{"id":1548,"title":"ERECTION ALL RISK 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/ERECTION_ALL_RISK_INSURANCE_Claim_Form_1_4e049aa408.pdf","sha256":"779fb705c771c4b1d005b41d7ad3ae9cc91d820ee42ee51421d2ad270ec36770","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify and claim for loss or damage under the Erection All Risk Insurance policy.","notes":["Attach sketches, photos, and other supporting documents as applicable.","Attach original blank cancelled cheque signed by the payee and PAN card copy for EFT payment.","The issuance/acceptance of this form is not to be taken as an admission of liability."],"title":"ERECTION ALL RISK 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":""},{"help":"Start date of insurance period","type":"date","label":"Period of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"End date of insurance period","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Supervisor Engineer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"PARTICULARS OF ACCIDENT","fields":[{"help":"Date and time when the damage occurred","type":"date","label":"Date & time of occurrence :","options":[],"required":null,"pdf_field":""},{"help":"Location details of the damage site","type":"text","label":"State the site where the damage occurred and name the nearest Railway Station :","options":[],"required":null,"pdf_field":""},{"help":"Describe damage to contract works","type":"text","label":"Give the details of the damage: a) to Contract Works","options":[],"required":null,"pdf_field":""},{"help":"Describe damage to construction plant and equipment","type":"text","label":"b) to Construction Plant & Equipment","options":[],"required":null,"pdf_field":""},{"help":"Describe damage to third party property","type":"text","label":"c) to Property belonging to Third Parties","options":[],"required":null,"pdf_field":""},{"help":"Explain cause of damage","type":"text","label":"What was the cause of the damage?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is any one responsible for the damage?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if someone is responsible","type":"text","label":"If yes, state details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there any possibility of recovery?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF THE DAMAGED SECTION/WORKS","fields":[{"help":"Describe damage occurrence and cause; attach sketches/photos","type":"text","label":"How did the damage occur and what was its probable cause? (attach sketches, photos, etc)","options":[],"required":null,"pdf_field":""},{"help":"State construction progress at time of damage","type":"text","label":"How far had the construction of the damaged item(s) progressed at the time of the occurrence of damage?","options":[],"required":null,"pdf_field":""},{"help":"Explain repair method","type":"text","label":"How will the damaged items be repaired?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Will any alterations or improvements be made to design, construction or material when repairs are carried out?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide witness details","type":"text","label":"Give name & address of witness to the occurrence","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are existing buildings/surrounding properties damaged?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Third Party Liability involved?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Estimated repair cost for contract works","type":"amount","label":"What are the estimated costs for repair of damage to: a) Contract Works","options":[],"required":null,"pdf_field":""},{"help":"Estimated repair cost for construction plant and machinery","type":"amount","label":"b) Construction Plant & Machinery","options":[],"required":null,"pdf_field":""},{"help":"Estimated repair cost for third party property","type":"amount","label":"c) Third Party Property","options":[],"required":null,"pdf_field":""},{"help":"Estimated repair cost for owner's surrounding property","type":"amount","label":"d) Owner's Surrounding Property","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAIL OF OTHER INSURANCES","fields":[{"help":"Provide other insurance details if applicable","type":"text","label":"Give details of other Insurance, if any, covering the present loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide previous claim details if any","type":"text","label":"Give details of previous Claims, if any, on the project","options":[],"required":null,"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":"Fill only if answer above is No","type":"text","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":"Bank name","type":"text","label":"Name of the bank","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""},{"help":"Bank branch address","type":"text","label":"Address of the bank","options":[],"required":true,"pdf_field":""},{"help":"IFSC code for bank branch","type":"text","label":"IFSC Code of the bank","options":[],"required":true,"pdf_field":""},{"help":"MICR code for bank branch","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 with signature","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 AND SIGNATURE","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"}],"deadlines":[],"applies_to":"Erection All Risk Insurance claims","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 endorsement.","No material information relevant to claim processing has been withheld or undisclosed.","False or fraudulent statements or suppression 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":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/1548-erection-all-risk-insurance-claim-form-notification-of-loss-or-damage"}