{"id":1559,"title":"Commercial Crime Insurance 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/Claim_Form_Crime_Insurance_3f165b5a1f.pdf","sha256":"3d140bfa1ae72522cb734cf298595c10bd1dd24bca8ff479a2396f4d6391ae40","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify and claim for loss or damage under the Commercial Crime Insurance policy.","notes":["Attach original blank cancelled cheque signed by the payee for NEFT payment.","Attach PAN card copy of the payee for NEFT payment.","Submission of documents or bank details does not imply admission of liability.","Use the corporate address for sending termination notices related to RTGS/NEFT facility.","The RTGS/NEFT facility will be activated within 15 days of receipt of mandate form.","The claimant must sign the form to validate the claim."],"title":"Commercial Crime Insurance Claim Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai – 400063, Maharashtra, India"},"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 including Pin code.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number.","options":[],"required":null,"pdf_field":""},{"help":"Specify the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Date from which coverage is effective retroactively","type":"date","label":"Retroactive Date","options":[],"required":null,"pdf_field":""},{"help":"Maximum coverage amount under the policy","type":"amount","label":"Limit of Indemnity under the Policy","options":[],"required":null,"pdf_field":""},{"help":"Provide details if other insurance covers the same incident","type":"text","label":"Do you have any other insurance policies covering in respect to the same incident? If yes, give details of insurer, policy no., etc.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of Incident","fields":[{"help":"Specify when the incident happened","type":"date","label":"Time and Date of Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Location where the incident occurred","type":"text","label":"Address of the incident site/location with pin code.","options":[],"required":null,"pdf_field":""},{"help":"Provide a detailed description of the incident","type":"text","label":"Describe fully how the said incident had occurred?","options":[],"required":null,"pdf_field":""},{"help":"State date and source of first knowledge of incident","type":"text","label":"When did you first come to know of the incident and from whom?","options":[],"required":null,"pdf_field":""},{"help":"Explain steps taken immediately after incident","type":"text","label":"Describe in detail your immediate actions taken upon receipt of the incident?","options":[],"required":null,"pdf_field":""},{"help":"Mention if investigations were done and attach reports","type":"text","label":"Have you conducted any internal investigations / police / regulatory authorities’ enquiries conducted? - If yes, please provide copies of relevant reports of enquiries along with correspondence exchanged","options":[],"required":null,"pdf_field":""},{"help":"Provide details and attach related legal documents if any","type":"text","label":"Has there been any demand, suit or legal proceeding related to this incident that has been made against the Insured by any third party? If yes, please give all details. Also attach the notices and correspondence","options":[],"required":null,"pdf_field":""},{"help":"Identify perpetrator and their work nature","type":"text","label":"Is the subject incident committed by employee / third party / outsider What is the nature of work of the perpetrator?","options":[],"required":null,"pdf_field":""},{"help":"State if perpetrator was under influence or misconducted","type":"text","label":"Was he guilty of any insobriety, misconduct or disobedience to instructions or rules?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of authority and attach report copy","type":"text","label":"Has the incident been reported to any authority / Police ? If so, state to whom, attach a copy of the report submitted.","options":[],"required":null,"pdf_field":""},{"help":"Describe any action taken by authorities","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":null,"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 the form","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form to declare correctness","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? Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide if not continuing with existing NEFT details","type":"text","label":"Payee name (as per bank records)","options":[],"required":false,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Payee account no","options":[],"required":false,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of account : Saving / Current / Others","options":["Saving","Current","Others"],"required":false,"pdf_field":""},{"help":"Bank name for payment","type":"text","label":"Name of the bank","options":[],"required":false,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch Name","options":[],"required":false,"pdf_field":""},{"help":"Bank branch address","type":"text","label":"Address of the bank","options":[],"required":false,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code of the bank","options":[],"required":false,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR code of the Bank","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number of payee","type":"text","label":"PAN of the payee","options":[],"required":false,"pdf_field":""},{"help":"Sign to authorize fund transfer","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Commercial Crime Insurance claims","attachments":["Copies of relevant reports of enquiries along with correspondence exchanged","Notices and correspondence related to any legal proceeding","Copy of the police or authority report if incident reported","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 similar claim has been made with any other insurance company except as disclosed.","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 constitute 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/1559-commercial-crime-insurance-claim-form"}