{"id":187,"title":"FIRE SURAKSHA POLICY CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/fire-suraksha-policy/claim-forms/fire-suraksha-policy-claim-form.pdf","sha256":"7da0a4cf20d6dab416339b23a06947cacec33044fcabad30363c803fd3499bf9","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured claimant to file a claim under the Fire Suraksha Policy for losses due to fire or related incidents.","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.","Claim cheque will be dispatched to the address mentioned in the form and updated in the policy.","Legal Heir Certificate is mandatory if nominee details are not available in policy for death claims.","Use separate sheet if required for details of property destroyed or damaged.","Submit photographs of loss or physical damage wherever possible."],"title":"FIRE SURAKSHA POLICY 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":"Full name of the insured or claimant","type":"text","label":"Name Of Insured/Claimant","options":[],"required":true,"pdf_field":""},{"help":"Full postal address; claim cheque will be sent here","type":"text","label":"*Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Contact Details 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":"Describe the nature of business or occupation","type":"text","label":"Brief Description of Business/Office/Industry/occupation","options":[],"required":null,"pdf_field":""},{"help":"Sum insured or indemnity limits","type":"amount","label":"Limits of Indemnity under the Policy(s)","options":[],"required":null,"pdf_field":""},{"help":"For home and content claims, specify occupancy","type":"text","label":"Occupancy Dwelling","options":[],"required":null,"pdf_field":""},{"help":"Name of nominee if applicable","type":"text","label":"In Case of Death : Please provide following details: a. Name of Nominee","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of nominee","type":"phone","label":"b. Nominee’s Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of nominee","type":"email","label":"E Mail ID","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":true,"pdf_field":""},{"help":"Time of loss with am or pm","type":"text","label":"Time of Loss am/pm","options":[],"required":null,"pdf_field":""},{"help":"Address where loss occurred","type":"text","label":"Loss Location Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":true,"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":"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 type of loss or accident","type":"text","label":"Type of Loss/Accident under which claim is lodged","options":[],"required":null,"pdf_field":""},{"help":"Details if claim is under optional covers","type":"text","label":"Details of Loss/Accident under any optional cover/add-ons under the policy","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss or damage occurred","type":"text","label":"Describe the circumstances of Loss, how it happened, and what Caused Loss/Damage","options":[],"required":true,"pdf_field":""},{"help":"Describe the occupancy of the premises","type":"text","label":"Premises Occupied as","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary loss in rupees","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Indicate if there were witnesses","type":"yes-no","label":"Witness Details 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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witness","type":"phone","label":"Contact Details Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of witness","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of witness","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Indicate if loss was reported to any authority","type":"yes-no","label":"Information to Authority 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 which authority was informed","type":"text","label":"If Yes, Provide details: Fire/Police/Municipality/Other","options":[],"required":null,"pdf_field":""},{"help":"Name of the authority informed","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Reference or report number from authority","type":"text","label":"Information report No./Authority reference no.","options":[],"required":null,"pdf_field":""},{"help":"Date of report to authority","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Contact person at authority","type":"text","label":"Contact Person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of authority","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":"Phone number of authority contact","type":"phone","label":"Contact Details 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? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide 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":"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":"6-digit postal code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other insurer","type":"phone","label":"Contact Details 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 persons with interest","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":"Phone number of persons with interest","type":"phone","label":"Contact Details Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of persons with interest","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of persons with interest","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":"Provide details of losses in last 3 years with date, description, amount, and insurer","type":"table","label":"Losses during the 3 preceding years Date of loss, Claim description and Cause of loss, 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 of loss or physical damage","fields":[{"help":"Attach photographs showing the loss or damage","type":"attachment","label":"Please submit photographs of loss or physical damage, wherever possible.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature of the insured or claimant","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":true,"pdf_field":""},{"help":"Print name of insured or claimant signing","type":"text","label":"Name of Insured/Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured claimant"}],"deadlines":[],"applies_to":"Fire Suraksha Policy claims for business and home & content insurance","attachments":["Copy of other insurance policy if applicable","Photographs of loss or physical damage","Separate sheet for details of property destroyed or damaged if required","Legal Heir Certificate if nominee details are not available in policy (for death claims)"],"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":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/187-fire-suraksha-policy-claim-form"}