{"id":1468,"title":"Standalone Terrorism Policy","purpose":"claim","insurer":{"slug":"zuno-general-insurance","name":"Zuno General Insurance Ltd"},"source_pdf":"https://cms.hizuno.com/uploads/Standalone_Terrorism_Claim_form_V_1_0_ccca92b20f.pdf?updated_at=2024-12-16T13:18:18.431Z","sha256":"fb965d3e7173dc5687804700d2d275387768698c59da7e941a40f3885bb490d7","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim losses under the Standalone Terrorism Policy.","notes":["Submitting this form does not mean the claim is approved.","Attach a cancelled cheque for NEFT payment."],"title":"Standalone Terrorism Policy","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Your details and loss information","fields":[{"help":"","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Title of the contract insured:","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of insurance period","type":"date","label":"Period of insurance:                                                      to","options":[],"required":null,"pdf_field":""},{"help":"Name of the claimant or insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Office address of the claimant","type":"text","label":"Address- Office:","options":[],"required":null,"pdf_field":""},{"help":"Address of the insured site","type":"text","label":"Address – Contract site:","options":[],"required":null,"pdf_field":""},{"help":"City of the insured site or office","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"State of the insured site or office","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Primary contact number","type":"phone","label":"Contact No.1:","options":[],"required":null,"pdf_field":""},{"help":"Secondary contact number (optional)","type":"phone","label":"Contact No.2:","options":[],"required":false,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"When the loss occurred","type":"date","label":"Time & Date of Loss:","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of the loss","type":"text","label":"Cause of Loss:","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident in detail","type":"text","label":"Narrate How the Incident Occurred:","options":[],"required":null,"pdf_field":""},{"help":"List and describe affected items","type":"text","label":"Items affected (give description):","options":[],"required":null,"pdf_field":""},{"help":"What the premises were used for at loss time","type":"text","label":"Occupation of the premises at the time of Loss:","options":[],"required":null,"pdf_field":""},{"help":"Location for loss inspection","type":"text","label":"Address where the loss can be inspected:","options":[],"required":null,"pdf_field":""},{"help":"Contact number of site representative","type":"phone","label":"Contact details of representative at site: Mobile no./Phone No.:","options":[],"required":null,"pdf_field":""},{"help":"Email of site representative (optional)","type":"email","label":"Email ID:","options":[],"required":false,"pdf_field":""},{"help":"Estimated financial loss amount","type":"amount","label":"Extent/Estimate of Loss (as more particularly described in the statement overleaf):","options":[],"required":null,"pdf_field":""},{"help":"Any other relevant details (optional)","type":"text","label":"Any additional information relevant to processing of claim.","options":[],"required":false,"pdf_field":""},{"help":"Details of any mortgagee or financial interest holders (optional)","type":"text","label":"Name and Address of Mortgagee(s) Or other persons having financial interest in the property:","options":[],"required":false,"pdf_field":""},{"help":"Table columns: Sr. No., Details of Item affected, Quantity, Rate (INR), Total Amount (INR)","type":"table","label":"Sr. No.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss details and other information","fields":[{"help":"Total amount of loss","type":"amount","label":"Total","options":[],"required":null,"pdf_field":""},{"help":"Specify type of loss or policy section","type":"text","label":"Type of Loss/damage / section under which claim is lodged","options":[],"required":null,"pdf_field":""},{"help":"List any extension covers applicable","type":"text","label":"List of selected extension covers:","options":[],"required":false,"pdf_field":""},{"help":"Indicate if loss was reported to any authority","type":"yes-no","label":"Has the loss been reported to an authority: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why loss was not reported (if applicable)","type":"text","label":"If No, reason for not reporting","options":[],"required":false,"pdf_field":""},{"help":"Details of authority where loss was reported","type":"text","label":"If Yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"Select the authority type","type":"choice","label":"Fire           Police              Municipality                       Other","options":["Fire","Police","Municipality","Other"],"required":false,"pdf_field":""},{"help":"Name of the authority reported to","type":"text","label":"Name of authority:","options":[],"required":false,"pdf_field":""},{"help":"Report or reference number and date","type":"text","label":"Information Report No./Authority Reference No. And Date:","options":[],"required":false,"pdf_field":""},{"help":"Contact person at the authority","type":"text","label":"Contact Person/S","options":[],"required":false,"pdf_field":""},{"help":"Address of the authority","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"City of the authority","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"State of the authority","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Postal code of the authority","type":"number","label":"Pin code","options":[],"required":false,"pdf_field":""},{"help":"Phone number of the authority","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Email of the authority","type":"email","label":"Email Id","options":[],"required":false,"pdf_field":""},{"help":"Name of other insurers if any","type":"text","label":"Please tell us who else is insuring this project with us","options":[],"required":false,"pdf_field":""},{"help":"Details of any previous claims","type":"text","label":"Have you claimed before? Give us the details","options":[],"required":false,"pdf_field":""},{"help":"Bank for NEFT payment","type":"text","label":"Bank name:","options":[],"required":null,"pdf_field":""},{"help":"Bank branch","type":"text","label":"Branch name:","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC code:","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Account No:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Signature of the claimant or insured","type":"signature","label":"Signature of insured","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Name and designation of signatory if juristic person","type":"text","label":"Name and designation.","options":[],"required":false,"pdf_field":""},{"help":"Company stamp if applicable","type":"text","label":"Stamp, where insured is a juristic person.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Standalone Terrorism Policy claims","attachments":["Cancelled cheque for NEFT payment"],"declarations":["The information given is accurate and correct to the best of the claimant's knowledge.","If any information is false or incorrect, the policy shall be void and rights to claims forfeited.","The claimant agrees to help the company recover the loss amount from responsible parties.","The claimant agrees to provide additional information if needed."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"support@hizuno.com","label":"Health claims support email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.hizuno.com/health-insurance/health-claim","quote":"ls, you will need to submit a reimbursement claim. For cashless services at a common network hospital, you can write to\nsupport@hizuno.com\n, call us at 1800 12000, or connect with your TPA as mentioned on your card.\nWhen you’re covered by a health insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 12000","label":"Health claims toll free number","level":null,"hours":null,"applies_to":"health","source_url":"https://www.hizuno.com/health-insurance/health-claim","quote":"imbursement claim. For cashless services at a common network hospital, you can write to\nsupport@hizuno.com\n, call us at 1800 12000, or connect with your TPA as mentioned on your card.\nWhen you’re covered by a health insurance policy and need to be ho","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 423 12000","label":"Paid Landline","level":null,"hours":null,"applies_to":"all","source_url":"https://www.hizuno.com/contact-us","quote":"uote\nHome\nContact us\nReach out to us for any Query/ Request or Grievance\nCall us\nToll free - 1800 12000\nPaid Landline -\n022 423 12000\nSenior citizen -\n022 423 12001\nEmail address\nsupport@hizuno.com\nsenior.citizen@hizuno.com\nGrievance Redressal Officer\nM","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/zuno-general-insurance/1468-standalone-terrorism-policy"}