{"id":177,"title":"BUSINESS SURAKSHA-LAGHU (RETAIL) CLAIMS FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/business-suraksha-laghu-retail/claim-forms/business-suraksha-laghu-retail-claim-form.pdf","sha256":"6afe6350a9afc43f93cbe2beca2bbae584f41ea3bfc51eaa44f8fd0c65418a35","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured claimant to file a claim under the Business Suraksha-Laghu (Retail) insurance policy for losses or damages covered by the policy.","notes":["Issue of this claim form is not to be taken as an admission of liability.","If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later."],"title":"BUSINESS SURAKSHA-LAGHU (RETAIL) CLAIMS FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Registered Office: Unit No. 801 & 802, 8th Floor, Tower C, Embassy Park, LBS Marg, Vikhroli (West), Mumbai – 400083"},"purpose":"claim","sections":[{"title":"A. DETAILS OF INSURED CLAIMANT","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"Start date of the insurance period","type":"date","label":"Period Of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"End date of the insurance period","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":"Postal PIN 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":"Email address","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Briefly describe the nature of your business or occupation","type":"text","label":"Brief Description of Business/Office/Industry/occupation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"B. DETAILS OF LOSS/ACCIDENT","fields":[{"help":"Select the applicable section(s) for the claim","type":"choice","label":"Please indicate claim is in respect of which section","options":["Fire and Allied Perils","Fire Loss of Profit","Burglary","Machinery Breakdown","Electronic Equipment","All Risks","Accident Suraksha","Liability","Baggage","Plate Glass","Money Insurance","Fidelity Guarantee","Pedal Cycle","Neon Sign/Glow Sign","Add-ons Pls Specify"],"required":null,"pdf_field":""},{"help":"Date when the loss or accident occurred","type":"date","label":"Date of Loss/Accident","options":[],"required":null,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Address where the loss or accident happened","type":"text","label":"Loss Location 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":"Postal PIN code of loss location","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person at loss location","type":"text","label":"Contact Details of person/s at Loss location - Name","options":[],"required":null,"pdf_field":""},{"help":"Relationship of contact person to insured","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number of contact person","type":"phone","label":"Contact Details - Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of contact person","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of contact person","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Specify the type of loss or accident","type":"text","label":"Type of Loss/Accident under which claim is lodged","options":[],"required":null,"pdf_field":""},{"help":"Explain details of the loss or accident","type":"text","label":"Describe the circumstances of Loss, how it happened, and what Caused Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Describe the use of the premises","type":"text","label":"Premises Occupied as","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary value of the loss","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if there were witnesses","type":"yes-no","label":"Were there any witnesses to the loss/accident? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name(s) of witness(es)","type":"text","label":"If Yes, Name as Person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of witness(es)","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":"PIN code of witness(es)","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witness(es)","type":"phone","label":"Contact Details - Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of witness(es)","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of witness(es)","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Indicate if loss was reported to any authority","type":"yes-no","label":"Has the Loss been reported to an Authority? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why loss was not reported","type":"text","label":"If No, Reason for not reporting","options":[],"required":null,"pdf_field":""},{"help":"Name of authority where loss was reported","type":"text","label":"If Yes, Provide details: Fire/Police/Municipality/Other Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Reference number of report","type":"text","label":"Information report No./Authority reference no.","options":[],"required":null,"pdf_field":""},{"help":"Date of report","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Address of contact person at authority","type":"text","label":"Contact Person/s 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":"PIN code of contact person at authority","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of contact person at authority","type":"phone","label":"Contact Details - Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of contact person at authority","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of contact person at authority","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Indicate if other insurance covers the loss","type":"yes-no","label":"Is the loss / damage covered under any other insurance? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other insurance","type":"text","label":"If Yes, specify details and attach a copy of the policy","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","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":"PIN code of other insurer","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other insurer","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other insurer","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of other insurer","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start date of other insurance","type":"date","label":"Period of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"End date of other insurance","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"Sum Insured (rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"D. DETAILS OF OTHERS INTEREST","fields":[{"help":"Indicate if insured solely owns the property","type":"yes-no","label":"Is the Insured the Sole Owner of the property? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe nature of others' interest in property","type":"text","label":"If No, please specify Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Name(s) of other interested persons","type":"text","label":"Person/s who has/have Interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of other interested persons","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":"PIN code of other interested persons","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other interested persons","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other interested persons","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of other interested persons","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"E. DETAILS OF CLAIM FOR PROPERTY DESTROYED OR DAMAGED OR LOST","fields":[{"help":"List items destroyed, damaged or lost as per policy item numbers","type":"text","label":"Item no of the policy? (Please attach separate sheet if required)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"F. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide details of previous losses in a table with columns: Date of loss, Claim description, Cause of loss, Amount of loss (Rs.), Insurer","type":"table","label":"Losses during the 3 preceding years - Date of loss, Claim description, Cause of loss and Amount of loss (Rs.), Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"G. DETAILS OF OTHER INFORMATION","fields":[{"help":"Indicate if you want to provide additional information and specify if yes","type":"choice","label":"Do you wish to provide any other information? □ Yes □No, If “Yes”, specify","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"H. PHOTOGRAPHS","fields":[{"help":"Attach photographs showing the loss or damage","type":"photo","label":"Please submit photographs of loss or physical damage, wherever possible.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing the form","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured or claimant","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":null,"pdf_field":""},{"help":"Print name of insured or claimant","type":"text","label":"Name of Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"}],"deadlines":[],"applies_to":"Business Suraksha-Laghu (Retail) insurance claims","attachments":["Copy of other insurance policy if loss is covered under any other insurance","Photographs of loss or physical damage"],"declarations":["The claimant agrees to provide additional information if required by the company.","The claimant warrants the truth of the statements made in the form to the best of their knowledge and belief.","If any false or fraudulent statement or concealment is made, the policy shall be void and rights to recover under the policy shall be forfeited."],"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/177-business-suraksha-laghu-retail-claims-form"}