{"id":1532,"title":"TERRORISM 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/TERRORISM_INSURANCE_Claim_Form_6b161499aa.pdf","sha256":"f4ec87c723cdaf108ff46ba448924a3fdf64b4d25998191cf8a1b7e1cbcbbf19","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to notify and claim for loss or damage under terrorism insurance policies.","notes":["The issuance/acceptance of this form is not to be taken as an Admission of Liability.","Attach a copy of other insurance policy if loss is covered elsewhere.","Attach an Original Blank Cancelled Cheque signed by the payee and PAN Card copy for EFT payments.","The Direct Fund Transfer / EFT Mandate Form details will be used for claim payment.","Terms and conditions for RTGS/NEFT payments apply as stated in the form."],"title":"TERRORISM INSURANCE Claim Form 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","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number or email","type":"text","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"Sum Insured :","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss/ Accident","fields":[{"help":"Enter date and time of loss","type":"date","label":"Date and time of accident/ loss/ damage Date: DD / MM/ YYYY Time:","options":[],"required":null,"pdf_field":""},{"help":"Full address of loss location","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":"Relationship to insured","type":"text","label":"Relationship with Insured:","options":[],"required":null,"pdf_field":""},{"help":"Phone or email of contact person","type":"text","label":"Contact Details:","options":[],"required":null,"pdf_field":""},{"help":"Describe what caused the loss or damage","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary loss in rupees","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Select if witnesses were present","type":"yes-no","label":"Were there any witnesses to the loss/accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Address of witnesses","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Contact details of witnesses","type":"text","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"Select if loss was reported to authority","type":"yes-no","label":"Has the loss been reported to an Authority? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why 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":"Report or reference number from 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":"text","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Other Insurance","fields":[{"help":"Indicate if other insurance covers loss","type":"yes-no","label":"Is the loss/damage covered under any other Insurance? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide other insurer details if applicable","type":"text","label":"If 'Yes', specify details and attach a copy of the policy","options":[],"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":"text","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 policy","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Other Interest","fields":[{"help":"Indicate if insured solely owns property","type":"yes-no","label":"Is the Insured the Sole Owner of the property? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other owners or interests","type":"text","label":"If 'No', specify","options":[],"required":null,"pdf_field":""},{"help":"Type of interest others have in 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 persons with interest","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Contact details of persons with interest","type":"text","label":"Contact Number/ Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Business Interruption","fields":[{"help":"Indicate if business nature changed after policy start","type":"yes-no","label":"Whether any alteration has been made in the nature of business/occupation of premises after inception of Policy? Yes No","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":"Indicate if premises were occupied","type":"yes-no","label":"Were the premises occupied at the time of loss? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if anyone responsible for loss","type":"yes-no","label":"Were there any person/organization, in your opinion, responsible for the loss? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of suspected persons or organizations","type":"text","label":"If 'Yes', please provide details along with contact numbers and address, if available (this information will be used only for investigation of this claim and source will not be divulged to the suspected party)","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":"List previous losses with date, description, value, and insurer","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":"Indicate if additional information is provided","type":"yes-no","label":"Do you wish to provide any other information? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide other relevant information","type":"text","label":"If 'Yes', specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration 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 the form","type":"signature","label":"Signature and Stamp of the Insured/ Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"help":"Choose if using existing NEFT details","type":"yes-no","label":"Would you like to continue with the NEFT details provided in the proposal form for Claim payment? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Fill bank details if not using existing NEFT info","type":"text","label":"If No, Kindly provide the below mentioned details","options":[],"required":null,"pdf_field":""},{"help":"Name as per bank records","type":"text","label":"Payee name (as per bank records)","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Payee account no","options":[],"required":true,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of account : Saving Current Others","options":["Saving","Current","Others"],"required":true,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name of the bank","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""},{"help":"Bank branch address","type":"text","label":"Address of the bank","options":[],"required":true,"pdf_field":""},{"help":"IFSC code for bank branch","type":"text","label":"IFSC Code of the bank","options":[],"required":true,"pdf_field":""},{"help":"MICR code for bank branch","type":"text","label":"MICR code of the Bank","options":[],"required":true,"pdf_field":""},{"help":"PAN card number of payee","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Signature of bank account holder","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Terrorism Insurance","attachments":["copy of the 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 the proposal or policy endorsements.","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 claim 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/1532-terrorism-insurance-claim-form-notification-of-loss-or-damage"}