating that she has 2 daughters and she has not any support so
what would she do she doesn’t know so further observing her situation we left the place collecting KYC docs.

Insured’s Past Health Details

During Visit at vicinity it got confirmed that LA has been ill for a long time and treated at several hospitals and
doctors so we at first searched at nearby hospital of the area in Kota Town but there nothing could be found against the
LA. we have collected at first death summary of Mahatma Gandhi hospital Jaipur and there we found the LA’s prior
medical history and treatment and on the basis of the same we collected other pre and post medical documents and
diagnosis reports of LA’s treatment and ailments which shows that La had been ill prior to policy and he had been
suffering from cancer and he died of the same. Even during the taking policy period he was admit at sir Ganga ram
hospital. LA died at Mahatma Gandhi hospital Jaipur where he was admitted on 24/04/2023 and died on 26/04/2023
die to prolonged diseases.

DEATH CERTIFICATE / CEMETERY VERIFICATION

Name of the Authority Govt. of Rajasthan Directorate of statistics and Economics

Registrar death and birth ,
Designation & Location
Jagatpur Zone Jaipur
Contact No NA

Date of death in register 26/04/2023

Death Certificate issued date 13/05/2023

 Cause of Death (if available) NA
Life Assured Cremated / Buried & Timing Not provided
Death Certificate Verified ( Genuine / Bogus) Genuine

Death Certificate has been verified online and it is found to be genuine.

POLICE STATION CHECK (In unnatural death like Accidents, Suicide and Homicide): NA

NA
Name of the Police station and Address

NA
Name of the officer (in-charge of the case)

NA
Exact Cause of Death

NA
FIR , PMR & FPR Details

DOCUMENTS PROCURED / COLLECTED

Submitted with
Particulars Evidence Collected by investigator Findings
Proposal / Claim stage
Verified as
Age Proof Pan card
genuine
Positive

Occupation Proof Not given Hotel owner Referred

Not provided by
Income Proof Not given Referred
the claimant
Pre and post
medical
treatment
Medical Evidence Not given records Negative
collected from
the claimant
and hospital
Death certificate
has been
Death Certificate 26/04/2023 verified online Positive
and it is found
to be genuine
Existing Insurance No Such Findings NA Positive

Nominee Age proof Pan card Pan card Positive

 Nominee Address &
Adhar card Adhar card Positive
ID Proof

Mandatory points to be remembered

Age Verification-

We had received Pan card as an age proof which has been verified and found to be genuine and an alternate age proof we have collected adhar card
1) In-addition we need any of the below mentioned documents to support LA age (Mandate).

(a) Voter list – NA

(b) Aadhar Card : collected
(c) Pension Card: NA
(d) Pan card: collected
(e) Ration card: NA
(f) Pariwar register: NA

Occupation & Income Verification - Complete details verification to be done

(a) Business:- Hotel owner
(b) Registration certificate / Sales or Service Tax Registration Details : Not found
(c) Income Proof (ITR – Mandatory for last 3 years): Not provided by the claimant
(d) Photocopy of the shop / store (whatever): NA
(e) In case of vendor (E.g fruit or vegetable seller) details should be verified with nearest vendor / locality: NA

1) Salaried:-
(a) Statement from employer on letter head re duration of employment, salary and medical leave details: NA
(b) Salary Slip for the last 3 salary drawn (Duly authenticated by employer). Point A to be collected in lieu of this: NA
(c) Bank Statement with Salary credit details, if available: NA
(d) Income Proof (ITR) of last 2years: NA

2) Agriculture:-
(a) Land details i.e. 7/ 12 extract duly certified by relevant issuing authority: NA
(b) Mandi receipts (last 2 or 3 years): NA
(c) Village Revenue officer statement ( only for negative cases):NA

3) House Wife – Collect husband insurance policy details with supporting documents. : NA
Note:
If occupation is mismatch with proposal get written declaration (Affidavit) from claimant with exact nature of duties and Life Style photograph for all
cases: NA

Medical History:

1. Admission card/ papers and discharge card/ summary. Pre and post policy medical documents collected from the claimant and the hospital
2. Doctor certificate – NA
3. Details of any Lab Test reports or other special medical reports: NA
4. Claim Form B submitted at claim stage has to be verified with issuing doctor with complete details. NA

If any medical documents collected from hospital, collected documents has to be authenticate by concern hospital authority / Doctor.

Name of Investigator: Delver

Signature of Investigator: _____________ _ _______

Seal of Investigator : _______________ ____

Date: 16/08/2023 __ ____