{"id":1527,"title":"ADVANCE LOSS OF PROFITS INSURANCE Claim Form","purpose":"claim","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/ADVANCE_LOSS_OF_PROFITS_INSURANCE_Claim_Form_fa0b78cb51.pdf","sha256":"17e393cd866fa596e22942c5398a6810a2e25087aea093555d4e5d3e64f53447","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for notifying and claiming loss or damage under the Advance Loss of Profits Insurance policy. It is filled by the insured party who has suffered interruption during the project period.","notes":["Attach original blank cancelled cheque signed by the payee (mandatory).","Attach PAN Card copy of payee (mandatory).","Issuance or acceptance of this form is not an admission of liability.","The form should be filled for each occurrence of interruption during the project period."],"title":"ADVANCE LOSS OF PROFITS INSURANCE Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Notification of Loss or Damage","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number and/or email","type":"text","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the project where the claim has occurred","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of Business","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Project Manager at the plant","options":[],"required":null,"pdf_field":""},{"help":"Date of loss or damage","type":"date","label":"When did the material damage/ loss occur?","options":[],"required":null,"pdf_field":""},{"help":"Describe cause of loss","type":"text","label":"What was the cause of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Number of prior interruptions","type":"number","label":"How many interruptions have occurred during the project period prior to this incident?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Damaged plant/equipment","options":[],"required":null,"pdf_field":""},{"help":"Policy coverage period","type":"text","label":"ALOP Policy Period","options":[],"required":null,"pdf_field":""},{"help":"Sum insured amount","type":"amount","label":"ALOP Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Number of months indemnity covers","type":"number","label":"Period of Indemnity in Months","options":[],"required":null,"pdf_field":""},{"help":"Number of days excess period","type":"number","label":"Time Excess in days","options":[],"required":null,"pdf_field":""},{"help":"Date interruption started","type":"date","label":"Interruption commencement date","options":[],"required":null,"pdf_field":""},{"help":"Estimated duration of interruption","type":"number","label":"Probable interruption period in days","options":[],"required":null,"pdf_field":""},{"help":"Percentage affected of sum insured","type":"number","label":"What percentage of the sum insured is estimated to be affected?","options":[],"required":null,"pdf_field":""},{"help":"Enter related EAR/CAR policy number","type":"text","label":"State the EAR/CAR Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Period of EAR/CAR policy","type":"text","label":"State the EAR/CAR Policy Period","options":[],"required":null,"pdf_field":""},{"help":"Describe repair possibilities and loss minimisation actions","type":"text","label":"Loss Minimisation\nis provisional repair possible ?\nIf so how long will the repair take?\nis it possible to reduce the period required for repair by using spare parts in stock or by applying any other measures\nIf yes please give details\nWhat other action is being taken to minimise interruption loss?","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated loss and compensation possibilities","type":"text","label":"Cost of interruption\nEstimated loss exclusive of cost for minimising loss\nIs it possible to compensate for the loss of production by increased plant utilisation after the plant is commissioned?\nIf So to what extent?","options":[],"required":null,"pdf_field":""},{"help":"Describe spoilage loss and prevention measures","type":"text","label":"Spoilage\nWill the interruption cause a spoilage loss?\nIf so which goods will be affected and to what extent?\nWhat measures to prevent or minimise spoilage loss has been taken?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Working Periods and Other Insurance","fields":[{"help":"","type":"number","label":"Number of days per year on which the plant is proposed to run?","options":[],"required":null,"pdf_field":""},{"help":"Specify working hours","type":"text","label":"Normal working hours?","options":[],"required":null,"pdf_field":""},{"help":"Provide insurer name and policy number","type":"text","label":"If so state the insurer and policy number?","options":[],"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":null,"pdf_field":""},{"help":"Fill the following bank details if not continuing with previous NEFT details","type":"section","label":"If No, Kindly provide the below mentioned details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payee name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payee account no","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Type of account","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the bank","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code of the bank","options":[],"required":null,"pdf_field":""},{"help":"Bank MICR code","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":""}],"filled_by":"insured"},{"title":"Declarations and Signature","fields":[{"help":"Location where form is signed","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 the form","type":"signature","label":"Signature and Stamp of the Insured/ Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"claims for each occurrence of interruption reported during the project period under Advance Loss of Profits Insurance","attachments":["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 undisclosed.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this form or documents does not imply admission of liability by the company."],"dropped_labels":2},"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/1527-advance-loss-of-profits-insurance-claim-form"}