{"id":1087,"title":"SURETY BOND INSURANCE - CLAIM FORM","purpose":"claim","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd."},"source_pdf":"https://rahejaqbe.com/uploads/images/surety-bond/pdf/download/surety-bond-claim-form-V01.pdf","sha256":"fc951e08c5593919b4a241db55d97d316e2222987f6f71a8ba078ae7f7f79afb","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used to claim under a surety bond insurance policy and is to be filled by the authorized person of the Insured/Claimant.","notes":["Read the claim form fully before answering the questions.","All questions must be answered as fully as possible; use additional sheets if necessary.","Attach copies of relevant documentation, self-attested by the authorized signatory.","Payments to the beneficiary will be made only through electronic mode as per IRDAI guidelines."],"title":"SURETY BOND INSURANCE - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Name of Insured /Obligor (Contractor):","options":[],"required":null,"pdf_field":""},{"help":"Include full address with city, state, and pin code","type":"text","label":"Address of Insured:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Phone number with STD code","type":"phone","label":"Contact Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Provide GSTIN or PAN number","type":"text","label":"GSTIN / PAN:","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person if different from insured","type":"text","label":"Represented By/Contact Person (if applicable):","options":[],"required":false,"pdf_field":""},{"help":"Contact person's phone number","type":"phone","label":"Phone Number:","options":[],"required":false,"pdf_field":""},{"help":"Contact person's mobile number","type":"phone","label":"Mobile No:","options":[],"required":false,"pdf_field":""},{"help":"Contact person's email","type":"email","label":"Email ID:","options":[],"required":false,"pdf_field":""}],"filled_by":"Insured/Claimant"},{"title":"Beneficiary/Claimant Details","fields":[{"help":"","type":"text","label":"Name of Beneficiary / Obligee:","options":[],"required":null,"pdf_field":""},{"help":"Include full address with city, state, and pin code","type":"text","label":"Address of Beneficiary:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Phone number with STD code","type":"phone","label":"Contact Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person if different from beneficiary","type":"text","label":"Represented By/Contact Person (if applicable):","options":[],"required":false,"pdf_field":""},{"help":"Contact person's phone number","type":"phone","label":"Phone Number:","options":[],"required":false,"pdf_field":""},{"help":"Contact person's mobile number","type":"phone","label":"Mobile No:","options":[],"required":false,"pdf_field":""},{"help":"Contact person's email","type":"email","label":"Email ID:","options":[],"required":false,"pdf_field":""}],"filled_by":"Claimant"},{"title":"Bond/Policy Details","fields":[{"help":"Name or description of the project","type":"text","label":"Project:","options":[],"required":null,"pdf_field":""},{"help":"Select one","type":"choice","label":"Policy Type:","options":["Conditional","Unconditional"],"required":null,"pdf_field":""},{"help":"Enter contract value in Indian Rupees","type":"amount","label":"Contract Value (₹):","options":[],"required":null,"pdf_field":""},{"help":"Enter bond value in Indian Rupees","type":"amount","label":"Bond Value (₹):","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of Insurance: From","options":[],"required":null,"pdf_field":""},{"help":"End date of insurance period","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Select one or more","type":"choice","label":"Obligation Secured by the Bond:","options":["Bid Bond","Advance Payment Bond","Performance Bond","Retention and Maintenance Bond"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Whether the Bond was subject to any extension/ Renewal:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide revised expiry date if bond was extended","type":"date","label":"If yes, please mention revised expiry date:","options":[],"required":false,"pdf_field":""}],"filled_by":"Claimant"},{"title":"Loss Details","fields":[{"help":"Provide date and time when default occurred","type":"text","label":"Date and Time of Default:","options":[],"required":null,"pdf_field":""},{"help":"Provide date/time default was discovered and by whom","type":"text","label":"Date / Time Discovered and by whom:","options":[],"required":null,"pdf_field":""},{"help":"Full address including city, state, and pin code","type":"text","label":"Location / Address of Loss:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Select one; if Other, specify","type":"choice","label":"Nature of Default (please specify):","options":["Non-performance","non-completion","Payment default","Other"],"required":null,"pdf_field":""},{"help":"Use additional sheets if space is insufficient","type":"text","label":"Describe full circumstances of Loss, reasons for invoking Surety Bond, along with supporting information","options":[],"required":null,"pdf_field":""},{"help":"Date when claim notice was served","type":"text","label":"Date of Demand / Claim Notice served on Surety:","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed breakup of claimed amount","type":"text","label":"Amount Claimed under the Bond (₹) – please provide break-up:","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No; if Yes, attach copy","type":"yes-no","label":"Whether any cure / show-cause notice issued to the Obligor before invoking the bond?