{"id":143,"title":"LONG TERM TWO-WHEELER PACKAGE POLICY CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/motor-insurance/long-term-two-wheeler-package-policy/claim-forms/long-term-two-wheeler-package-policy-claim-form.pdf","sha256":"ea512db85b9a21085a19cb030dbe70429f95a64ba77291a3de38f567f1d0e9ac","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim insurance for damages or losses related to their two-wheeler vehicle under the Long Term Two Wheeler Package Policy.","notes":["Issue of this claim form is not to be taken as an admission of liability.","The damaged vehicle shall not be left unattended without proper precaution to prevent further damage.","The list of documents is indicative; additional documents may be called for depending on the nature of the claim."],"title":"LONG TERM TWO-WHEELER PACKAGE POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","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":"Full name of the insured or claimant","type":"text","label":"Name Of Insured/Claimant","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"*Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email Id:","options":[],"required":null,"pdf_field":""},{"help":"Name as registered in bank account","type":"text","label":"Name (As per Bank Account)","options":[],"required":null,"pdf_field":""},{"help":"Name of bank","type":"text","label":"Bank Details - Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"Savings, Current, etc.","type":"text","label":"Type of Account","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"A/c No.","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN No.","options":[],"required":null,"pdf_field":""},{"help":"MICR code of bank branch","type":"text","label":"MICR","options":[],"required":null,"pdf_field":""},{"help":"Aadhar number","type":"text","label":"Aadhar No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Date when accident occurred","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Time of accident with am or pm","type":"text","label":"Time of Accident: am/pm","options":[],"required":null,"pdf_field":""},{"help":"Location where accident happened","type":"text","label":"Place of Accident","options":[],"required":null,"pdf_field":""},{"help":"Select the type of loss","type":"choice","label":"Type of Loss Own Damage Theft Third Party","options":["Own Damage","Theft","Third Party"],"required":null,"pdf_field":""},{"help":"Details of any add-on claims","type":"text","label":"In case, the claim has triggered in any of the add-on. Please provide the details.","options":[],"required":null,"pdf_field":""},{"help":"Brief description of the accident","type":"text","label":"Short Description of Accident","options":[],"required":null,"pdf_field":""},{"help":"Details of police report if available","type":"text","label":"Police Report Details, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Driver Details at the Time of Accident","fields":[{"help":"Driver's full name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Driver's age","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"Driver's license number","type":"text","label":"Driver License No.","options":[],"required":null,"pdf_field":""},{"help":"Name of Regional Transport Office","type":"text","label":"Name of RTO","options":[],"required":null,"pdf_field":""},{"help":"Indicate if driver had learner's license","type":"yes-no","label":"Learner’s License Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of any co-passengers","type":"text","label":"Co-passenger details","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Applicable for Commercial Vehicle","fields":[{"help":"Number of passengers in vehicle during accident","type":"number","label":"No. of passengers carried at the time of Accident","options":[],"required":null,"pdf_field":""},{"help":"Goods Receipt number and date","type":"text","label":"G R Number & Date","options":[],"required":null,"pdf_field":""},{"help":"Permit number for commercial vehicle","type":"text","label":"Permit No.","options":[],"required":null,"pdf_field":""},{"help":"Authority that issued the permit","type":"text","label":"Permit Issuing Authority","options":[],"required":null,"pdf_field":""},{"help":"Permit expiry date","type":"date","label":"Permit Valid Up to","options":[],"required":null,"pdf_field":""},{"help":"Area for which permit is valid","type":"text","label":"Permit Valid for (Area)","options":[],"required":null,"pdf_field":""},{"help":"Authority granting vehicle fitness","type":"text","label":"Fitness Granting Authority","options":[],"required":null,"pdf_field":""},{"help":"Fitness certificate expiry date","type":"date","label":"Fitness Valid up to","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Applicable for Third Party Property Damage or Injury","fields":[{"help":"Name