{"id":189,"title":"GC BHARAT LAGHU UDYAM SURAKSHA CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/gc-bharat-laghu-udyam-suraksha/claim-forms/gc-bharat-laghu-udyam-suraksha-retail-claim-form.pdf","sha256":"a20449837f8fb02e73326959c806bd219c65b30de9e2f2baef613f012cfff1d5","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured claimant to file a claim under the GC Bharat Laghu Udyam Suraksha insurance policy for loss or damage to insured property.","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":"GC BHARAT LAGHU UDYAM SURAKSHA CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"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":"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":"Briefly describe the nature of business or occupation","type":"text","label":"Brief Description of Business/Office/Industry/occupation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"Details of Loss/Accident","fields":[{"help":"Date when the loss or accident occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Full 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":"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 phone number of contact person","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address of contact person","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"Specify the type/category of loss or accident","type":"text","label":"Type of Loss/Accident under which claim is lodged","options":[],"required":null,"pdf_field":""},{"help":"Provide a detailed description of the loss event and cause","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 or occupation of the premises","type":"text","label":"Premises Occupied as","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary value of the loss in rupees","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if there were any 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":"Postal PIN code of witness(es)","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number of witness(es)","type":"phone","label":"Contact Details Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of witness(es)","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address 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":"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":"Select the authority to which loss was reported","type":"choice","label":"If Yes, Provide details: Fire/Police/Municipality/Other","options":["Fire","Police","Municipality","Other"],"required":null,"pdf_field":""},{"help":"Name of the reporting authority","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Reference or report number given by 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":"Name of 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":"Postal PIN code of authority","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number of authority contact","type":"phone","label":"Contact Details Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of authority contact","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address of authority contact","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"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 policy","type":"text","label":"If Yes, specify details and attach a copy of the policy","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurance company","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":"Postal PIN code of other insurer","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number of other insurer","type":"phone","label":"Contact Details Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of other insurer","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address 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":"Details of Others Interest","fields":[{"help":"Indicate if insured is sole owner","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 other interests 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":"Postal PIN code of other interested persons","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number of other interested persons","type":"phone","label":"Contact Details Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of other interested persons","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address of other interested persons","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"Details of Claim for Property Destroyed or Damaged or Lost","fields":[{"help":"List items 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":"Details of Previous Losses","fields":[{"help":"Provide date, description, amount, and insurer for losses in last 3 years","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":"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":"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":null,"pdf_field":""}],"filled_by":"insured claimant"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place where declaration 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 full name of insured or claimant","type":"text","label":"Name of Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured claimant"}],"deadlines":[],"applies_to":"claims under GC Bharat Laghu Udyam Suraksha insurance policy","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 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/189-gc-bharat-laghu-udyam-suraksha-claim-form"}