{"id":1526,"title":"MAXIMA PROFESSIONAL LIABILITY INSURANCE – TECHNOLOGY 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/MAXIMA_4_9a720125d6.PDF","sha256":"d525118a3d30beaba3c467f54e2ff67ffa5a9ea5ee4475864684c6a1471a176f","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for notifying a claim of loss or damage under the Maxima Professional Liability Insurance – Technology policy. It is filled by the insured party who is making the claim.","notes":["Attach original blank cancelled cheque signed by the payee (mandatory).","Attach PAN card copy of the payee (mandatory).","The issuance/acceptance of this form is not to be taken as an Admission of Liability.","Use the NEFT details provided in the proposal form unless providing new details.","The RTGS/NEFT facility will be activated within 15 days of receipt of the mandate form.","The claimant must sign the form and provide place and date.","Submission of documents or bank details does not imply admission of liability."],"title":"MAXIMA PROFESSIONAL LIABILITY INSURANCE – TECHNOLOGY 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 including Pin code.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Date from which coverage is effective retroactively","type":"date","label":"Retroactive Date","options":[],"required":null,"pdf_field":""},{"help":"Enter the maximum liability amount under the policy","type":"amount","label":"Limit of Liability under the Policy","options":[],"required":null,"pdf_field":""},{"help":"Provide details if other insurance policies exist for this incident","type":"text","label":"Do you have any other insurance policies covering in respect to the same incident? If yes, give details of insurer, policy no., etc.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of the Claimant","fields":[{"help":"Provide full name and address of claimant","type":"text","label":"Full name & address of the claimant or potential claimant. (i.e. the party making the claim or potential claim against the Insured)","options":[],"required":null,"pdf_field":""},{"help":"Describe the relationship between insured and claimant","type":"text","label":"Insured’s relation with the claimant","options":[],"required":null,"pdf_field":""},{"help":"Describe the claim and allegations in detail","type":"text","label":"Description of the claim including a description of the allegations made by the claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of Loss","fields":[{"help":"Date and time when claim was first notified by claimant","type":"date","label":"Date & Time Date on which intimation of the claim was first made against the Insured by the Claimant","options":[],"required":null,"pdf_field":""},{"help":"Provide a detailed chronological description of the wrongful act and awareness","type":"text","label":"Detailed description of the act in chronological order, as to how, when and where the wrongful act happened as well as when the Insured became first aware of the wrongful act","options":[],"required":null,"pdf_field":""},{"help":"Indicate if legal proceedings have started and attach court documents if yes","type":"yes-no","label":"Have proceedings commenced? If so, please attach a copy of the court documents to be filed or filed before the court by the parties?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other liable parties if any","type":"text","label":"Details of other persons or entities who may be responsible or liable for the loss or damage being claimed -","options":[],"required":null,"pdf_field":""},{"help":"State the nature and amount of damages claimed or estimated","type":"amount","label":"Nature and Quantum of damages claimed against Insured with supporting or, if the claimant has not quantified its damages, insured’s estimate of the quantum of damages which may be claimed against the insured?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if any authority has taken action and attach communications if yes","type":"yes-no","label":"Has any action has been taken by any authority? If yes, please mention the details of the authority and attach copies of all communications exchanged between the insured and authority?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach copies of relevant contracts, agreements and communications","type":"attachment","label":"Copy of all relevant contract(s) and/or agreement(s) and all communications between the parties, (e.g. emails, internal memo(s), letter(s), minute(s) or record(s) of meeting(s) if any?","options":[],"required":null,"pdf_field":""},{"help":"Attach investigation reports and lawyer engagement letters if any","type":"attachment","label":"Copy of an internal or external, survey, investigation or test reports and all other relevant reports, including the details of lawyers appointed (if any), and the respective engagement letters;","options":[],"required":null,"pdf_field":""},{"help":"Attach legal opinion from insured’s counsel","type":"attachment","label":"Detailed opinion of the Insured’s counsel in connection to the merits and demerits of the case (Please attach the opinion)","options":[],"required":null,"pdf_field":""},{"help":"Provide any other relevant details and attach supporting documents","type":"text","label":"Are there additional details about which the insured wish to advice, or which may be of interest to an insurer, so that an insurer will have a better understanding of this matter? If so, please provide details along with supporting documentation.","options":[],"required":false,"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":"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":"Enter the payee name exactly as per bank records","type":"text","label":"Payee name (as per bank records)","options":[],"required":true,"pdf_field":""},{"help":"Enter the bank account number of the payee","type":"text","label":"Payee account no","options":[],"required":true,"pdf_field":""},{"help":"Select the type of bank account","type":"choice","label":"Type of account : Saving / Current / Others","options":["Saving","Current","Others"],"required":true,"pdf_field":""},{"help":"Enter the bank's name","type":"text","label":"Name of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter the bank branch name","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the bank branch address","type":"text","label":"Address of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter the IFSC code of the bank branch","type":"text","label":"IFSC Code of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter the MICR code of the bank branch","type":"text","label":"MICR code of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter the PAN number of the payee","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Sign here as the account holder","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signature","fields":[{"help":"Enter the place where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Claimant must sign here","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Professional Liability Insurance – Technology claims","attachments":["Copy of court documents if proceedings have commenced","Copies of all communications exchanged with authorities if any action taken","Copy of all relevant contracts and agreements and communications","Copy of internal or external survey, investigation or test reports and lawyer engagement letters","Detailed opinion of the Insured’s counsel","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 not disclosed.","False or fraudulent statements or suppression 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/1526-maxima-professional-liability-insurance-technology-claim-form-notification-of-lo"}