of third party or occupants involved","type":"text","label":"Name of Third party / occupants/driver/property","options":[],"required":null,"pdf_field":""},{"help":"Contact number of third party","type":"phone","label":"Contact No","options":[],"required":null,"pdf_field":""},{"help":"Describe injury or property damage","type":"text","label":"Type of Injury/property damage","options":[],"required":null,"pdf_field":""},{"help":"Hospital name if admitted","type":"text","label":"Name of the hospital where admitted","options":[],"required":false,"pdf_field":""},{"help":"Details of any legal or court notices","type":"text","label":"Any Legal / Court Notice Received","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Signature of the insured","type":"signature","label":"Insured Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Long Term Two Wheeler Package Policy claims","attachments":["Copy of Policy/Cover Note","Copy of RC Book","Copy of Driving License","Estimate of repairs","Copy of Fitness Certificate","Copy of Permit","Copy of FIR","G.R Form","Claim Intimation","Photos","Survey Report","Survey Fees Bills","Supplementary Report / Re-inspection report","Final repair invoice and receipt / Satisfaction voucher for cashless payment","Fitness Certificate (for Commercial Vehicle)","Copy of FIR (for Commercial Vehicle)","Permit (for Commercial Vehicle)","Original Policy (for Theft Claims)","Original Registration certificate (for Theft Claims)","FIR (for Theft Claims)","Original Set of Keys (for Theft Claims)","Original Sales Invoice & Tax Receipt (for Theft Claims)","Intimation to RTO (for Theft Claims)","Final Report (for Theft Claims)","Transfer papers (for Theft Claims)","Indemnity Bond (for Theft Claims)","Subrogation Letter (for Theft Claims)","Cancelled Cheque for NEFT Payment","Photo Identity Proof (for claims above One Lakh Rupees)","Passport size photo – (Individual) – Mandatory (for claims above One Lakh Rupees)","Pan card - Mandatory (for claims above One Lakh Rupees)","Passport / Driving License / voters ID Card (for claims above One Lakh Rupees)","Proof of Address – (last six month) (for claims above One Lakh Rupees)","Telephone Bill / Electricity Bill / Bank Statement / Ration Card Memorandum of understanding / Registration of Company – (Regd. Company / firm / establishment) (for claims above One Lakh Rupees)"],"declarations":["The details given above are true and correct to the best of my belief and knowledge.","If any information is found incorrect, all rights under the policy will be forfeited.","I agree to provide additional information to the company if required."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"GCIcare@generalicentral.com","label":"Claim Intimation Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"ses.\nCLAIM FORM\nYou can\nclick here\nand check our claim form\nCALL ON\n1800 220233\n1860 500 3333\n022 6783 7800\nEMAIL US AT\nGCIcare@generalicentral.com\nVISIT OUR BRANCH\nYou can check for your nearest branch\nhere\nClaim Process Simplified\nSimple steps to help you file a cl","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"GCIClaims@generalicentral.com","label":"Other Claim Intimation Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/other-claim-process","quote":"NLINE CLAIM INTIMATION\nYou can\nclick here\nto intimate claim\nCALL ON\n1800 220233\n1860 500 3333\n022 6783 7800\nEMAIL US AT\nGCIClaims@generalicentral.com\nVISIT OUR BRANCH\nYou can check for your nearest branch\nhere\nInitiate Quick Claim\nExtended Warranty\nMarine & Others\nProd","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 220 233","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"aim under your insurance policy.\nCashless Claim Process\nReimbursement Claim Process\n1\nIntimate us online or  Call us on 1800 220 233\n2\nSurveyor will inspect the vehicle.\n3\nProvide requested documents to surveyor\n4\nApproved claim amount will be communic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1860 500 3333","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"Motor Claim Process | Generali Central\nGrievance Redressal\nQuick Pay\nNeed Analysis\n1860 500 3333\n|\n022 6783 7800\n1860 500 3333\n022 6783 7800\nProducts\nRenew\nClaim\nHelp & Support\nAbout Us\nTrending Searches\nHealth Insur","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 6783 7800","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"Motor Claim Process | Generali Central\nGrievance Redressal\nQuick Pay\nNeed Analysis\n1860 500 3333\n|\n022 6783 7800\n1860 500 3333\n022 6783 7800\nProducts\nRenew\nClaim\nHelp & Support\nAbout Us\nTrending Searches\nHealth Insurance\nDog Insuran","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/generali-central-insurance/143-long-term-two-wheeler-package-policy-claim-form"}