{"id":186,"title":"JEWELLERS BLOCK 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/jewellers-block-insurance/claim-forms/jewellers-block-insurance-retail-claim-form.pdf","sha256":"0477c42a03c11c374d62a64fd3c3255be7e4d8406780370fe5678613bb32baa1","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to report and claim losses under the Jewellers Block Insurance policy.","notes":["Issue of this claim form is not an admission of liability.","If any detail is not readily available, dispatch the form without delay and send particulars later.","Please enclose original or certified copy of FIR if loss reported to police.","Use block letters to fill the form."],"title":"JEWELLERS BLOCK 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":"A. DETAILS OF INSURED / CLAIMANT","fields":[{"help":"","type":"text","label":"Name as Per Policy -","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address: Plot No. / Door No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Building Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Road","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Include area code if applicable","type":"phone","label":"Contact Details: Phone No.","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email id","options":[],"required":null,"pdf_field":""},{"help":"Describe your business or occupation briefly","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":"Date when the loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Time of loss with a.m. or p.m.","type":"text","label":"Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loss Location Address: Plot No. / Door No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Building Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Road","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pincode","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Name of person at loss location","type":"text","label":"Contact Details of Person/s at Loss Location: Name","options":[],"required":null,"pdf_field":""},{"help":"Relationship to insured person","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Include area code if applicable","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email id","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss or damage happened","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary value of loss","type":"amount","label":"Estimated Loss (Rs)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Has the loss been reported to the Police Authority?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Explain why loss was not reported to police","type":"text","label":"If “NO”, Reason for Not Reporting","options":[],"required":null,"pdf_field":""},{"help":"Tick applicable authority","type":"checkbox","label":"If “YES”, Provide details: FIRE(  ) POLICE (  ) MUNICIPALITY(  ) OTHER(  )","options":["FIRE","POLICE","MUNICIPALITY","OTHER"],"required":null,"pdf_field":""},{"help":"Name of the authority where loss was reported","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Provide FIR or reference number and attach copy","type":"text","label":"FIR No. / Authority Reference No. (Please Enclose Original or Certified Copy of FIR)","options":[],"required":null,"pdf_field":""},{"help":"Name of carrier or authority holding the lost items","type":"text","label":"Name of the Carrier / Authority in whose custody the loss has taken place (if Applicable)","options":[],"required":null,"pdf_field":""},{"help":"State if claim lodged with carrier/authority","type":"text","label":"Has the claim has been lodged on the carrier/ authority","options":[],"required":null,"pdf_field":""},{"help":"Date claim was lodged with carrier/authority","type":"date","label":"Date when the claim has been lodged on the carrier / authority (Please enclose copies of the correspondence exchanged with them)","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed breakup of estimated loss","type":"text","label":"Estimate of loss (with complete breakup)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"","type":"choice","label":"Is the loss/damage covered under any other Insurance?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide other insurance 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":"","type":"text","label":"Address: Plot No. / Door No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Building Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Road","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Include area code if applicable","type":"phone","label":"Contact Details: Phone No.","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email id","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start and end dates of other insurance","type":"date","label":"Period of Insurance: From - To -","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant"},{"title":"D. DETAILS OF ITEMS AFFECTED","fields":[{"help":"List each item affected with description and sum insured","type":"table","label":"Sl. No., Description of Items, Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant"},{"title":"E. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"List previous losses with date, description, value and insurer","type":"table","label":"Losses during the 3 preceding years: Date of Loss, Claim Description and Causes of Loss, Value of Loss, Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant"},{"title":"F. DETAILS OF OTHER INFORMATION","fields":[{"help":"","type":"choice","label":"Do you wish to provide any other information?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide any additional relevant information","type":"text","label":"If “YES”, Specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant"},{"title":"Declaration and Signature","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured/ Claimant","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name of Insured / Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured / claimant"}],"deadlines":[],"applies_to":"Jewellers Block Insurance claims","attachments":["Original or Certified Copy of FIR","Copies of correspondence with carrier/authority","Copy of other insurance policy if applicable"],"declarations":["The insured warrants the truth of all statements made in this form to the best of their knowledge and belief.","If any false or fraudulent statement or concealment is made, the claim will be forfeited and the policy null and void."],"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/186-jewellers-block-insurance-claim-form"}