{"id":166,"title":"CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/travel-insurance/easy-travel-schengen/claim-forms/easy-travel-schengen-claim-form.pdf","sha256":"af3a92f61dba4d5bd13741da664a13066de76d028c491671d55afb77a11db153","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant or insured person to file a claim under the Easy Travel Schengen insurance policy for various travel-related incidents and expenses.","notes":["Use original bills only.","Attach all original bills, receipts, credit card slips or bank statements to your claim (mandatory).","Issuance of the form does not imply acceptance of liability or waiver of policy terms, conditions & exclusions.","Contact the 24 hour Helpline Number +91 22 67347841 or country specific numbers as mentioned in 'HOW TO REACH US'."],"title":"CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Personal Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Passport No","options":[],"required":null,"pdf_field":""},{"help":"DD / MM / YYYY","type":"date","label":"Policy Start Date","options":[],"required":null,"pdf_field":""},{"help":"DD / MM / YYYY","type":"date","label":"Policy End date","options":[],"required":null,"pdf_field":""},{"help":"List other insurance policy numbers if any","type":"text","label":"Please Indicate any other insurance coverage (In India/ overseas): Policy Number/ s","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured Person (in whose name the policy is issued)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Claimant Person (in respect of whom the claim is made)","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship to insured","type":"text","label":"Relationship to the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-mail ID/s","options":[],"required":null,"pdf_field":""},{"help":"Include country and area code if applicable","type":"phone","label":"Contact Numbers (INDIA)","options":[],"required":null,"pdf_field":""},{"help":"Include country and area code","type":"phone","label":"Contact Numbers (Overseas)","options":[],"required":null,"pdf_field":""},{"help":"Full address in India","type":"text","label":"Residential Address (INDIA)","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or insured person"},{"title":"Trip Details","fields":[{"help":"DD / MM / YYYY","type":"date","label":"Date of Departure","options":[],"required":null,"pdf_field":""},{"help":"DD / MM / YYYY","type":"date","label":"Date of Arrival","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claim Type Selection","fields":[{"help":"Tick all applicable claim types","type":"checkbox","label":"Claim in Respect of following section (please tick against the applicable claim type)","options":["Medical Expense","Baggage Loss","Repatriation of Remains","Baggage Delay","Emergency Medical Evacuation","Compassionate Visit","Daily Allowance in case of Hospitalization","Financial Emergency","Emergency Sickness Dental Relief","Balance Period of Policy","Accidental Death","Permanent Total Disability","Hijack Distress","Accidental Death (Common Carrier)","Allowance Trip Delay","Accidental Death (Air Travel Only)","Trip Cancellation","Trip Curtailment","Golfers Hole in one Celebration","Missed Connection","Burglary (Home Contents)","Loss of Passport","Child Escort","Personal Liability"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Medical Expense Coverage and Related Details","fields":[{"help":"Hospital where treatment was received","type":"text","label":"Name of the Hospital","options":[],"required":null,"pdf_field":""},{"help":"Full hospital address","type":"text","label":"Address of the Hospital","options":[],"required":null,"pdf_field":""},{"help":"Doctor who treated the illness","type":"text","label":"Name of Treating Doctor and Contact details","options":[],"required":null,"pdf_field":""},{"help":"Describe illness and treatment received","type":"text","label":"Details of illness & Treatment","options":[],"required":null,"pdf_field":""},{"help":"DD / MM / YYYY","type":"date","label":"Date of First Symptom","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Please confirm if the illness was also treated in past (Pre-Existing)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify start and end dates for past treatment","type":"date","label":"Treatment / Hospitalization dates for any illness / disease in past: From / To","options":[],"required":null,"pdf_field":""},{"help":"Describe past treatments or surgeries","type":"text","label":"Treatment or surgery details of any past illness/ailment","options":[],"required":null,"pdf_field":""},{"help":"List routine medicines","type":"text","label":"Name of medicines you are routinely taking","options":[],"required":null,"pdf_field":""},{"help":"Columns: Disease / Ailment, Duration (Years/Months/Days), Yes/No for each condition","type":"table","label":"Past History Of Any Chronic Illness With