{"id":1501,"title":"Zurich Kotak Bharat Laghu Udyam Suraksha Claim Form","purpose":"claim","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://www.zurichkotak.com/docs/documents/commercial/claim-forms/zurich-kotak-bharat-laghu-udyam-suraksha-claim-form-zk-v1-24-25-16072024.pdf","sha256":"b4895372d55d83c9ca9221e487562050a444426bd2d7a9c552c7f638988dacc4","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify and claim for physical loss or damage under the Zurich Kotak Bharat Laghu Udyam Suraksha insurance policy.","notes":["Claims must be based on the actual value of goods at the time of fire, excluding any profit.","Attach copies of other insurance policies if applicable.","Attach original blank cancelled cheque signed by payee and PAN card copy for EFT payment.","Use the NEFT details from the proposal form or provide new details for claim payment.","The form includes terms and conditions for payments through RTGS/NEFT."],"title":"Zurich Kotak Bharat Laghu Udyam Suraksha Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"Enter your insurance policy number","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"For company use","type":"text","label":"Claim No:","options":[],"required":false,"pdf_field":""},{"help":"Enter the name of the insured","type":"text","label":"i) Name","options":[],"required":null,"pdf_field":""},{"help":"Enter your mailing address","type":"text","label":"ii) Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Enter a phone number to contact you","type":"phone","label":"iii) Contact Number","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any mortgagee or other interested parties","type":"text","label":"iv) Name and Address of Mortgagee(s) or other persons having financial interest in the property.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of other Insurance","fields":[{"help":"Name of any other insurer covering the property","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Policy number(s) of other insurance","type":"text","label":"Policy No. (s).","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policies","type":"amount","label":"Sum Insured (`)","options":[],"required":null,"pdf_field":""},{"help":"Start date of other insurance coverage","type":"date","label":"Period From","options":[],"required":null,"pdf_field":""},{"help":"End date of other insurance coverage","type":"date","label":"To","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss","fields":[{"help":"Provide the date and time when the loss occurred","type":"date","label":"a) Time & Date of Fire / Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of the fire or loss","type":"text","label":"b) Cause of Fire / Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the affected items under the policy","type":"text","label":"c) Item of Policy affected (give description)","options":[],"required":null,"pdf_field":""},{"help":"State the use or occupation of the premises when loss occurred","type":"text","label":"d) Occupation of the premises at the time of Fire / Loss","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the fire brigade was informed; if no, explain why","type":"yes-no","label":"e) Has the Fire / Loss been reported to Fire Brigade?  (If not, give reasons)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if the police were informed; if no, explain why","type":"yes-no","label":"f) Has the Fire / Loss been reported to Police? (If not, give reasons)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide the location address for inspection of loss","type":"text","label":"4. Address where the loss can be inspected.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Claim for Property Destroyed or Damaged","fields":[{"help":"List each item affected with description, value at fire time, salvage deduction, and net claim amount","type":"table","label":"Item No. of Policy, Description of affected Property, Value at the time of Fire (`), Deduction for Value of Salvage (`), Net Amount Claimed (`)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"help":"Select Yes to use existing NEFT details or No to provide new details","type":"choice","label":"A) Would you like to continue with the NEFT details provided in the proposal form for Claim payment?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter the payee name exactly as per bank records","type":"text","label":"Payee name (as per bank records):","options":[],"required":null,"pdf_field":""},{"help":"Enter the bank account number of the payee","type":"text","label":"Payee account no.:","options":[],"required":null,"pdf_field":""},{"help":"Select the type of bank account","type":"choice","label":"Type of account :","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"Enter the bank's name","type":"text","label":"Name of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter the bank branch name","type":"text","label":"Branch Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter the bank branch address","type":"text","label":"Address of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter the IFSC code of the bank branch","type":"text","label":"IFSC Code of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter the MICR code if available","type":"text","label":"MICR code of the Bank:","options":[],"required":false,"pdf_field":""},{"help":"Enter the PAN number of the payee","type":"text","label":"PAN of the payee:","options":[],"required":true,"pdf_field":""},{"help":"Sign to authorize the bank details","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Claims for physical loss or damage under the Zurich Kotak Bharat Laghu Udyam Suraksha policy","attachments":["Copies of other insurance policies if insurance is effected with other companies","Original Blank Cancelled Cheque signed by the payee","PAN Card copy of Payee"],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having an interest in the property are disclosed as per the proposal or policy endorsement.","No material information relevant to the claim has been withheld or undisclosed.","False or fraudulent statements or concealment of material information will void the policy and claims.","Receipt of this claim form or documents does not constitute admission of liability by the company."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Family Health Plan Insurance TPA Limited, Srinilaya – Cyber Spazio, Suite # 101,102,109&110, Ground Floor,Road No. 2, Banjara Hills, Hyderabad : 500034, Telangana , India","label":"Health claims department address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.zurichkotak.com/services/claims","quote":"g address as early as possible, but no later than 30 days from the date of discharge.\nHealth claims department address:\nFamily Health Plan Insurance TPA Limited, Srinilaya – Cyber Spazio, Suite # 101,102,109&110, Ground Floor,Road No. 2, Banjara Hills, Hyderabad : 500034, Telangana , India\nIs there any time period for filing pre and post hospital claims?\nThe pre-hospitalisation claim documents duly complete","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"care@zurichkotak.com","label":"Email Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/services/claims","quote":"in\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is chat only number.\nAccessibility\nZoom in page\nZoom out page\nIncrea","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 2120","label":"Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/services/claims","quote":"age claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is cha","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91-22-69417220","label":"Toll Number (INDIA And Overseas)","level":null,"hours":"IST 8 am to 8 pm","applies_to":"all","source_url":"https://www.zurichkotak.com/services/claims","quote":"Download policy\nManage policy\nManage claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be","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/zurich-kotak-general-insurance/1501-zurich-kotak-bharat-laghu-udyam-suraksha-claim-form"}