{"id":1533,"title":"BOILER AND PRESSURE PLANT 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/BOILER_AND_PRESSURE_PLANT_INSURANCE_Claim_Form_6c138e5642.pdf","sha256":"19af209ce0ef34449bd90e85885b2025761e697f7b6ad1522228809ebced7dae","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for notifying loss or damage under Boiler and Pressure Plant Insurance policies. It is filled by the insured person making the claim.","notes":["Attach estimate of repairs.","Attach original blank cancelled cheque signed by payee and PAN card copy for NEFT payment.","Issuance or acceptance of this form is not admission of liability.","Use details as per policy schedule for damaged items.","Declaration and signature required on page 2."],"title":"BOILER AND PRESSURE PLANT INSURANCE Claim Form NOTIFICATION OF LOSS OR DAMAGE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"DETAILS OF INSURED","fields":[{"help":"","type":"text","label":"i)  Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"ii)  Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number and/or email","type":"text","label":"iii)  Contact Number/ Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"iv)  Occupation of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF LOSS/ DAMAGE","fields":[{"help":"Refer to your policy schedule for item and serial number","type":"text","label":"a) Boiler or Pressure Plant Damaged and SL. No. of item affected under the Policy (Please refer to Policy Schedule and write)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"b) Make & Model of the affected Boiler or Pressure Plant","options":[],"required":null,"pdf_field":""},{"help":"Provide technical details like capacity, speed","type":"text","label":"c) Technical Specifications, if any applicable, such as, capacity, speed, etc.","options":[],"required":null,"pdf_field":""},{"help":"Provide current replacement cost in INR","type":"amount","label":"d) Current Replacement value of the item (INR). Please give cost of new Boiler or Pressure Plant as on the date of loss for Boiler or Pressure Plant of same type, specification, capacity etc.","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time when loss occurred","type":"date","label":"e) Date & Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"List damaged parts and repair costs; attach repair estimate","type":"text","label":"f) Brief details of the loss-Give list of Parts, Boiler or Pressure Plant damaged & Repair Cost. Please attach the Estimate of repairs","options":[],"required":null,"pdf_field":""},{"help":"Explain cause and list witnesses with designation","type":"text","label":"g) Probable cause of loss-How the loss has occurred? Also mention the Names, Designation of the persons who witnessed/examined the damage","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"h) Is the damaged item under Guarantee period either with Manufacturer or Vendor or anyone else such as AMC vendor","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide date and details of last maintenance; attach logs","type":"text","label":"i) When was last maintenance carried out (attach log records) Specify nature of maintenance & Give full details","options":[],"required":null,"pdf_field":""},{"help":"Provide repairer's contact details","type":"text","label":"j) Name & address of the repairer and their contact person with telephone numbers.","options":[],"required":null,"pdf_field":""},{"help":"List any accidents in last 3 years","type":"text","label":"k) Details of accidents during the past 3 years (whether claim preferred or not)","options":[],"required":null,"pdf_field":""},{"help":"Provide details if insured elsewhere","type":"text","label":"l) Is the property insured under any other Policy with any other insurer? If so, details","options":[],"required":null,"pdf_field":""},{"help":"Provide inspection time and place","type":"text","label":"m) When and Where can the damaged machinery be inspected?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"n) Do you want to reinstate the policy for the Sum Insured subsequent to payment of claim?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"POLICY AND CLAIM DETAILS","fields":[{"help":"Enter your policy number","type":"text","label":"POLICY NO:","options":[],"required":null,"pdf_field":""},{"help":"Enter claim number if any","type":"text","label":"CLAIM NO:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DIRECT FUND TRANSFER / EFT MANDATE FORM","fields":[{"help":"","type":"yes-no","label":"A) 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 answer to A) is No","type":"text","label":"B) 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":"","type":"text","label":"Name of the bank","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address of the bank","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code of the bank","options":[],"required":true,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR code of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number of payee","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Attach original cancelled cheque signed by payee","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the payee.","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"Please attach a PAN Card copy of Payee","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION","fields":[{"help":"Sign here","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"Location of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Boiler and Pressure Plant Insurance claims","attachments":["Estimate of repairs","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 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 claim form or documents does not imply admission of liability by the company."],"dropped_labels":0},"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/1533-boiler-and-pressure-plant-insurance-claim-form-notification-of-loss-or-damage"}