{"id":1522,"title":"NOTIFICATION OF LOSS OR DAMAGE","purpose":"claim","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/KSI_Claim_Form_22_23_v1_25052022_656b0333b9.pdf","sha256":"536595217aff5e2171b183f16d189ee91a7b60f7cbef00507e2bc9d62d2a3a4e","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for notifying and claiming loss or damage under Signage Insurance policies. It is filled by the insured claimant.","notes":["If insurance is effected with other companies, attach copies of such policies.","Attach original blank cancelled cheque signed by payee and PAN card copy for EFT mandate.","Attach relevant reports and statements as indicated in the form.","The form issuance/acceptance is not admission of liability.","Use separate sheets if space is insufficient."],"title":"NOTIFICATION OF LOSS OR DAMAGE","submit":{"to":"","how":"","address":""},"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":"","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"LOSS DETAILS","fields":[{"help":"Provide 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 separate sheet if necessary","type":"text","label":"Details of the circumstances leading to the loss and cause","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":"claimant"},{"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":"","type":"yes-no","label":"Whether the loss is intimated Police Authorities","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach police or fire brigade reports if applicable","type":"attachment","label":"If yes please attach copy of reports","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Previous loss history (if any)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of other insurance on insured premises (if any)","options":[],"required":null,"pdf_field":""},{"help":"Attach relevant reports if loss due to Act of God","type":"attachment","label":"In case of Act of God peril please attach relevant reports","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"In your opinion is any third party responsible for loss","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide name and address of third party if responsible","type":"text","label":"if yes then please specify the name and address of that person","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"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":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"Payee name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"Payee account no :","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of account :","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"Name of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"Branch Name :","options":[],"required":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"Address of the bank:","options":[],"required":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"IFSC Code of the bank :","options":[],"required":null,"pdf_field":""},{"help":"Fill only if not continuing with proposal form NEFT details","type":"text","label":"MICR code of the Bank :","options":[],"required":null,"pdf_field":""},{"help":"Mandatory: attach PAN card copy","type":"text","label":"PAN of the payee:","options":[],"required":true,"pdf_field":""},{"help":"Mandatory","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the payee.","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Account Holder","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Signage Insurance claims","attachments":["copies of other insurance policies if any","copy of fire brigade report if loss intimated","copy of police report if loss intimated","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 proposal or policy endorsement.","No material information relevant to claim processing is withheld or undisclosed.","False or fraudulent statements or concealment voids the policy and claim rights.","Receipt of this form does not constitute admission of claim liability by the company."],"dropped_labels":3},"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/1522-notification-of-loss-or-damage"}