{"id":1090,"title":"FIRE INSURANCE 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/Fire-Claim-Form.pdf","sha256":"5479cc591e0da0a01c704f7678c2e21e7a405527d2f820a5c4c0adf4666080f4","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for policyholders to claim compensation for loss or damage due to fire under their insurance policy.","notes":["Complete the form in capital letters.","Attach additional sheets if required to answer a question.","The issue of this form is not to be taken as an admission of liability."],"title":"FIRE INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Incident Details","fields":[{"help":"Enter your insurance policy number.","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Enter the date and time when the fire incident occurred.","type":"date","label":"Date & time of Occurrence","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Insured Details","fields":[{"help":"Enter your full name and address.","type":"text","label":"Name & Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter your phone number.","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Enter fax number if available.","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"Enter your mobile number.","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance Policies","fields":[{"help":"Enter name of other insurance companies covering the same interest.","type":"text","label":"NAME OF THE COMPANY","options":[],"required":false,"pdf_field":""},{"help":"Enter policy numbers of other insurance policies.","type":"text","label":"POLICY NO.","options":[],"required":false,"pdf_field":""},{"help":"Enter the policy period of other insurance policies.","type":"text","label":"POLICY PERIOD","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured under other policies.","type":"amount","label":"SUM INSURED","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Details","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":"Explain the probable cause of the fire loss.","type":"text","label":"Probable Cause of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the extent of the loss or damage.","type":"text","label":"Extent of Loss","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Ownership Details","fields":[{"help":"Indicate if you are the sole owner of the damaged property.","type":"yes-no","label":"Are you the sole owner of the property lost/damaged?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other owners if applicable.","type":"text","label":"If not state the name and address of the other parties involved and their interest","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claim Details for Property Destroyed or Damaged","fields":[{"help":"List each damaged item with its value at loss, salvage value, and amount claimed.","type":"table","label":"Description of Items damaged, Value at the time of Loss or damage, Value of Salvage, Amount Claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Claim for Loss of Profit","fields":[{"help":"Describe any production loss if claiming loss of profit.","type":"text","label":"Has any production been lost? (Give Details)","options":[],"required":false,"pdf_field":""},{"help":"Provide the expected date to resume normal production.","type":"date","label":"By what date will it be possible to resume normal production?","options":[],"required":false,"pdf_field":""},{"help":"Estimate the turnover loss during the interruption period.","type":"amount","label":"What is the estimated loss of turnover during the period of interruption?","options":[],"required":false,"pdf_field":""},{"help":"State any additional costs incurred to reduce loss.","type":"amount","label":"Have you incurred any increased cost of working to minimize the loss? If yes, Please state the amount incurred.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Enter the place where you sign the form.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign the form here.","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Print your name.","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Print your address.","type":"text","label":"Address","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Please submit the claim form along with relevant documents within 15 days"],"applies_to":"","attachments":["FIR","Invoice /Bills / Receipts","Photographs","Fire Brigade Report","Metrological report","KYC details of insured","Cancelled cheque leaf in the name of the proposer for effecting claim 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/1090-fire-insurance-claim-form"}