Annexure VI-A and Form VI-A for Insurance Ombudsman: Meaning & How to Fill It

If you have already been trying to resolve an insurance grievance, encountering another form labelled Annexure VI-A can make the process feel more complicated than it needs to be. Fortunately, the form becomes much easier once you understand what each section is asking for.
 

Annexure VI-A for the Insurance Ombudsman is the complainant form published by the Council for Insurance Ombudsmen (CIO). It asks for details about you, your policy, the insurance company, your grievance, your earlier communication with the insurer and the relief you are seeking.
 

Here is how to understand and complete it, one section at a time.

 

What Is Annexure VI-A in an Insurance Ombudsman Complaint?
 

Annexure VI-A is the complainant form published by the Council for Insurance Ombudsmen (CIO) for providing the details of an insurance grievance to the Insurance Ombudsman.
 

CIO's E-Forms page specifically lists two different forms: Annexure VI-A, Annexure VI
 

The similar names can easily cause confusion, a simple way to remember the distinction is this:
 

Complainant → Annexure VI-A
 

and
 

Ombudsman Offices → Annexure VI
 

It is also important to know that an Ombudsman complaint can currently be submitted through a signed written representation, email or CIO's online complaint platform. So, Annexure VI-A should not be understood as the only possible way to initiate a complaint.
 

In the next section, we will delve deeper into the difference between Annexure VI-A and Annexure VI.

 

Annexure VI-A vs Annexure VI: What's the Difference?
 

A simple way to remember the distinction is:

 

The current Annexure VI notice asks the complainant to provide written consent for mediation and send complaint details using the enclosed Annexure VI-A, along with relevant supporting documents.
 

So, if you receive Annexure VI from the Ombudsman office, do not confuse it with the VI-A form you need to complete.

 

How to Fill Annexure VI-A: A Field-by-Field Guide
 

The official form looks formal, but most fields are asking for information you are likely to already have.
 

1. Complaint and Complainant Details
 

At the top, the form provides space for the complaint number, the relevant Insurance Ombudsman office and basic details such as:
 

• insurance company against which the complaint is made;
   
• branch or division;
   
• policy number; and
   
• complainant's name.
   

The first numbered section then asks for your full name, address, telephone/mobile number, email address and relationship to the insured person.
 

If the complainant and insured person are different, make this relationship clear.

 

2. Insurance Company and Policy Details
 

Next, provide the name of the insurance company, its office address, relevant division or branch and the policy number.
 

Use the details from your policy and correspondence rather than relying on memory.

 

3. Subject Matter of the Complaint
 

This is where you briefly explain the grievance.
 

Keep it factual and chronological. A useful structure is:
 

What happened → what the insurer decided or failed to do → why you disagree → what remains unresolved.
 

For example, instead of writing several paragraphs about every conversation, identify the central issue and the important dates.

 

4. Date You First Raised the Claim or Complaint
 

The form asks when you raised the claim or complaint with the insurance company's office and asks you to enclose a copy of the relevant letter.
 

This date matters because approaching the insurer or insurance broker first is an important part of the Ombudsman complaint process.

 

5. Date of the Insurance Company's Reply
 

If the insurer replied, enter the date and attach a copy of that communication.
 

If you did not receive a reply, make that clear rather than inventing a date.

 

6. Court, Consumer Forum or Arbitration Proceedings
 

The form asks whether proceedings involving the same subject matter are pending before a court, consumer forum or arbitrator, or were so earlier.
 

Answer this accurately.
 

Under the applicable Ombudsman framework, a complaint on the same subject matter is not maintainable where proceedings are pending before or have been disposed of by a court, consumer forum or arbitrator.

 

7. Nature and Extent of Monetary Loss
 

The official form marks this field as applicable to general insurance cases only.
 

Where relevant, state the monetary loss you say has resulted from the dispute and ensure the amount is supported by your documents.
 

Life insurance complainants should not try to force information into a field that the form itself identifies as specific to general insurance.

 

8. Quantum of Relief Sought
 

This field asks what relief you want from the complaint.
 

Be specific. The Ombudsman should be able to understand the outcome you are requesting.
 

If you are seeking monetary relief, state the amount accurately. Under the current Ombudsman framework, the compensation awarded cannot exceed ₹50 lakh, including relevant expenses, if any.

 

9. Your Earlier Representation to the Insurer
 

The form asks for particulars of the representation you made against repudiation of the claim to the insurer's relevant office or grievance cell and its outcome.
 