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No; if Yes, attach copy","type":"yes-no","label":"Has the Insured/Obligor provided any explanation or dispute regarding the claim?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No; if Yes, provide details","type":"yes-no","label":"Has arbitration / legal proceeding been initiated between the Obligee and Insured/Obligor?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"Claimant"},{"title":"Bank Details (for Claim Payment)","fields":[{"help":"Name as registered with bank","type":"text","label":"Payee Name (as per Bank Record):","options":[],"required":null,"pdf_field":""},{"help":"Bank account number for payment","type":"text","label":"Bank Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Name and branch of bank","type":"text","label":"Bank Name & Branch:","options":[],"required":null,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFSC Code:","options":[],"required":null,"pdf_field":""},{"help":"Magnetic Ink Character Recognition code","type":"text","label":"MICR Code:","options":[],"required":false,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account Type:","options":["Saving","Current"],"required":null,"pdf_field":""},{"help":"PAN or GSTIN of payee","type":"text","label":"PAN/ GSTIN of Beneficiary:","options":[],"required":null,"pdf_field":""},{"help":"Attach one or both documents","type":"checkbox","label":"Attachment in support of bank details:","options":["Cancelled Cheque","Bank Passbook Copy"],"required":null,"pdf_field":""}],"filled_by":"Claimant"},{"title":"List of Documents Submitted","fields":[{"help":"Tick all documents attached","type":"checkbox","label":"Documents submitted","options":["Copy of Surety Bond","Contract agreement between the Beneficiary and the Insured","Claim / Invocation Letter to the Surety","Proof of invocation within Bond Validity","Correspondence, progress reports, invoices, photographs or project documents.","Evidence of Insured’s inability to perform / discharge contractual obligation","Default notices/ termination letters","A certified copy of the award or judgement in favour of the Beneficiary (in case of court arbitration)","Any other documents supporting the claim"],"required":null,"pdf_field":""}],"filled_by":"Claimant"},{"title":"Declaration","fields":[{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Signature of claimant or authorized signatory","type":"signature","label":"Signature of the Claimant or any authorized person","options":[],"required":true,"pdf_field":""}],"filled_by":"Claimant or authorized person"}],"deadlines":["Please send the completed claim form, as soon as possible"],"applies_to":"Surety Bond Insurance claims","attachments":["Copy of Surety Bond","Contract agreement between the Beneficiary and the Insured","Claim / Invocation Letter to the Surety","Proof of invocation within Bond Validity","Correspondence, progress reports, invoices, photographs or project documents.","Evidence of Insured’s inability to perform / discharge contractual obligation","Default notices/ termination letters","A certified copy of the award or judgement in favour of the Beneficiary (in case of court arbitration)","Any other documents supporting the claim","Cancelled Cheque or Bank Passbook Copy in support of bank details"],"declarations":["No other surety bond or guarantee has been invoked for the same obligation.","The claimant warrants the truth and completeness of the statements and understands that false or fraudulent claims will result in forfeiture and policy nullification.","The company may request additional information for claim assessment."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customercare@rahejaqbe.com","label":"Claims service mail ID","level":null,"hours":"Monday to Saturday, 9 am to 8 pm","applies_to":"all","source_url":"https://rahejaqbe.com/claims","quote":"Commercial Lines Claims\nClick here\nto track you claim status\nClick here\nto Register a Claim\nIntermediaries\n18001027723\ncustomercare@rahejaqbe.com\nContact Us\nHospital\nLocator\nGarage\nLocator\nRegister\na Claim\nRegister\nComplaint With Us\nPolicy\nServicing\nLet us call you","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"info@mediassistindia.com","label":"Medi Assist TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.c","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashless@mediassist.in","label":"Medi Assist TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":", kindly visit\nhttps://www.medibuddy.in/claim\nToll Free Number :\n1800-4259-449\nEmail Address :\ninfo@mediassistindia.com\ncashless@mediassist.in\nCashless everywhere\nReimbursement claim registration :\nRetail\nCorp employee\nMedi Assist Insurance TPA Pvt. Ltd.