{"id":156,"title":"STANDALONE THIRD PARTY LONG TERM TWO WHEELER INSURANCE POLICY - CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/motor-insurance/standalone-third-party-long-term-two-wheeler-insurance-policy/claim-forms/standalone-third-party-long-term-two-wheeler-insurance-policy-claim-form.pdf","sha256":"430fd107e19602f694e5be320b48f02041f8ccdfd14788e3d1a541fcbb462993","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim under the Standalone Third Party Long Term Two Wheeler Insurance Policy. The insured fills this form to provide details of the accident and claim.","notes":["Issue of this claim form is not to be taken as an admission of liability.","The damaged vehicle shall not be left unattended without proper precaution being taken to prevent further damage.","The list of documents is indicative; additional documents may be called for depending on the nature of the claim."],"title":"STANDALONE THIRD PARTY LONG TERM TWO WHEELER INSURANCE POLICY - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Policy Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","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":""}],"filled_by":"insured"},{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Name Of Insured/Claimant","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"*Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email Id:","options":[],"required":null,"pdf_field":""},{"help":"Name exactly as in bank account","type":"text","label":"Name (As per Bank Account)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Details - Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"Savings/Current etc.","type":"text","label":"Type of Account","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"A/c No.","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN No.","options":[],"required":null,"pdf_field":""},{"help":"MICR code of bank branch","type":"text","label":"MICR","options":[],"required":null,"pdf_field":""},{"help":"Aadhar number","type":"text","label":"Aadhar No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Specify time and am or pm","type":"text","label":"Time of Accident: am/pm","options":[],"required":null,"pdf_field":""},{"help":"Location of accident","type":"text","label":"Place of Accident","options":[],"required":null,"pdf_field":""},{"help":"Select applicable loss type","type":"choice","label":"Type of Loss Own Damage / Theft / Third Party","options":["Own Damage","Theft","Third Party"],"required":null,"pdf_field":""},{"help":"Provide add-on claim details if any","type":"text","label":"In case, the claim has triggered in any of the add-on. Please provide the details.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Accident and Driver Details","fields":[{"help":"Briefly describe the accident","type":"text","label":"Short Description of Accident","options":[],"required":null,"pdf_field":""},{"help":"Provide police report details if available","type":"text","label":"Police Report Details, if any","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Age (Driver)","options":[],"required":null,"pdf_field":""},{"help":"Driving license number of driver","type":"text","label":"Driver License No.","options":[],"required":null,"pdf_field":""},{"help":"RTO issuing the license","type":"text","label":"Name of RTO","options":[],"required":null,"pdf_field":""},{"help":"Indicate if driver had learner’s license","type":"yes-no","label":"Learner’s License Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of any co-passengers","type":"text","label":"Co-passenger details","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Commercial Vehicle Details (if applicable)","fields":[{"help":"Number of passengers in vehicle","type":"number","label":"No. of passengers carried at the time of Accident","options":[],"required":false,"pdf_field":""},{"help":"Goods Receipt number and date","type":"text","label":"G R Number & Date","options":[],"required":false,"pdf_field":""},{"help":"Permit number of vehicle","type":"text","label":"Permit No.","options":[],"required":false,"pdf_field":""},{"help":"Authority issuing permit","type":"text","label":"Permit Issuing Authority","options":[],"required":false,"pdf_field":""},{"help":"Permit expiry date","type":"date","label":"Permit Valid Up to","options":[],"required":false,"pdf_field":""},{"help":"Area for which permit is valid","type":"text","label":"Permit Valid for (Area)","options":[],"required":false,"pdf_field":""},{"help":"Authority granting fitness certificate","type":"text","label":"Fitness Granting Authority","options":[],"required":false,"pdf_field":""},{"help":"Fitness certificate expiry date","type":"date","label":"Fitness Valid up to","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Third Party Property Damage or Injury Details","fields":[{"help":"Name of affected third party","type":"text","label":"Name of Third party / occupants/driver/property","options":[],"required":false,"pdf_field":""},{"help":"Contact number of third party","type":"phone","label":"Contact