Claim Intimation Form

Claim Intimation Form (Fire, Health & Others)

General Information Common to all Lines of Business

Nature Of Loss

Fire Health Others

Insured’s Details

Your Name*

Email Address*

Address*

Contact Details*

Policy Details

Policy No*

Policy Period*

Loss Details

Date & Time of loss *

Place of loss /accident*

Brief Description of loss*

Approximate Loss Amount (INR)*

Survey Details

Place of survey*

Details of Contact person for survey*

ADDITIONAL INFORMATION COMMON TO ALL LINES OF BUSINESS

FIR / Injury Details

FIR Lodged*

Yes No

If Yes FIR No. & Police Station*

Third Party Liability – Property Damage*

TIf Yes, Furnish Details*

Injuries sustained by any Occupant/Employee/Third Party*

Any other information relevant to loss / accident:*

Claim Intimation Form (Motor & Marine)

General Information Common to all Lines of Business

Insured’s Details

Your Name*

Email Address*

Address*

Contact Details*

Policy Details

Policy No*

Policy Period*

Loss Details

Date & Time of loss *

Place of loss /accident*

Brief Description of loss*

Approximate Loss Amount (INR)*

Survey Details

Place of survey*

Details of Contact person for survey*

ADDITIONAL DETAILS IN CASE OF MARINE & MOTOR

Voyage / Transit Details (For Marine claims only)

Marine Certificate No.*

Invoice No & Date*

LR/RR /AWB/BL No & Date*

Drivers Details ( For Motor claims only)

Name of Driver*

Driving License No.*

ADDITIONAL INFORMATION COMMON TO ALL LINES OF BUSINESS

FIR / Injury Details

FIR Lodged*

Yes No

If Yes FIR No. & Police Station*

Third Party Liability – Property Damage*

TIf Yes, Furnish Details*

Injuries sustained by any Occupant/Employee/Third Party*

Any other information relevant to loss / accident:*

Claim Intimation Form (Fire, Health & Others)

General Information Common to all Lines of Business

ADDITIONAL INFORMATION COMMON TO ALL LINES OF BUSINESS

Claim Intimation Form (Motor & Marine)

General Information Common to all Lines of Business

ADDITIONAL DETAILS IN CASE OF MARINE & MOTOR

ADDITIONAL INFORMATION COMMON TO ALL LINES OF BUSINESS

Download Enquiry Form

Download the Document. Fill it and Upload it.

Enter your details and we'll get back to you!

IRDAI Certificate of Registration No. 321 Category ( Life & General) Renewal Valid upto 05-01-2027

Quick Links