Duration","options":[],"required":null,"pdf_field":""},{"help":"Family doctor in India","type":"text","label":"Name of Family Physician (INDIA)","options":[],"required":null,"pdf_field":""},{"help":"Contact details of family physician","type":"text","label":"Email ID and contact details of Family Physician (INDIA)","options":[],"required":null,"pdf_field":""},{"help":"Explain reason for evacuation","type":"text","label":"If Claiming for Medical Evacuation / Compassionate visit then specify reasons for Medical Evacuation","options":[],"required":null,"pdf_field":""},{"help":"Place from where evacuation is requested","type":"text","label":"Evacuation Request Place From","options":[],"required":null,"pdf_field":""},{"help":"Place to where evacuation is requested","type":"text","label":"Evacuation Request Place To","options":[],"required":null,"pdf_field":""},{"help":"Date evacuation is needed","type":"date","label":"Date of Medical Evacuation required","options":[],"required":null,"pdf_field":""},{"help":"Cause of death or reason for transportation","type":"text","label":"Repatriation of Mortal Remains: Cause of Death/ Medical Transportation","options":[],"required":null,"pdf_field":""},{"help":"Location where death occurred","type":"text","label":"Place of Death","options":[],"required":null,"pdf_field":""},{"help":"Locations for medical transportation","type":"text","label":"Medical Transportation from / to","options":[],"required":null,"pdf_field":""},{"help":"DD / MM / YYYY","type":"date","label":"Date of Death / Medical Transportation","options":[],"required":null,"pdf_field":""},{"help":"Columns: Item no, Details of expenses, Amount","type":"table","label":"Details of expenses incurred – under medical expenses","options":[],"required":null,"pdf_field":""},{"help":"Total amount claimed for medical expenses","type":"amount","label":"TOTAL CLAIMED AMOUNT *Kindly specify this total claimed amount","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Financial Emergency Assistance","fields":[{"help":"Date of loss","type":"date","label":"Date on which fund was lost","options":[],"required":null,"pdf_field":""},{"help":"Describe incident of fund loss","type":"text","label":"Details of incident of loss of fund i.e. how, when, where","options":[],"required":null,"pdf_field":""},{"help":"Name of local contact in India","type":"text","label":"Local contact Person (INDIA) who can provide payment security","options":[],"required":null,"pdf_field":""},{"help":"Contact number of local person","type":"phone","label":"Contact Number/s","options":[],"required":null,"pdf_field":""},{"help":"Police station where FIR was filed","type":"text","label":"Name of the Police Station","options":[],"required":null,"pdf_field":""},{"help":"FIR number","type":"text","label":"Police Information (FIR) No","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Loss of Passport, Baggage Loss/Delay, Trip Delay/Curtailment","fields":[{"help":"Date and time of actual arrival","type":"date","label":"Date & Time of actual arrival","options":[],"required":null,"pdf_field":""},{"help":"Specify AM or PM","type":"text","label":"Time of actual arrival","options":[],"required":null,"pdf_field":""},{"help":"Date and time of scheduled arrival","type":"date","label":"Date & Time of scheduled arrival","options":[],"required":null,"pdf_field":""},{"help":"Specify AM or PM","type":"text","label":"Time of scheduled arrival","options":[],"required":null,"pdf_field":""},{"help":"Date and time baggage was retrieved","type":"date","label":"Date & Time of Retrieval of Baggage","options":[],"required":null,"pdf_field":""},{"help":"Specify AM or PM","type":"text","label":"Time of Retrieval of Baggage","options":[],"required":null,"pdf_field":""},{"help":"Number of hours baggage was delayed","type":"number","label":"Total Hours of Delay","options":[],"required":null,"pdf_field":""},{"help":"Describe incident of loss or delay","type":"text","label":"Details of Incident i.e. how, when, where","options":[],"required":null,"pdf_field":""},{"help":"Date of loss","type":"date","label":"Date on which baggage/passport was lost","options":[],"required":null,"pdf_field":""},{"help":"Location of loss","type":"text","label":"Place where baggage/passport was lost","options":[],"required":null,"pdf_field":""},{"help":"Columns: Item no, Details of expenses, Amount","type":"table","label":"Details of expenses incurred – under travel inconvenience","options":[],"required":null,"pdf_field":""},{"help":"Total amount claimed for travel inconvenience","type":"amount","label":"TOTAL CLAIMED AMOUNT *Kindly specify this total claimed amount","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Personal Accident Death / Disability Insurance","fields":[{"help":"Tick one and specify disability details if applicable","type":"choice","label":"Claiming for Personal Accident resulting into DEATH / DISABILITY (exact details of Disability)","options":["DEATH","DISABILITY"],"required":null,"pdf_field":""},{"help":"Date accident occurred","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Location of accident","type":"text","label":"Place of Accident","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed for personal accident","type":"amount","label":"Claimed Amount","options":[],"required":null,"pdf_field":""},{"help":"Describe accident details","type":"text","label":"Details & Circumstances of Accident i.e. how, when, where","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the injured person under the influence of alcohol / drugs / medicines at the time of accident","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Police station name","type":"text","label":"Name of the Police Station informed about accident","options":[],"required":null,"pdf_field":""},{"help":"FIR number","type":"text","label":"Police Information (FIR) No.","options":[],"required":null,"pdf_field":""},{"help":"Hospital where treatment was received","type":"text","label":"Name & Address of Hospital","options":[],"required":null,"pdf_field":""},{"help":"Doctor who treated casualty","type":"text","label":"Name & Address of Casualty Doctor","options":[],"required":null,"pdf_field":""},{"help":"Regular doctor in India","type":"text","label":"Name & address of Insured’s Regular physician in India","options":[],"required":null,"pdf_field":""},{"help":"Nominee details for claim","type":"text","label":"Nominee Name, Address & Contact Details","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Bank Details for NEFT Payment","fields":[{"help":"Name of insured's bank in India","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Branch details","type":"text","label":"Branch Name & Address","options":[],"required":true,"pdf_field":""},{"help":"Branch contact number","type":"phone","label":"Branch Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Name as per bank account","type":"text","label":"Name of Proposer (As per Bank A/c)","options":[],"required":true,"pdf_field":""},{"help":"Relationship to insured","type":"text","label":"Relation with Insured","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Account No. (as appearing in Cheque Book)","options":[],"required":true,"pdf_field":""},{"help":"IFSC code for electronic transfer","type":"text","label":"Branch IFSC Code for NEFT","options":[],"required":true,"pdf_field":""},{"help":"MICR code of branch","type":"text","label":"Branch MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account Type","options":["Savings","Current","Cash / Credit"],"required":true,"pdf_field":""},{"help":"Phone number for contact","type":"phone","label":"Contact numbers in India","options":[],"required":null,"pdf_field":""},{"help":"Alternate email address","type":"email","label":"Alternate Email ID","options":[],"required":null,"pdf_field":""},{"help":"Attach cancelled cheque image for verification","type":"attachment","label":"Please attach a scanned image of a blank, duly cancelled cheque - of your bank","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the claimant/ Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Print full name","type":"text","label":"Name of the claimant/ Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant or insured"}],"deadlines":["Failure to intimate your claim within 24 hours to our Assistance Company shall invalidate your claim"],"applies_to":"claims under Easy Travel Schengen insurance policy for medical care, travel inconvenience, personal accident, special care, legal liability, and related coverages","attachments":["Originals bills, receipts, credit card slips or bank statement","Treating Doctor’s Certificate for the necessity of an attendant/ evacuation (if applicable)","Attending Physician's Statement/ Civil Surgeon Certificate as per standard format (for personal accident claims)","Scanned image of a blank, duly cancelled cheque of your bank"],"declarations":["I hereby declare that the particulars given above are correct and complete.","If any transaction is delayed or not effected due to incomplete or incorrect information, Generali Central Insurance Company Limited is not responsible.","I undertake to advise any change in the particulars of my account for credit of claim amount through NEFT.","I authorize the service provider, Insurance Company & its authorized representative to collect my Medical Records, Treatment Papers, Investigation Reports etc. from Treating Doctor / Family Physician / Hospitals in India or Overseas.","I warrant the truth of the above details to the best of my knowledge and belief.","If any false or fraudulent declarations are made or material facts are suppressed, the policy shall be void and all rights of compensation forfeited."],"dropped_labels":6},"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/166-claim-form"}