{"id":1507,"title":"Maxima Directors and Officers Liability Insurance 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/maxima-directors-and-officers-liability-insurance-claim-form-zk-v1-24-25-16072024.pdf","sha256":"51be4f622b982bf751699994fb4f359614de786acb41ca7daf0bb9f073e3ed4e","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify and claim for loss or damage under the Maxima Directors and Officers Liability Insurance policy.","notes":["The insured must provide information and cooperation as reasonably required by the insurer.","Do not settle or admit liability for any claim without the insurer's prior written consent.","Completion and return of this form should not be delayed if some particulars are not immediately available.","Attach mandatory documents as listed including legal notices, correspondence, and bank documents for payment.","The RTGS/NEFT payment terms and conditions apply as stated in the form.","Use original documents and provide accurate bank details for claim payment.","The form is to be signed and dated by the claimant."],"title":"Maxima Directors and Officers Liability Insurance Claim Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai - 400063. Maharashtra, India"},"purpose":"claim","sections":[{"title":"Policy Details","fields":[{"help":"Enter your insurance policy number","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Enter the name of the insured","type":"text","label":"i) Insured Name","options":[],"required":null,"pdf_field":""},{"help":"Enter full correspondence address with pin code","type":"text","label":"ii) Address for correspondence including Pin code.","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid contact phone number","type":"phone","label":"iii) Contact Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"iv) Period of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim Details","fields":[{"help":"Describe the claim in detail","type":"text","label":"i) Description of the Claim","options":[],"required":null,"pdf_field":""},{"help":"Specify where the claim event occurred","type":"text","label":"ii) Location of Claim","options":[],"required":null,"pdf_field":""},{"help":"Describe the wrongful act alleged","type":"text","label":"iii) The nature of the alleged Wrongful Act","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when the loss occurred","type":"date","label":"iv) Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage alleged","type":"text","label":"v) The nature of the alleged damage","options":[],"required":null,"pdf_field":""},{"help":"List all claimants involved","type":"text","label":"vi) The names of the claimants","options":[],"required":null,"pdf_field":""},{"help":"List defendants involved in the claim","type":"text","label":"vii) Defendants","options":[],"required":null,"pdf_field":""},{"help":"Explain how the insured first learned of the claim","type":"text","label":"viii) The manner in which the Insured first became aware of the Claim","options":[],"required":null,"pdf_field":""},{"help":"Provide an estimated claim amount","type":"amount","label":"ix) Estimated amount of claim","options":[],"required":null,"pdf_field":""},{"help":"Provide a timeline of events related to the claim","type":"text","label":"x) Chronology of events","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Status of Proceedings as on Date","fields":[{"help":"Indicate if other insurance covers this claim","type":"yes-no","label":"Is there any other insurance that may be applicable to this notification? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify the type of other insurance cover","type":"text","label":"Type of Cover","options":[],"required":null,"pdf_field":""},{"help":"Name of the other insurer","type":"text","label":"Insurer","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured under other insurance","type":"text","label":"Insured","options":[],"required":null,"pdf_field":""},{"help":"Start date of other insurance policy","type":"date","label":"Policy Period From","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the insurer has been notified","type":"yes-no","label":"Has the matter been notified to the Insurer? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Attachments to be submitted with Claim Intimation Form","fields":[{"help":"Attach copy of legal notice or written intimation","type":"attachment","label":"Copy of the legal notice/ written intimation received by the Insured","options":[],"required":null,"pdf_field":""},{"help":"Attach any legal opinion obtained","type":"attachment","label":"Any legal opinion considered by the Insured","options":[],"required":null,"pdf_field":""},{"help":"Provide details of appointed lawyer if any","type":"text","label":"Have you appointed a solicitor or other lawyer to act for you? If so, what is the lawyers name, Firm, address and charge out rates?","options":[],"required":null,"pdf_field":""},{"help":"Attach all correspondence related to the claim","type":"attachment","label":"Copy of the complete correspondence till date","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claimant Declaration and Signature","fields":[{"help":"Enter the date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter the place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"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? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Fill in the following bank details if not continuing with existing NEFT details","type":"text","label":"B) If No, Kindly provide the below mentioned details","options":[],"required":null,"pdf_field":""},{"help":"Enter payee name exactly as per bank records","type":"text","label":"Payee name (as per bank records):","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Payee account no.:","options":[],"required":null,"pdf_field":""},{"help":"Select the type of bank account","type":"choice","label":"Type of account : Saving Current Others","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Branch Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch address","type":"text","label":"Address of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of the bank branch","type":"text","label":"IFSC Code of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter MICR code of the bank branch","type":"text","label":"MICR code of the Bank:","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN number of the payee","type":"text","label":"PAN of the payee:","options":[],"required":true,"pdf_field":""},{"help":"Attach a signed blank cancelled cheque","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the payee. (Mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Attach a copy of the payee's PAN card","type":"attachment","label":"Please attach a PAN Card copy of Payee (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Signature of the bank account holder","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Claims under Maxima Directors and Officers Liability Insurance policies","attachments":["Copy of the legal notice/ written intimation received by the Insured","Any legal opinion considered by the Insured","Copy of the complete correspondence till date","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 form or policy endorsement.","No similar claim has been made with any other insurance company except as disclosed.","No material information relevant to the claim has been withheld or not disclosed.","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 the claim by the company."],"dropped_labels":1},"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/1507-maxima-directors-and-officers-liability-insurance-claim-form"}