{"id":167,"title":"BURGLARY (HOUSEBREAKING) INSURANCE CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/burglary-(housebreaking)-insurance/claim-forms/burglary-housebreaking-insurance-retail-claim-form.pdf","sha256":"d665fe4be3f92c63d292e348e2b9a54ec0c9e60f2754854856fd97f1de0d75df","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to claim insurance for burglary or housebreaking losses. The policyholder fills it.","notes":[],"title":"BURGLARY (HOUSEBREAKING) INSURANCE CLAIM FORM","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","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Include country and area code if applicable","type":"phone","label":"Contact Telephone","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"e-mail","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"PARTICULARS OF ACCIDENT","fields":[{"help":"Provide date and time when burglary occurred","type":"date","label":"Date & time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"Describe the burglary incident briefly","type":"text","label":"Brief description of accident","options":[],"required":null,"pdf_field":""},{"help":"State date/time, person who found the loss, and place","type":"text","label":"When the loss was discovered and by whom. Place of discovery","options":[],"required":null,"pdf_field":""},{"help":"Explain how entry and exit were made during burglary","type":"text","label":"How the entrance and exit effected in the premises","options":[],"required":null,"pdf_field":""},{"help":"State if premises were occupied and last occupied date/time if not","type":"text","label":"Whether the premises were occupied at the time of the Burglary ? If not, at what date and time was it last occupied?","options":[],"required":null,"pdf_field":""},{"help":"Describe the use of the premises (e.g. residence, office)","type":"text","label":"What was the premises used for?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of police complaint filed","type":"text","label":"Details of police complaint","options":[],"required":null,"pdf_field":""},{"help":"Date when First Information Report was filed","type":"date","label":"When was FIR Filed ?","options":[],"required":null,"pdf_field":""},{"help":"Provide any known details of suspects","type":"text","label":"Give the details of suspects ? if any","options":[],"required":null,"pdf_field":""},{"help":"Describe security measures in place at the premises","type":"text","label":"Provide details of the security arrangements for the premises affected","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"DETAILS OF DAMAGE","fields":[{"help":"","type":"yes-no","label":"Are you the sole owner of the property stolen","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter total value of property present at loss time","type":"amount","label":"Please provide total Value of property up on the premises at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any fire insurance and attach copy","type":"text","label":"Pleas provide the full details of fire insurance (please attach policy copy)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"DETAIL OF OTHER INSURANCES","fields":[{"help":"List other insurance policies covering this loss","type":"text","label":"Give details of other Insurance, if any, covering the present loss","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide information on any prior claims on this property","type":"text","label":"Give details of previous Claims, if any, on the project","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you wish to Reinstate the Policy : Yes/ No :","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"DECLARATION","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign and affix company seal","type":"signature","label":"Signature of insured with company seal","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Burglary (Housebreaking) Insurance claims","attachments":["policy copy of fire insurance"],"declarations":["I/We agree to provide additional information to the company if required.","I/We warrant the truth of the foregoing statement to the best of my/our knowledge and belief.","If any false or fraudulent statement or concealment is made, the policy shall be void and rights to recover forfeited."],"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/167-burglary-housebreaking-insurance-claim-form"}