{"id":178,"title":"BUSINESS SURAKSHA-SOOKSHMA CLAIM 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-sookshma/claim-forms/business-suraksha-sookshma-claim-form.pdf","sha256":"b3b8014b67d0da00f26c1778be1b037f556bf83d27c179974e6db92cc604bf97","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured claimant to file a claim under the Business Suraksha-Sookshma 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-SOOKSHMA CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Claim Details","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":""}],"filled_by":""},{"title":"A. DETAILS OF INSURED CLAIMANT","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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline 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":"Briefly describe 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 and specify add-ons if any","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","Baggage","All Risks","Accident Suraksha","Plate Glass","Liability","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":""}],"filled_by":"insured claimant"},{"title":"Loss Location Details","fields":[{"help":"Address where the loss occurred","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":"6-digit postal code","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 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 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 premises","type":"text","label":"Premises Occupied as","options":[],"required":null,"pdf_field":""},{"help":"Estimated amount of loss in rupees","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if witnesses were present and provide their names","type":"text","label":"Were there any witnesses to the loss/accident? Yes/No If Yes, Name as Person/s","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"Information to Authority","fields":[{"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":"Specify the authority to which loss was reported","type":"text","label":"If Yes, Provide details: Fire/Police/Municipality/Other","options":[],"required":null,"pdf_field":""},{"help":"Name of the reporting authority","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Reference number given by authority","type":"text","label":"Information report No./Authority reference no.","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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline number of authority contact","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of authority contact","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of authority contact","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?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide other insurer details and attach policy copy","type":"text","label":"If Yes, specify details and attach a copy of the policy","options":[],"required":null,"pdf_field":""},{"help":"","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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline 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?","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 persons with interest in property","type":"text","label":"Person/s who has/have Interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of persons with interest","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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address","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 claimed 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":"Date of previous loss","type":"date","label":"Losses during the 3 preceding years - Date of loss","options":[],"required":null,"pdf_field":""},{"help":"Description of previous claim","type":"text","label":"Claim description","options":[],"required":null,"pdf_field":""},{"help":"Cause of previous loss","type":"text","label":"Cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Amount of previous loss in rupees","type":"amount","label":"Amount of loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Name of insurer for previous loss","type":"text","label":"Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"G. Details of Other Information","fields":[{"help":"Provide any additional information if applicable","type":"text","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 photos showing the loss or damage","type":"attachment","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 of signing the form","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of the claimant","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":null,"pdf_field":""},{"help":"Print name of claimant","type":"text","label":"Name of Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"}],"deadlines":[],"applies_to":"Business Suraksha-Sookshma insurance claims","attachments":["copy of other insurance policy if applicable","photographs of loss or physical damage"],"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, suppression or concealment is made, the policy shall be void and rights to recover shall be forfeited."],"dropped_labels":8},"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/178-business-suraksha-sookshma-claim-form"}