No","options":[],"required":false,"pdf_field":""},{"help":"Describe injury or property damage","type":"text","label":"Type of Injury/property damage","options":[],"required":false,"pdf_field":""},{"help":"Hospital name if admitted","type":"text","label":"Name of the hospital where admitted","options":[],"required":false,"pdf_field":""},{"help":"Details of any legal or court notice","type":"text","label":"Any Legal / Court Notice Received","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Documents Submitted","fields":[{"help":"Tick all documents submitted","type":"checkbox","label":"I HEREBY DECLARE HAVING SUBMITTED THE FOLLOWING DOCUMENTS","options":["Copy of Policy/Cover Note","Copy of RC Book","Copy of Driving License","Estimate of repairs","Copy of Fitness Certificate","Copy of Permit","Copy of FIR","G.R Form"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Agree to declaration statement","type":"text","label":"Declaration","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Insured Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Standalone Third Party Long Term Two Wheeler Insurance Policy claims","attachments":["Claim Intimation","Policy Copy","Claim form","Copy of RC book","Copy of Driving License","Estimate","Photos","Survey Report","Survey Fees Bills","Supplementary Report / Re-inspection report","Final repair invoice and receipt / Satisfaction voucher for cashless payment","Fitness Certificate (for Commercial Vehicle)","Copy of FIR (for Commercial Vehicle)","Permit (for Commercial Vehicle)","Load Challan (for Commercial Vehicle)","Original Policy (for Theft Claims)","Original Registration certificate (for Theft Claims)","FIR (for Theft Claims)","Original Set of Keys (for Theft Claims)","Original Sales Invoice & Tax Receipt (for Theft Claims)","Intimation to RTO (for Theft Claims)","Final Report (for Theft Claims)","Transfer papers (for Theft Claims)","Indemnity Bond (for Theft Claims)","Subrogation Letter (for Theft Claims)","Cancelled Cheque for NEFT Payment","Photo Identity Proof (for claims above One Lakh Rupees)","Passport size photo – (Individual) – Mandatory (for claims above One Lakh Rupees)","Pan card - Mandatory (for claims above One Lakh Rupees)","Passport / Driving License / voters ID Card (for claims above One Lakh Rupees)","Proof of Address – (last six month) (for claims above One Lakh Rupees)","Telephone Bill / Electricity Bill / Bank Statement / Ration Card Memorandum of understanding / Registration of Company – (Regd. Company / firm / establishment) (for claims above One Lakh Rupees)"],"declarations":["The details given above are true and correct to the best of my belief and knowledge.","If any information is found incorrect, all rights under the policy will be forfeited.","I agree to provide additional information to the company if required."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"GCIcare@generalicentral.com","label":"Claim Intimation Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"ses.\nCLAIM FORM\nYou can\nclick here\nand check our claim form\nCALL ON\n1800 220233\n1860 500 3333\n022 6783 7800\nEMAIL US AT\nGCIcare@generalicentral.com\nVISIT OUR BRANCH\nYou can check for your nearest branch\nhere\nClaim Process Simplified\nSimple steps to help you file a cl","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"GCIClaims@generalicentral.com","label":"Other Claim Intimation Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/other-claim-process","quote":"NLINE CLAIM INTIMATION\nYou can\nclick here\nto intimate claim\nCALL ON\n1800 220233\n1860 500 3333\n022 6783 7800\nEMAIL US AT\nGCIClaims@generalicentral.com\nVISIT OUR BRANCH\nYou can check for your nearest branch\nhere\nInitiate Quick Claim\nExtended Warranty\nMarine & Others\nProd","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 220 233","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"aim under your insurance policy.\nCashless Claim Process\nReimbursement Claim Process\n1\nIntimate us online or  Call us on 1800 220 233\n2\nSurveyor will inspect the vehicle.\n3\nProvide requested documents to surveyor\n4\nApproved claim amount will be communic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1860 500 3333","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"Motor Claim Process | Generali Central\nGrievance Redressal\nQuick Pay\nNeed Analysis\n1860 500 3333\n|\n022 6783 7800\n1860 500 3333\n022 6783 7800\nProducts\nRenew\nClaim\nHelp & Support\nAbout Us\nTrending Searches\nHealth Insur","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 6783 7800","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"Motor Claim Process | Generali Central\nGrievance Redressal\nQuick Pay\nNeed Analysis\n1860 500 3333\n|\n022 6783 7800\n1860 500 3333\n022 6783 7800\nProducts\nRenew\nClaim\nHelp & Support\nAbout Us\nTrending Searches\nHealth Insurance\nDog Insuran","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/generali-central-insurance/156-standalone-third-party-long-term-two-wheeler-insurance-policy-claim-form"}