{"id":1525,"title":"MEGA RISKS INSURANCE Claim Form 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/MEGA_RISKS_INSURANCE_Claim_Form_921209f021.pdf","sha256":"649ad709e8fbe450f0711b2beb38c300c0b1c6737aeec7cb1c72b575c5e5c2dd","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify the insurance company of loss or damage covered under the Mega Risks Insurance policy.","notes":["Attach original blank cancelled cheque signed by payee and PAN card copy for EFT payment.","This is a generic form and may change depending on reinsurer or lead insurer requirements.","Use the NEFT details from proposal form unless providing new details.","The form must be signed and stamped by the insured or claimant."],"title":"MEGA RISKS INSURANCE Claim Form NOTIFICATION OF LOSS OR DAMAGE","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":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone | email","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured :","options":[],"required":null,"pdf_field":""},{"help":"To be entered by Insured","type":"text","label":"POLICY NO:","options":[],"required":null,"pdf_field":""},{"help":"For Company Use","type":"text","label":"CLAIM NO:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss/Damage","fields":[{"help":"Enter date in DD/MM/YYYY format and time in HH/MM","type":"date | text","label":"Date and time of accident/ loss/ damage Date: DD / MM/ YYYY Time:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please give the complete address of loss location including the unit number or block number","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person at loss location","type":"text","label":"Contact Details of person/s at Loss Location Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured:","options":[],"required":null,"pdf_field":""},{"help":"Phone number or email of contact person at loss location","type":"phone | email","label":"Contact Details:","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss or damage occurred","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary value of loss","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Witness Details","fields":[{"help":"","type":"yes-no","label":"Were there any witnesses to the loss/accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, provide witness names","type":"text","label":"Name of Person/s","options":[],"required":null,"pdf_field":""},{"help":"Witness address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Witness contact details","type":"phone | email","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Information to Authority","fields":[{"help":"","type":"yes-no","label":"Has the loss been reported to an Authority?","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":null,"pdf_field":""},{"help":"Select authority to which loss was reported","type":"choice","label":"If 'Yes', provide details Fire Police Municipality Other","options":["Fire","Police","Municipality","Other"],"required":null,"pdf_field":""},{"help":"Name of reporting authority","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Reference number given by authority","type":"text","label":"Information Report No/ Authority Reference No.","options":[],"required":null,"pdf_field":""},{"help":"Date of report","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Contact person at authority","type":"text","label":"Contact Person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of authority","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Contact details of authority","type":"phone | email","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Other Insurance","fields":[{"help":"If yes, attach a copy of the other policy","type":"yes-no","label":"Is the loss/damage covered under any other Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurance company","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Contact details of other insurer","type":"phone | email","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Coverage period of other insurance","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Other Interest","fields":[{"help":"","type":"yes-no","label":"Is the Insured the Sole Owner of the property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other owners or interested parties","type":"text","label":"If 'No', specify","options":[],"required":null,"pdf_field":""},{"help":"Type of interest in the property","type":"text","label":"Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Names of persons with interest","type":"text","label":"Person/s who has/have interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of interested persons","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Contact details of interested persons","type":"phone | email","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Business Interruption","fields":[{"help":"","type":"yes-no","label":"Whether any alteration has been made in the nature of business/occupation of premises after inception of Policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe alterations if any","type":"text","label":"If 'Yes', please give details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of insurer for material damage","type":"text","label":"Details of Damage under Material Damage Section under IAR Policy: Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Contact details of insurer","type":"phone | email","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"Policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Sum insured amounts for each category","type":"amount","label":"Sum Insured (Rs.) a) Building b) P&M c) FFF d) Stocks e) Others 1 f) Others 2","options":[],"required":null,"pdf_field":""},{"help":"Select occupation type","type":"choice","label":"Occupation of premises at the time of loss: Manufacturing Facility Warehouse Shop Office","options":["Manufacturing Facility","Warehouse","Shop","Office"],"required":null,"pdf_field":""},{"help":"Estimated loss amounts for each category","type":"amount","label":"Estimated Loss Material Damage (Rs.) a) Building b) P&M c) FFF d) Stocks e) Others 1 f) Others 2","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were there any person/organization, in your opinion, responsible for the loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of responsible persons/organizations for investigation","type":"text","label":"If 'Yes', please provide details along with contact numbers and address, if available","options":[],"required":null,"pdf_field":""},{"help":"Describe preventive measures taken","type":"text","label":"What steps have been taken to prevent recurrence of similar incidence?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Previous Losses","fields":[{"help":"Provide date, description, value, and insurer for losses in last 3 years","type":"table","label":"Losses during the 3 preceding years Date of Loss Claim Description and Cause of Loss Value of Loss (Rs.) Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Other Information","fields":[{"help":"","type":"yes-no","label":"Do you wish to provide any other information?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional information if any","type":"text","label":"If 'Yes', specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"help":"","type":"yes-no","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":"Name of payee as per bank records","type":"text","label":"If No, Kindly provide the below mentioned details Payee name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"Bank account number of payee","type":"text","label":"Payee account no","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of account : Saving Current Others","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Bank branch address","type":"text","label":"Address of the bank","options":[],"required":null,"pdf_field":""},{"help":"IFSC code for bank branch","type":"text","label":"IFSC Code of the bank","options":[],"required":null,"pdf_field":""},{"help":"MICR code for bank branch","type":"text","label":"MICR code of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number of payee","type":"text","label":"PAN of the payee","options":[],"required":null,"pdf_field":""},{"help":"Mandatory to attach","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the payee.","options":[],"required":true,"pdf_field":""},{"help":"Mandatory to attach","type":"attachment","label":"Please attach a PAN Card copy of Payee","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signature","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign and stamp here","type":"signature","label":"Signature and Stamp of the Insured/ Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Material Damage, Business Interruption (Fire), Business Interruption (Machinery Breakdown)","attachments":["Copy of other insurance policy if applicable","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 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":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/1525-mega-risks-insurance-claim-form-notification-of-loss-or-damage"}