{"id":1511,"title":"Plate Glass 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/plate-glass-insurance-claim-form-zk-v1-24-25-12072024.pdf","sha256":"794dd5b0ce281229c9ddeeb6aae2a3abcf13457a94e1ae68a1dc4c3500362881","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify the insurance company of loss or damage to plate glass covered under their policy and to provide details necessary for claim processing.","notes":["Use original bills and attach all required documents.","Attach statements and separate sheets if necessary for detailed information.","Attach original blank cancelled cheque and PAN card copy for NEFT payment details.","The issuance or acceptance of this form is not an admission of liability by the insurer."],"title":"Plate Glass 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"},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for correspondence including Pin code.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number.","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Provide exact time and date of loss","type":"date","label":"Time and Date of Loss (Hrs)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the accident site/location with pin code.","options":[],"required":null,"pdf_field":""},{"help":"Attach a separate sheet if necessary","type":"text","label":"Details of the circumstances leading to the loss and cause","options":[],"required":null,"pdf_field":""},{"help":"Include kind of glass, size, frame damage, location of damage, kind of damage","type":"text","label":"Nature of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please give the address where the affected items can be inspected","options":[],"required":null,"pdf_field":""},{"help":"Attach separate sheet if necessary","type":"amount","label":"Estimated amount of Loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Intimation","fields":[{"help":"","type":"yes-no","label":"Whether the loss is intimated to Fire brigade","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes please attach copy of reports","type":"yes-no","label":"Whether the loss is intimated Police Authorities","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Previous loss history (if any)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of other insurance on insured premises (if any)","options":[],"required":false,"pdf_field":""},{"help":"","type":"attachment","label":"In case of Act of God peril please attach relevant reports","options":[],"required":false,"pdf_field":""},{"help":"If yes then please specify the name and address of that person","type":"yes-no","label":"In your opinion is any third party responsible for loss","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"help":"","type":"choice","label":"Would you like to continue with the NEFT details provided in the proposal form for Claim payment?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"Payee name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"Payee account no :","options":[],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"choice","label":"Type of account :","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"Name of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"Branch Name :","options":[],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"Address of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"IFSC Code of the bank :","options":[],"required":null,"pdf_field":""},{"help":"Fill only if 'No' above","type":"text","label":"MICR code of the Bank :","options":[],"required":false,"pdf_field":""},{"help":"Fill only if 'No' above; attach PAN card copy","type":"text","label":"PAN of the payee:","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Plate Glass Insurance claims","attachments":["Copies of other insurance policies if insurance is effected with other companies","Copy of Fire brigade and Police reports if loss intimated to them","Statement of the person who noticed the loss first","Separate sheet for details of circumstances leading to loss if necessary","Separate sheet for estimated amount of loss if necessary","Relevant reports in case of Act of God peril","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 interest in the property are disclosed as per the proposal or policy endorsement.","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 supporting documents does not constitute admission of liability by the company.","Details provided in the mandate form are final and the company is not responsible for cross verification.","RTGS/NEFT facility will be effective within 15 days of receipt of mandate form.","Customer agrees to indemnify the company against claims arising from RTGS/NEFT transactions.","Customer may terminate RTGS/NEFT facility with 15 days prior written notice to the company.","Transaction charges by customer's bank for RTGS/NEFT will be borne by the customer.","Company may amend terms and conditions with prior notice where feasible.","Submission of documents or bank details does not imply admission of liability.","Terms and conditions governed by laws of India and disputes to be settled in Indian courts.","Customer undertakes to refund any excess amount credited to their account within 7 days of notification."],"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/1511-plate-glass-insurance-claim-form"}