{"id":1545,"title":"HOME SECURE Claim Form","purpose":"claim","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/HOME_SECURE_Claim_Form_906b217e79.pdf","sha256":"33405830faf01245b913b24a4a0b1524ae8027338f4ef5bba54870c2eaeedbdf","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Home Secure insurance policy for losses related to fire, burglary, theft, or other covered incidents.","notes":["Proof of tenancy is required for loss of rent claims.","Claims for rent and temporary resettlement expenses are admissible only if the insured structure claim is accepted and declared unfit for occupation.","Claims for certain covers are payable only if a claim is accepted under Section A.","Use separate sheets if further details are required.","Attach original cancelled cheque and PAN card copy for NEFT payment details.","The issuance of this form does not imply admission of liability."],"title":"HOME SECURE Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Basic Claim Information","fields":[{"help":"","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Provide a valid phone number","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YY and time in hrs and min","type":"date","label":"Date and Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YY and time in hrs and min","type":"date","label":"Date and Time of Discovery","options":[],"required":null,"pdf_field":""},{"help":"Brief description of incident","type":"text","label":"Cause/Reason/Nature of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Other insurance on same Loss:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if other insurance exists","type":"text","label":"If yes kindly share the details of the same:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Previous losses under the policy:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"POLICY NO:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"CLAIM NO:","options":[],"required":false,"pdf_field":""},{"help":"Select applicable claim section","type":"choice","label":"Claim under Section:","options":["Zurich Kotak Bharat Griha Raksha","All Risk Cover – Structure and Contents","Claim under Extensions/ Optional Covers"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Information for Zurich Kotak Bharat Griha Raksha or All Risk Cover – Structure and Contents","fields":[{"help":"If No, provide date from when vacant","type":"text","label":"Whether the premises was occupied at the time of fire / loss? Yes /No, if No, Please provide the date from when it was vacant.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"State whether the property damaged, is Hypothecated / Lease / Hire purchase, If yes give details?","options":[],"required":null,"pdf_field":""},{"help":"Provide total value in currency","type":"amount","label":"State the total sum value/s of loss / damaged property on date of loss.","options":[],"required":null,"pdf_field":""},{"help":"Value of salvage recovered","type":"amount","label":"State the value of Salvage, if any?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"State the total value of the property insured upon the premises at the time of loss.","options":[],"required":null,"pdf_field":""},{"help":"Attach evidence if Yes","type":"yes-no","label":"Is case loss reported is due to Earthquake? If Yes, then submit the evidence of it.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of rent paid / received by the insured","options":[],"required":false,"pdf_field":""},{"help":"Proof of tenancy is required","type":"amount","label":"What is the amount of loss of rent?*","options":[],"required":false,"pdf_field":""},{"help":"Provide duration","type":"text","label":"What is the period of which property remained unfit for occupation","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address of the premises at which loss occurred?","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Information in Case of Claim Under Burglary and Theft","fields":[{"help":"","type":"text","label":"Which portion of the premises affected by the entry / exit?","options":[],"required":null,"pdf_field":""},{"help":"Provide police complaint details","type":"text","label":"Has a complaint been lodged with the police? If so, by whom and when and at which police station?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide date and time","type":"text","label":"If not, on what date and at what hour were they last occupied?","options":[],"required":false,"pdf_field":""},{"help":"Provide duration","type":"text","label":"For how long have the premises been unoccupied?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Is anybody suspected of theft? If so, state full details.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If no, the property belongs to whom?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the insured responsible for repairs to the premises?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"State the total value of property upon the premises at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe lost contents with value","type":"text","label":"Value and description of contents lost","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Any other relevant information","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claim under Extensions/ Optional Covers","fields":[{"help":"","type":"amount","label":"What is the amount to be paid for damage due to terrorism","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for Architects, Surveyors and Consulting Engineers Fees?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for removal of debris?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for Burglary or Theft of Content of Unoccupied Structure?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for Trees and Plants / Garden Cover / Landscaping Damage?","options":[],"required":false,"pdf_field":""},{"help":"Proof of tenancy is required","type":"amount","label":"What is the amount to be paid against loss of Rent*?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid as an additional rent for alternate accommodation?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for Additional Living Expenses?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for Temporary Resettlement Expenses?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount to be paid for Contents Temporarily removed?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss for Enhanced cover during Wedding / Other Occasion?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss for Search & found in for exploratory and repair cost reasonable incurred in locating the source of water damage?","options":[],"required":false,"pdf_field":""},{"help":"Describe items and losses","type":"text","label":"What is the amount of loss for Jewellery and Valuables? Kindly describe the item wise loss","options":[],"required":false,"pdf_field":""},{"help":"Describe items and losses","type":"text","label":"What is the amount of loss for Curios, Works of Art & Paintings? Kindly describe the item wise loss","options":[],"required":false,"pdf_field":""},{"help":"Describe items and losses","type":"text","label":"What is the amount of loss for Portable Equipments? Kindly describe the item wise loss","options":[],"required":false,"pdf_field":""},{"help":"Include Make, Model, Serial Number, Date of Purchase","type":"text","label":"What is the amount of loss for Electronic Equipment? Kindly describe the item wise loss covering Make & Model ,Serial Number Date of Purchase","options":[],"required":false,"pdf_field":""},{"help":"Include Make, Model, Serial Number, Date of Purchase","type":"text","label":"What is the amount of loss for Breakdown of Domestic and Electronic equipment? Kindly describe the item wise loss covering Make & Model , Serial Number, Date of Purchase","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss of contents during Transit?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss of Cash Whilst in Transit?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss of Keys & Locks Replacement Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Purchase Protection Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Pedal Cycle Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Plate Glass Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Baggage Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Tenant Liability Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Public /Personal Liability Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Liability to Domestic Staff Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Safety for Documents Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Golf Cover?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss under Job Loss covering 3 EMI of Housing loan?","options":[],"required":false,"pdf_field":""},{"help":"Use separate sheets if needed","type":"text","label":"Any additional information relevant to processing of claim.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"","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 declarations","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"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":"Fill only if you choose No above","type":"section","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":"","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","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Sign as account holder","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""},{"help":"Attach original cancelled cheque","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the payee. (Mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"Please attach a PAN Card copy of Payee (mandatory)","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Claims under Zurich Kotak Bharat Griha Raksha or All Risk Cover – Structure and Contents, Burglary and Theft, and Extensions/Optional Covers","attachments":["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 undisclosed.","False or fraudulent statements or concealment of material 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":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/1545-home-secure-claim-form"}