{"id":1539,"title":"ELECTRONIC EQUIPMENT 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/ELECTRONIC_EQUIPMENT_INSURANCE_Claim_Form_94e639dc36.pdf","sha256":"1d57f60f3df8d9d22de344cc32d3e79815500f785639eed68973f774e985c985","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to notify and claim for loss or damage to electronic equipment covered under their insurance policy.","notes":["Attach original blank cancelled cheque signed by payee and PAN card copy for EFT mandate.","Provide full and accurate details to avoid claim rejection.","Issuance or acceptance of this form is not admission of liability.","Use additional questionnaire only if Sections II and/or III are covered by additional premium."],"title":"ELECTRONIC EQUIPMENT 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 and/or email address","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":""}],"filled_by":"insured"},{"title":"DETAILS OF LOSS/ DAMAGE","fields":[{"help":"Provide date and time when the loss or damage occurred","type":"date","label":"Date and time of accident/ loss/ damage","options":[],"required":null,"pdf_field":""},{"help":"Give complete address including unit or block number","type":"text","label":"Situation of risk where accident/loss/damage occurred","options":[],"required":null,"pdf_field":""},{"help":"State the main cause of the loss or damage","type":"text","label":"Cause of Accident –Please state the Primary Cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe fully how the loss occurred; include a sketch if possible","type":"text","label":"Brief circumstances of accident- (with sketch)","options":[],"required":null,"pdf_field":""},{"help":"Include mobile numbers and email IDs of witnesses","type":"text","label":"Names and addresses of witnesses to the accident","options":[],"required":null,"pdf_field":""},{"help":"Attach a list of items with nature of damages, including make and model","type":"attachment","label":"Details of items destroyed /damaged.","options":[],"required":null,"pdf_field":""},{"help":"Attach a detailed schedule of repair and replacement costs","type":"attachment","label":"Estimates of repairs and replacements (item-wise)","options":[],"required":null,"pdf_field":""},{"help":"Provide contact details of repairers or suppliers","type":"text","label":"Particulars/Details of component repairers / suppliers (Name, Address, Phone number etc.)","options":[],"required":null,"pdf_field":""},{"help":"Provide serial number as per policy schedule","type":"text","label":"Serial No. of property as per Schedule attached to Policy","options":[],"required":null,"pdf_field":""},{"help":"Provide supplier name and supply date","type":"text","label":"Name of original supplier for machinery, spares etc. damaged and date of supply.","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated replacement cost","type":"amount","label":"Cost of replacement of the item of the same kind, size and capacity","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was the damaged item new or second hand?","options":["new","second hand"],"required":null,"pdf_field":""},{"help":"Provide last maintenance date","type":"date","label":"Date (before this accident) when the machine was last overhauled / attended for maintenance","options":[],"required":null,"pdf_field":""},{"help":"Provide warranty or guarantee details if applicable","type":"text","label":"Is there any warranty / guarantee from manufacturer / supplier covering the present loss/damage? If so, details","options":[],"required":null,"pdf_field":""},{"help":"Provide history of losses in last 3 years","type":"text","label":"Details of accidents/loss/damage during the past 3 years (whether claim preferred or not)","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other insurance policies if any","type":"text","label":"Is the property insured under any other Policy with any other insurer? If so, details","options":[],"required":null,"pdf_field":""},{"help":"Provide details of compensation from other insurers if any","type":"text","label":"Are you getting compensation in respect of the present loss / damage from any other insurance? If so, details.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any consequential losses or liabilities","type":"text","label":"Details of consequential loss / liability, if any, on account of this accident.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim under Section II","fields":[{"help":"List damaged external data media with names and numbers","type":"text","label":"Give full details of External Data Media which are damaged- Give Name and number","options":[],"required":null,"pdf_field":""},{"help":"Provide replacement cost item-wise","type":"text","label":"Replacement cost of External Data Media-Give Name of the items and Cost separately for each of the same.","options":[],"required":null,"pdf_field":""},{"help":"Explain how the cost is calculated","type":"amount","label":"Cost of replacing the lost data","options":[],"required":null,"pdf_field":""},{"help":"Attach bills with details: Bill No., Date, Vendor Name & Address","type":"attachment","label":"Bills in respect of above attached","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim under Section III","fields":[{"help":"Provide vendor details for hired equipment","type":"text","label":"Details of Vendor from whom the alternate equipment is hired-Name, Address, Phone number, Mail id etc.","options":[],"required":null,"pdf_field":""},{"help":"Provide hourly rental rate","type":"amount","label":"Hourly Rent","options":[],"required":null,"pdf_field":""},{"help":"Provide number of hours equipment was hired","type":"number","label":"Number of Hours","options":[],"required":null,"pdf_field":""},{"help":"Provide total rental charges","type":"amount","label":"Total Rental Charges","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other expenses if covered","type":"text","label":"Other Expenses-Personnel/Transportation","options":[],"required":null,"pdf_field":""},{"help":"Attach bills with details: Bill No., Date, Vendor Name & Address","type":"attachment","label":"Bills in respect of above attached","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION","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"},{"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":"Provide payee name as per bank records if not continuing with previous NEFT details","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":"","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 bank 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 card number","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Sign the mandate form","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""},{"help":"Attach original cancelled cheque with signature","type":"attachment","label":"Attach an Original Blank Cancelled Cheque signed by the payee","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"Attach a PAN Card copy of Payee","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Electronic Equipment Insurance claims","attachments":["List of items destroyed/damaged with nature of damages","Detailed schedule of estimates of repairs and replacements","Bills related to External Data Media replacement","Bills related to alternate equipment hire and other expenses","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 policy endorsement.","No material information relevant to claim processing has been withheld.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this form does not imply admission of liability; company may require further information or reject claim."],"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/1539-electronic-equipment-insurance-claim-form-notification-of-loss-or-damage"}