{"id":1535,"title":"FIRE SECURE Claim Form NOTIFICATION OF PHYSICAL 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/FIRE_SECURE_Claim_Form_abe3f03890.pdf","sha256":"cf2c95cfe27bfd560a99b53e62ff6875b1960ea0793284feb4fe361c74e0db7b","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to notify and claim for physical loss or damage due to fire under their fire insurance policy.","notes":["If insurance is effected with other companies, copies of such policies must be attached.","Attach an original blank cancelled cheque signed by the payee (mandatory).","Attach a PAN Card copy of the payee (mandatory).","All claims must be based on the actual value of goods at the time of fire, excluding any profit.","Use the NEFT details provided in the proposal form unless providing new details.","The form includes terms and conditions for payments through RTGS/NEFT."],"title":"FIRE SECURE Claim Form NOTIFICATION OF PHYSICAL 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":"","type":"phone","label":"Contact Number.","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Name and Address of Mortgagee(s) or other persons having financial interest in the property.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"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":"policyholder"},{"title":"DETAILS OF LOSS","fields":[{"help":"Provide date and time of the incident","type":"date","label":"Time & Date of Fire / Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of fire or loss","type":"text","label":"Cause of Fire / Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the affected insured items","type":"text","label":"Item of Policy affected (give description)","options":[],"required":null,"pdf_field":""},{"help":"State the use or occupation of the premises","type":"text","label":"Occupation of the premises at the time of Fire / Loss","options":[],"required":null,"pdf_field":""},{"help":"Yes or No and reasons if not reported","type":"text","label":"Has the Fire / Loss been reported to Fire Brigade? ( If not, give reasons )","options":[],"required":null,"pdf_field":""},{"help":"Yes or No and reasons if not reported","type":"text","label":"Has the Fire / Loss been reported to Police? (If not, give reasons)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Address where the loss can be inspected","fields":[{"help":"Provide the location for inspection","type":"text","label":"Address where the loss can be inspected.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Extent of Loss","fields":[{"help":"Describe the extent of loss in detail","type":"text","label":"Extent of Loss (as more particularly described in the statement overleaf)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Information","fields":[{"help":"Provide any other relevant details","type":"text","label":"Any additional information relevant to processing of claim.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claim Details for Property Destroyed or Damaged","fields":[{"help":"Number each item claimed","type":"number","label":"Item No.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claimant Declaration and Signature","fields":[{"help":"Place 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 to affirm the declaration","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"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":null,"pdf_field":""},{"help":"Provide payee name if No selected above","type":"text","label":"Payee name (as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"Provide 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":"Provide bank name","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"Provide branch name","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Provide bank branch address","type":"text","label":"Address of the bank","options":[],"required":null,"pdf_field":""},{"help":"Provide IFSC code","type":"text","label":"IFSC Code of the bank","options":[],"required":null,"pdf_field":""},{"help":"Provide MICR code","type":"text","label":"MICR code of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Provide PAN number","type":"text","label":"PAN of the payee","options":[],"required":null,"pdf_field":""},{"help":"Sign to authorize bank details","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Fire insurance claims for physical loss or damage","attachments":["Copies of other insurance policies 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 an interest in the property are disclosed as per the proposal or policy endorsements.","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":4},"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/1535-fire-secure-claim-form-notification-of-physical-loss-or-damage"}