{"id":1534,"title":"BURGLARY SECURE 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/Burglary_Secure_Claim_Form_ZK_v1_24_25_25092024_fd53191cb9.pdf","sha256":"586c7d8cb02ae19c1a37a316e25a748a28c9a45a28ab39252d58ec963c54f802","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to notify the insurance company of loss or damage due to burglary and to claim insurance benefits.","notes":["If insurance is effected with other companies, copies of such policies must be attached.","Attach original blank cancelled cheque signed by payee and PAN card copy for EFT mandate.","Issuance or acceptance of this form is not an admission of liability.","Use the NEFT details from proposal form unless providing new details.","The form includes terms and conditions for payments through RTGS/NEFT on page 3."],"title":"BURGLARY SECURE 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":"","type":"phone","label":"iii)  Contact Number.","options":[],"required":null,"pdf_field":""},{"help":"Provide names and addresses of any mortgagees or persons with financial interest","type":"text","label":"iv)  Name and Address of Mortgagee(s) or other persons having financial interest in the property.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF OTHER INSURANCE","fields":[{"help":"Provide details if the property is insured with other companies","type":"text","label":"DETAILS OF OTHER INSURANCE","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"PREMISES DETAILS","fields":[{"help":"Provide full address and occupancy details of the premises where loss occurred","type":"text","label":"STATE THE ADDRESS OF PREMISES AT WHICH THE LOSS OCCURRED. HOW WAS THE SAID PREMISES OCCUPIED?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF LOSS","fields":[{"help":"Provide estimated monetary value of the loss","type":"amount","label":"(i) Estimated Loss","options":[],"required":null,"pdf_field":""},{"help":"Provide exact or approximate time and date when loss occurred","type":"date","label":"(ii) Time and Date of loss","options":[],"required":null,"pdf_field":""},{"help":"State when the loss was discovered and by whom","type":"text","label":"(iii) When discovered and by whom?","options":[],"required":null,"pdf_field":""},{"help":"Describe how entry or exit was affected during the loss","type":"text","label":"(iv) How was entry to / exit from the premises affected?","options":[],"required":null,"pdf_field":""},{"help":"Specify the part of the premises affected","type":"text","label":"(iv) Which portion of the premises was affected by the entry or exit?","options":[],"required":null,"pdf_field":""},{"help":"Describe the loss event and list stolen or damaged items","type":"text","label":"(v) Give brief detail of how exactly the loss occurred. (Specify the articles stolen and property damaged)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police complaint was filed and attach copy","type":"yes-no","label":"(vi) Has a complaint been lodged with the police? If so, by whom and when and at which Police Station? (Attach a copy of the Police complaint.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"(vii) Were the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide last occupancy date and time if premises were unoccupied","type":"date","label":"(viii) If not, on what date and at what hour were they last occupied?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any suspected persons","type":"text","label":"Is anybody suspected of theft? If so, state full details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"(ix) Is the Insured the sole owner of (a) The property lost or damaged?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide total value of all property at premises at time of loss","type":"amount","label":"(x) (i) State the total value of property upon the premises at the time of loss.","options":[],"required":null,"pdf_field":""},{"help":"Provide any additional relevant information","type":"text","label":"(xi) Any other information relevant to processing of claim.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"POLICY AND CLAIM NUMBERS","fields":[{"help":"Enter your policy number","type":"text","label":"POLICY NO:","options":[],"required":null,"pdf_field":""},{"help":"To be entered by insured if known","type":"text","label":"CLAIM NO:","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":"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 these only if you selected No above","type":"section","label":"If No, Kindly provide the below mentioned details","options":[],"required":null,"pdf_field":""},{"help":"Enter payee name exactly as in bank records","type":"text","label":"Payee name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Payee account no","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of account :","options":["Saving","Current","Others"],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch address","type":"text","label":"Address of the bank","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code of the bank","options":[],"required":null,"pdf_field":""},{"help":"Enter MICR code","type":"text","label":"MICR code of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN number of payee","type":"text","label":"PAN of the payee","options":[],"required":null,"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 copy of PAN card of payee","type":"attachment","label":"Please attach a PAN Card copy of Payee","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION AND SIGNATURE","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Burglary Secure insurance policy claims","attachments":["copy of the Police complaint","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 and no duplicate claim is made with other insurers.","No material information relevant to claim processing is 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 and company may require further information."],"dropped_labels":3},"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/1534-burglary-secure-claim-form-notification-of-loss-or-damage"}