{"id":159,"title":"STANDALONE MOTOR SECURE OD PRIVATE CAR 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-motor-secure-od-private-car-policy/claim-forms/standalone-motor-secure-od-private-car-policy-claim-form.pdf","sha256":"689d656af124433106f2d47417c0dae7bc137a38b2ead9a279119f66d82b3d41","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to claim for damages or losses under the Standalone Motor Secure OD Private Car Policy. The insured fills this form to report the claim details and submit required documents.","notes":["Issue of this claim form is not an admission of liability.","The damaged vehicle should not be left unattended without proper precautions to prevent further damage.","The list of documents is indicative; additional documents may be requested depending on the claim nature."],"title":"STANDALONE MOTOR SECURE OD PRIVATE CAR POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured 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 policy coverage","type":"date","label":"Period Of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"End date of policy coverage","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured or claimant","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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Valid email address","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":"Name of bank for claim payment","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 of insured","type":"text","label":"Aadhar No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Date when accident occurred","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Time of accident with am or pm","type":"text","label":"Time of Accident: am/pm","options":[],"required":null,"pdf_field":""},{"help":"Location where accident happened","type":"text","label":"Place of Accident","options":[],"required":null,"pdf_field":""},{"help":"Select the type of loss","type":"choice","label":"Type of Loss Own Damage / Theft / Third Party","options":["Own Damage","Theft","Third Party"],"required":null,"pdf_field":""},{"help":"Details of any add-on cover claim","type":"text","label":"In case, the claim has triggered in any of the add-on. Please provide the details.","options":[],"required":null,"pdf_field":""},{"help":"Brief description of how accident happened","type":"text","label":"Short Description of Accident","options":[],"required":null,"pdf_field":""},{"help":"Details of police report or FIR if available","type":"text","label":"Police Report Details, if any","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Driver Details at the Time of Accident","fields":[{"help":"Driver's full name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Driver's age","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"Driver's license number","type":"text","label":"Driver License No.","options":[],"required":null,"pdf_field":""},{"help":"Regional Transport Office name","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":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Commercial Vehicle Details","fields":[{"help":"Number of passengers in vehicle","type":"number","label":"No. of passengers carried at the time of Accident","options":[],"required":null,"pdf_field":""},{"help":"Goods Receipt number and date if applicable","type":"text","label":"G R Number & Date","options":[],"required":null,"pdf_field":""},{"help":"Permit number for commercial vehicle","type":"text","label":"Permit No.","options":[],"required":null,"pdf_field":""},{"help":"Authority that issued permit","type":"text","label":"Permit Issuing Authority","options":[],"required":null,"pdf_field":""},{"help":"Permit expiry date","type":"date","label":"Permit Valid Up to","options":[],"required":null,"pdf_field":""},{"help":"Area for which permit is valid","type":"text","label":"Permit Valid for (Area)","options":[],"required":null,"pdf_field":""},{"help":"Authority granting vehicle fitness","type":"text","label":"Fitness Granting Authority","options":[],"required":null,"pdf_field":""},{"help":"Fitness certificate expiry date","type":"date","label":"Fitness Valid up to","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Third Party Property Damage or Injury Details","fields":[{"help":"Name of third party or affected persons","type":"text","label":"Name of Third party / occupants/driver/property","options":[],"required":null,"pdf_field":""},{"help":"Contact number of third party","type":"phone","label":"Contact No","options":[],"required":null,"pdf_field":""},{"help":"Describe injury or property damage","type":"text","label":"Type of Injury/property damage","options":[],"required":null,"pdf_field":""},{"help":"Hospital name if admitted","type":"text","label":"Name of the hospital where admitted","options":[],"required":null,"pdf_field":""},{"help":"Details of any legal or court notices","type":"text","label":"Any Legal / Court Notice Received","options":[],"required":null,"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":"Sign to confirm declaration","type":"signature","label":"I/We here by declare that the details given above are true and correct to the best of my belief and knowledge. In event above information or any part thereof is found incorrect, I/We agree that all rights under the policy will be fortified. I/We also agree to provide additional information to the company, if required.","options":[],"required":true,"pdf_field":""},{"help":"Signature of insured","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 Motor Secure OD Private Car 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 (to inform RTO that the vehicle is stolen and not to transfer) (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 in the form are true and correct to the best of the insured's knowledge.","If any information is found incorrect, all rights under the policy will be forfeited.","The insured agrees to provide additional information if required."],"dropped_labels":0},"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/159-standalone-motor-secure-od-private-car-policy-claim-form"}