If no such representation was made, the form also provides space to explain why.
 

Remember, however, that current CIO guidance generally requires you to have first made a representation to the insurer or insurance broker before approaching the Ombudsman.

 

10. Read the Declaration Carefully
 

Annexure VI-A contains a declaration covering important points, including that:
 

• the information provided is true to the complainant's knowledge and belief;
   
• the grievance was first lodged with the insurance company;
   
• the relevant Ombudsman filing period has not elapsed;
   
• the same subject matter is not covered by proceedings before the specified other forums; and
   
• the subject matter has not already been decided by an Insurance Ombudsman office.
   

Do not treat this section as routine fine print. Read it before signing and make sure the information you have provided is consistent with the declaration.

 

Additional Details for Health or Mediclaim Complaints
 

Annexure VI-A contains a separate section for mediclaim/health policy-related complaints.
 

It asks whether the policy is fresh or ported. Where porting is relevant, the form asks for details including:
 

• date of porting;
   
• previous insurance company;
   
• previous policy number;
   
• commencement date of the previous policy; and
   
• sum insured.
   

These details can be particularly relevant where the dispute involves matters such as continuity of coverage, waiting periods or pre-existing disease provisions.
 

Use your previous policy documents to complete this section accurately.

 

What Documents Should You Enclose?
 

The form itself lists:
 

• a copy of the complaint letter sent to the insurance company;
   
• a copy of the insurer's reply; and
   
• a copy of any reminder, if applicable.
   

Depending on the complaint, other supporting documents may also be relevant.
 

Current CIO complaint guidance, for example, refers to the policy copy, repudiation/denial or partial-settlement letter, representation made to the insurer or broker and relevant correspondence.
 

The aim is not to send every insurance document you own. Include the documents that help clearly establish the complaint.

 

What Is the Mediation Consent Section?
 

The current Annexure VI-A also contains a mediation consent section.
 

It allows the complainant to consent to the Insurance Ombudsman acting as a mediator between the complainant and the insurance company and to make a recommendation to resolve the complaint.
 

The form also includes an option relating to consent for an audio and/or video hearing.
 

Because this is a formal consent, read the wording carefully before signing rather than treating it as another routine field.

 

Where Can You Download Annexure VI-A?
 

Download the latest form directly from the official Council for Insurance Ombudsmen (CIO) website.
 

CIO's E-Forms page identifies Annexure VI-A under Complainant and Annexure VI under Ombudsman Offices.
 

Using the official source helps you avoid relying on an outdated or incorrectly reproduced form.
 

For the broader eligibility requirements, deadlines, and filing channels, see our guide to filing a complaint with the Insurance Ombudsman. If you are new to the grievance mechanism, our guide to the Insurance Ombudsman in India explains its role, scope, and key rules.

 

Making Annexure VI-A Easier to Complete
 

By the time you encounter Annexure VI-A, you may already have spent considerable time following up on an insurance grievance. The form should not add unnecessary uncertainty.
 

Work through it one section at a time. Keep your policy and insurer correspondence beside you, use the actual dates and policy details from your records, explain the dispute briefly and clearly, and attach the relevant documents.
 

Most importantly, do not rush through the declarations or mediation consent simply because they appear near the end.
 

A careful, complete form makes your complaint easier to understand and helps avoid preventable gaps in the information you submit.

 

FAQs About Annexure VI-A and Form VI-A
 

Is Form 6A the same as Annexure VI-A?
 

"Form VI-A", "Form 6A" and "Annexure 6A" may be used when people search for the document. On the official CIO website, however, the document is titled Annexure VI-A and is listed as the form for complainants.

 

Is Annexure VI the same as Annexure VI-A?
 

No. CIO lists Annexure VI-A as the complainant form and Annexure VI as a document for Ombudsman offices. Annexure VI may be sent after a complaint is registered and asks for consent to mediation; Annexure VI-A details and supporting documents.

 

Where can I download the Insurance Ombudsman complaint form?
 

You can download Annexure VI-A free from the official Council for Insurance Ombudsmen website at cioins.co.in, under its E-Forms section.

 

What is Annexure VI-A used for?
 

Annexure VI-A records important details about the complainant, insurance company, policy, dispute, earlier complaint to the insurer, relief sought and supporting documents. The current document also contains health-policy-specific fields and a mediation-consent section.
 

(This blog has been reviewed in consultation with our legal and compliance experts)