{"id":182,"title":"FIDELITY GUARANTEE 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/fidelity-guarantee-insurance/claim-forms/fidelity-guarantee-insurance-retail-claim-form.pdf","sha256":"5576f72b74f1170ccc7b0043a86e81016db560a190638c130b0a7cf50061c8ab","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim under the Fidelity Guarantee Insurance policy for losses caused by a defaulting employee.","notes":["The claim form must be duly filled and signed by the insured.","All facts and statements must be factual and unbiased.","Claim cheque will be dispatched to the address mentioned in the form.","Use original documents and provide factual information."],"title":"FIDELITY GUARANTEE INSURANCE CLAIM FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Unit No. 801 & 802, 8th Floor, Tower C, Embassy 247 Park, LBS Marg, Vikhroli (West), Mumbai – 400083"},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of the insurance period","type":"date","label":"Period of Insurance: From - _______/_____/________ To - ________/_____/_______","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured proposer","type":"text","label":"Name of the Proposer (in full):","options":[],"required":true,"pdf_field":""},{"help":"Full postal address where claim cheque will be sent","type":"text","label":"Address of the Proposer:","options":[],"required":true,"pdf_field":""},{"help":"State of the proposer's address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile","options":[],"required":true,"pdf_field":""},{"help":"Landline phone number (optional)","type":"phone","label":"Landline","options":[],"required":false,"pdf_field":""},{"help":"Email address (optional)","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Name of the bank for claim payment","type":"text","label":"Bank Details: Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"Type of bank account (e.g. Savings, Current)","type":"text","label":"Type of A/c","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"A/c no","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number (PAN)","type":"text","label":"Pan No","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Bank MICR code (optional)","type":"text","label":"MICR code","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss","fields":[{"help":"Full name of the employee who caused the loss","type":"text","label":"Please name the defaulting employee (in full)","options":[],"required":true,"pdf_field":""},{"help":"Current address of the defaulting employee","type":"text","label":"Please give present address of the defaulting employee","options":[],"required":true,"pdf_field":""},{"help":"Total amount of loss in Indian Rupees","type":"amount","label":"Please provide amount of Loss sustained (In Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Date when the loss was discovered","type":"date","label":"State the date of discovery of Loss","options":[],"required":true,"pdf_field":""},{"help":"Date or dates when the loss occurred","type":"date","label":"Date/s of loss/es","options":[],"required":true,"pdf_field":""},{"help":"Description of how the loss happened","type":"text","label":"How exactly was the loss committed?","options":[],"required":true,"pdf_field":""},{"help":"Role and location of the employee at the time of loss","type":"text","label":"In what capacity was the defaulting employee engaged and where?","options":[],"required":true,"pdf_field":""},{"help":"Indicate if you hold any assets of the employee","type":"yes-no","label":"Do you have any money, estate, or effects of the defaulting employee in your possession?   YES     NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Details and amounts of any assets held","type":"text","label":"If YES, please give particulars of it with amounts","options":[],"required":false,"pdf_field":""},{"help":"Indicate if you hold any other security from the employee","type":"yes-no","label":"Do you hold any other security from the defaulting employee?   YES     NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Details of other securities held","type":"text","label":"If YES, please give particulars","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any action has been taken","type":"yes-no","label":"Have you taken any action against the employee?   YES     NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Description of actions taken against the employee","type":"text","label":"If so, state the nature of action taken.","options":[],"required":false,"pdf_field":""},{"help":"Police station details and actions taken if reported","type":"text","label":"Has the loss been reported to the Police? If YES, please state at which Police Station and what action, if any has been taken by them","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Miscellaneous Information","fields":[{"help":"Details of any other insurance policies covering this loss","type":"text","label":"Please give details of other insurance, if any, covering the present loss.","options":[],"required":false,"pdf_field":""},{"help":"Information on any previous claims related to this project","type":"text","label":"Please give details of previous Claims, if any, on the project.","options":[],"required":false,"pdf_field":""},{"help":"Additional relevant information or documents","type":"text","label":"Please provide any other document and/or details relevant to Claim:","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of the proposer/insured","type":"signature","label":"Proposer Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Fidelity Guarantee Insurance claims","attachments":["Any other document and/or details relevant to Claim as provided by the insured"],"declarations":["The details given are true and correct to the best of my belief and knowledge.","If any information is found incorrect, all rights under the policy will be forfeited.","I agree to provide additional information to the company 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/182-fidelity-guarantee-insurance-claim-form"}