{"id":200,"title":"PUBLIC LIABILITY POLICY- INDUSTRIAL RISKS CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/public-liability-policy-industrial-risks/claim-forms/public-liability-policy-industrial-risks-claim-form.pdf","sha256":"669be38cd034d769f55aa04d432ebc4dd8c26b817a87337529149b3148289c47","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to report and claim for accidents under the Public Liability Policy for Industrial Risks.","notes":["The issue of this form is not an admission of liability.","Return the form without delay even if all particulars are not immediately available; missing information may be sent later."],"title":"PUBLIC LIABILITY POLICY- INDUSTRIAL RISKS 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 and Policy Details","fields":[{"help":"","type":"text","label":"Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy coverage period","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"Specify the indemnity limits under the policy","type":"text","label":"Limits of Indemnity","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of Accident","fields":[{"help":"Enter the date when the accident occurred","type":"date","label":"Date of accident","options":[],"required":null,"pdf_field":""},{"help":"Specify time with A.M./P.M.","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"Location where the accident happened","type":"text","label":"Place of accident","options":[],"required":null,"pdf_field":""},{"help":"Location of business operations related to the accident","type":"text","label":"Business operation Location","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When was the accident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When was the claim first notified to the Insurer?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of Consequences of the Accident","fields":[{"help":"List injured persons with their details","type":"text","label":"Has any person sustained any injuries in the accident? If so, Give name/s, address/es and occupation/s of such person/s.","options":[],"required":null,"pdf_field":""},{"help":"Location of injured persons during accident","type":"text","label":"State where such person was at the time of accident.","options":[],"required":null,"pdf_field":""},{"help":"Provide hospital or medical treatment details","type":"text","label":"Have the injured persons been removed to hospital or medically attended? If so, give particulars","options":[],"required":null,"pdf_field":""},{"help":"Describe property/livestock damage and owners' details","type":"text","label":"Has the accident caused damage to property or livestock? If so, give name/s and address/es of the owner/s of the property and/or the livestock and full description of the property and state the nature of and extent of damage.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claims and Estimated Amount","fields":[{"help":"Provide details of claims made against you and attach copies if available","type":"text","label":"Has any claim been made upon you by any person? If so, state by whom and give full particulars (If claim has been made in writing, attach a copy of the notification received and of the bill, If submitted)","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated claim amounts for injuries, property damage, and claims made","type":"text","label":"Estimated amount of claim separately under (a), (b) and (c)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Probable Cause of Loss","fields":[{"help":"Briefly describe the cause of the accident","type":"text","label":"Probable cause of loss (Brief Description)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Witnesses and Authorities","fields":[{"help":"List witnesses with their contact details","type":"text","label":"Give, if possible, the names and addresses of all witnesses to the accident","options":[],"required":null,"pdf_field":""},{"help":"Provide details of authority and attach report copy","type":"text","label":"Has the accident been reported to any authority? If so, state to whom and attach a copy of the report submitted.","options":[],"required":null,"pdf_field":""},{"help":"Describe any action taken by the authority","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other insurance policies covering the risk","type":"text","label":"Give particulars of any other insurance, if any, in respect of the same risk.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Type of Action and Legal Details","fields":[{"help":"Specify the type of legal action and attach relevant notices","type":"text","label":"Type of Action. (E.g. Claim only, Law suit) Please attach the copy of Notice of claim letter or legal notice received.","options":[],"required":null,"pdf_field":""},{"help":"Name of the court handling the case","type":"text","label":"Name of The Court","options":[],"required":null,"pdf_field":""},{"help":"Court case number","type":"text","label":"Case No.","options":[],"required":null,"pdf_field":""},{"help":"Name of the plaintiff in the case","type":"text","label":"Name of the Plaintiff.","options":[],"required":null,"pdf_field":""},{"help":"Notice period given","type":"text","label":"Notice Period.","options":[],"required":null,"pdf_field":""},{"help":"Date when the hearing is scheduled","type":"date","label":"Date of Hearing.","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed in the legal action","type":"amount","label":"Amount Claimed.","options":[],"required":null,"pdf_field":""},{"help":"Date when the case was disposed","type":"date","label":"If this is a follow up report, then following details must be provided: Date of Disposition.","options":[],"required":null,"pdf_field":""},{"help":"Describe how the case was resolved","type":"text","label":"Type of Disposition (e.g. settlement, judgement, dismissal, claim dropped, etc.)","options":[],"required":null,"pdf_field":""},{"help":"Amount involved in the disposition","type":"amount","label":"Amount of Disposition RS.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if an appeal was filed and by whom","type":"choice","label":"Appeal, □ yes □ No If Yes, by which party?","options":["yes","no"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign the form","type":"signature","label":"Insured’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Public Liability Policy - Industrial Risks","attachments":["Copy of notification received and bill if claim made in writing","Copy of report submitted to authority if accident reported","Copy of Notice of claim letter or legal notice received","Copy of court order or settlement agreement if applicable"],"declarations":["The insured warrants the truth of the statements to the best of their knowledge and belief.","If any false or fraudulent statement or concealment is made, the claim shall 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/200-public-liability-policy-industrial-risks-claim-form"}