{"id":1088,"title":"BURGLARY CLAIM FORM","purpose":"claim","insurer":{"slug":"royal-sundaram-general-insurance","name":"Royal Sundaram General Insurance Company Limited"},"source_pdf":"https://www.royalsundaram.in/assets/claim-forms/home-insurance/Burgalary.pdf","sha256":"acb00f7ebbc76e880bbc4b738c778ecad8709571e3ad05f3a8004255a235054e","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for policyholders to claim insurance for loss or damage due to burglary under their policy.","notes":["Complete this form in capital letters.","Attach additional sheet if required to answer a question.","The issue of this form is not to be taken as an admission of liability."],"title":"BURGLARY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the date and time when the burglary occurred","type":"date","label":"Date & time of Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Full name and address of the insured person","type":"text","label":"Name & Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Contact phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Fax number if available","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance Policies","fields":[{"help":"Name of other insurance companies covering the same interest","type":"text","label":"NAME OF THE COMPANY","options":[],"required":false,"pdf_field":""},{"help":"Policy number of other insurance policies","type":"text","label":"POLICY NO.","options":[],"required":false,"pdf_field":""},{"help":"Policy period of other insurance policies","type":"text","label":"POLICY PERIOD","options":[],"required":false,"pdf_field":""},{"help":"Sum insured under other policies","type":"amount","label":"SUM INSURED","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Property","fields":[{"help":"Describe the damaged item and its serial number as per the policy","type":"text","label":"Item damaged and the serial no. in the policy","options":[],"required":null,"pdf_field":""},{"help":"If not sole owner, provide details of other owners and their interest","type":"text","label":"Are you the sole owner of the property lost/damaged.? If not state the name and address of the other parties involved and their interest","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Loss","fields":[{"help":"Date and time when the loss occurred","type":"date","label":"Date and time of occurrence of loss","options":[],"required":null,"pdf_field":""},{"help":"Name of person who discovered the loss and the time","type":"text","label":"By whom was the loss discovered and when?","options":[],"required":null,"pdf_field":""},{"help":"Describe how the intruder entered the premises","type":"text","label":"How was entry to the Premises effected?","options":[],"required":null,"pdf_field":""},{"help":"State if police were informed and by whom, or reason if not informed","type":"text","label":"Have the Police been notified? If so by whom? If not, state the reason therefor.","options":[],"required":null,"pdf_field":""},{"help":"Details about occupancy of premises at time of loss","type":"text","label":"Were the premises occupied at the time of loss? If not, on what date and time were they last occupied? For how long have the premises been unoccupied since the policy was effected?","options":[],"required":null,"pdf_field":""},{"help":"Name any suspected persons involved","type":"text","label":"Whom do you suspect of being involved in the occurrence?","options":[],"required":false,"pdf_field":""},{"help":"Describe any evidence of theft or forced entry","type":"text","label":"Is there any evidence of theft or of forcible entry into the premises?","options":[],"required":null,"pdf_field":""},{"help":"Total value of all property at premises when loss occurred","type":"amount","label":"State the total value of property upon the premises at the time of loss?","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details on the amount of loss","fields":[{"help":"List each item lost or damaged with estimated repair cost or intrinsic value, year of purchase, and amount claimed","type":"table","label":"Item lost/damaged, Estimated cost of repairs / intrinsic value of property lost/damaged, Year of Purchase of the property lost/damaged, Amount Claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Name of the insured person signing","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address of the insured person","type":"text","label":"Address","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Please submit the following documents along with the claim form within 14 days."],"applies_to":"","attachments":["F.I.R.","Invoice/Bills","Photographs of the premises taken after the loss","Final Police report","Non-traceable report issued by police","Indemnity bond effecting subrogation of rights","KYC documents of the insured","Cancelled cheque leaf of the insured for effecting settlement through NEFT"],"declarations":["I declare that to the best of my knowledge and belief these particulars are full and true.","I agree to provide any further information that may be required."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"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/royal-sundaram-general-insurance/1088-burglary-claim-form"}