\n4th Flo","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"contact.phs@paramounttpa.com","label":"Paramount TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"nonetwork.phs@paramounttpa.com","label":"Paramount TPA Non-network Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ttpa.com/PolicyClaim/PolyClaimStatus.aspx\nToll Free Number :\n9122-66620808\nEmail Address :\ncontact.phs@paramounttpa.com\nnonetwork.phs@paramounttpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nParamount TPA Office","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"assistance@volohealthtpa.com","label":"Volo Health TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ed (Annual Disclosure) – Disclosures Data (22-23)\nTPA Details\nVolo Health\nToll Free Number :\n1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimburse","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashlesseverywhere@volohealthtpa.com","label":"Volo Health TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"losures Data (22-23)\nTPA Details\nVolo Health\nToll Free Number :\n1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@volohealthtpa.com","label":"Volo Health TPA Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Surak","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashless@volohealthtpa.com","label":"Volo Health TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nVolo Health Insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customersupport@healthindiatpa.com","label":"HealthIndia Insurance TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Suraksha Bima\n,\nPravasi Bhartiya Bima Yoja","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"preauth@healthindiaindiatpa.com","label":"HealthIndia Insurance TPA Preauth Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"pa.com/CustomerCorner/ClaimStatus.aspx\nToll Free Number :\n1800220102\nEmail Address :\ncustomersupport@healthindiatpa.com\npreauth@healthindiaindiatpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nHealthIndia Insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"help@vidalhealthtpa.com","label":"Vidal Health Insurance TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"o@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Suraksha Bima\n,\nPravasi Bhartiya Bima Yojana\n,\nGroup Hospital Cash\n,","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims@rahejaqbe.com","label":"Claims email for two wheeler bundled policy","level":null,"hours":null,"applies_to":"motor","source_url":"https://rahejaqbe.com/uploads/images/tw-bundle/pdf/download/tw-bundle-_Prospectus-V01.pdf","quote":"800-102-7723 or in writing at the nearest Offices or through an intermediary.\n• Alternatively, you can also reach us at claims@rahejaqbe.com You can report with vehicle/ report claim at network garage whereby claim registration shall be done by network garage","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18001027723","label":"Claims call centre","level":null,"hours":"Monday to Saturday, 9 am to 8 pm","applies_to":"all","source_url":"https://rahejaqbe.com/claims","quote":"ims!\nExplore\nCommercial Lines Claims\nClick here\nto track you claim status\nClick here\nto Register a Claim\nIntermediaries\n18001027723\ncustomercare@rahejaqbe.com\nContact Us\nHospital\nLocator\nGarage\nLocator\nRegister\na Claim\nRegister\nComplaint With Us\nPolic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-4259-449","label":"Medi Assist TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"p Up\n,\nArogya Sanjeevani\n,\nGroup Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"9122-66620808","label":"Paramount TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"njeevani\n,\nGroup Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800202022","label":"Volo Health TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsuppor","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800220102","label":"HealthIndia Insurance TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealtht","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"080-28004114/18004257878","label":"Vidal Health Insurance TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@he","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-102-7723","label":"Call centre for claims intimation","level":null,"hours":"9 am to 8 pm, Monday to Saturday","applies_to":"all","source_url":"https://rahejaqbe.com/uploads/images/two-wheeler-package/pdf/download/tw-package-prospectus-V01.pdf","quote":"ct numbers specified in the Schedule to the Policy.\n• Intimation of claim can also be made to Raheja QBE Call centre at 1800-102-7723 or in writing at the nearest Offices or through the intermediary.\n• Alternatively, you can also reach us at customercar","fetched_at":"2026-10-20"}],"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/raheja-qbe-general-insurance/1087-surety-bond-insurance-claim-form"}