{"id":1011,"title":"NEON SIGN CLAIM FORM","purpose":"claim","insurer":{"slug":"oriental-insurance","name":"The Oriental Insurance Company Limited"},"source_pdf":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Neon_Sign_Insurance_Claim_Form_1_82ee99af05.pdf","sha256":"55278170da9532c8204257b1e9293e138036917111816d1b60ffd8cf81921c14","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim insurance for damage to a neon sign covered under their policy.","notes":[],"title":"NEON SIGN CLAIM FORM","submit":{"to":"Issuing Office","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details and Claim Information","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":"Text41"},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":"Text42"},{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":"Text43"},{"help":"Enter start and end dates of the insurance period","type":"date","label":"Period of Insurance From_____________to____________","options":[],"required":null,"pdf_field":"Text44"},{"help":"Provide the installation date of the sign and the amount","type":"text","label":"Date of Installation of damage Sign Board and Amount","options":[],"required":null,"pdf_field":"Text45"},{"help":"Date when the damage or accident happened","type":"date","label":"State when the accident occurred","options":[],"required":null,"pdf_field":"Text46"},{"help":"Describe how the damage or accident happened","type":"text","label":"How did it occurred","options":[],"required":null,"pdf_field":"Text47"},{"help":"Select whether the loss is total or partial","type":"choice","label":"Whether total loss/Partial loss:","options":["Total loss","Partial loss"],"required":null,"pdf_field":"Text48"},{"help":"Enter the estimated amount needed for repair or replacement","type":"amount","label":"Estimated amount required","options":[],"required":null,"pdf_field":"Text49"},{"help":"Provide name and address of any witness","type":"text","label":"Name and Address of witness to accident","options":[],"required":null,"pdf_field":"Text50"},{"help":"Provide name and address of the person or company who will repair the sign","type":"text","label":"Name and address of repairer","options":[],"required":null,"pdf_field":"Text51"},{"help":"Enter the amount being claimed","type":"amount","label":"Amount claimed","options":[],"required":null,"pdf_field":"Text52"}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":null,"pdf_field":"Text53"},{"help":"Place where the declaration is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":"Text54"},{"help":"Sign here","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":"Signature57"}],"filled_by":"insured"}],"deadlines":[],"applies_to":"","attachments":[],"declarations":["The statements made are true and not concealed.","The insured declares the information is accurate to the best of their knowledge."],"dropped_labels":0},"pdf_fields":[{"name":"Text41","page":1,"type":"text"},{"name":"Text42","page":1,"type":"text"},{"name":"Text43","page":1,"type":"text"},{"name":"Text44","page":1,"type":"text"},{"name":"Text45","page":1,"type":"text"},{"name":"Text46","page":1,"type":"text"},{"name":"Text47","page":1,"type":"text"},{"name":"Text48","page":1,"type":"text"},{"name":"Text49","page":1,"type":"text"},{"name":"Text50","page":1,"type":"text"},{"name":"Text51","page":1,"type":"text"},{"name":"Text52","page":1,"type":"text"},{"name":"Text53","page":1,"type":"text"},{"name":"Text54","page":1,"type":"text"},{"name":"Text55","page":1,"type":"text"},{"name":"Text56","page":1,"type":"text"},{"name":"Signature57","page":1,"type":"signature"}],"fillable_pdf":true,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/oriental-insurance/1011-neon-sign-claim-form"}