{"id":203,"title":"PUBLIC LIABILITY POLICY – NON INDUSTRIAL RISKS (RETAIL) 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-non-industrial-risks/claim-forms/public-liability-policy-non-industrial-risk-claim-form-retail.pdf","sha256":"633c2e3bb04e11cfc326afa8ea2001bbfa48f4e87b066cd540db64b389e07c31","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for the insured to report and claim under the Public Liability Policy for Non Industrial Risks (Retail). The insured person fills this form to provide details of the accident and claim.","notes":["The claim form must be duly filled and signed by the insured.","All facts and statements must be factual and unbiased.","Do not admit any liability if any claim or notice is received in respect of product liability.","Claim cheque will be dispatched to the address mentioned in the form.","Insurance is the subject matter of solicitation."],"title":"PUBLIC LIABILITY POLICY – NON INDUSTRIAL RISKS (RETAIL) CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Name of the Proposer (in full):","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Proposer:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Landline","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Name of the bank for claim payment","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Branch of the bank","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"Type of bank account","type":"text","label":"Type of A/c","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"A/c no","options":[],"required":null,"pdf_field":""},{"help":"PAN number of the proposer","type":"text","label":"Pan No","options":[],"required":null,"pdf_field":""},{"help":"IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"MICR code of the bank branch","type":"text","label":"MICR code","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Accident","fields":[{"help":"Date and time when the accident happened","type":"date","label":"Date and time of occurrence:","options":[],"required":null,"pdf_field":""},{"help":"Location where the accident occurred","type":"text","label":"Place of accident:","options":[],"required":null,"pdf_field":""},{"help":"Date/time when the insured first became aware of the accident","type":"text","label":"When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""},{"help":"Date/time when the insured was informed about the accident","type":"text","label":"When was the accident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"Date when the insurer was first notified of the claim","type":"text","label":"When was claim first notified to the Insurer?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any person sustained any injuries in the accident?","options":["YES","NO"],"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":false,"pdf_field":""},{"help":"Medical treatment details of injured persons","type":"text","label":"Have the injured persons been removed to hospital or medically attended? If YES, please give particulars","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the accident caused damage to property or livestock?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Details of damaged property or livestock","type":"text","label":"If YES, please 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":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any claim been made upon you by any person?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Details of claim made against insured","type":"text","label":"If YES, please 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":false,"pdf_field":""},{"help":"Estimated claim amounts for injuries, property damage, and claims made","type":"amount","label":"Please specify estimated amount of claim separately under a., b. and c.","options":[],"required":false,"pdf_field":""},{"help":"Brief description of cause of accident","type":"text","label":"Please provide probable cause of loss (Brief Description)","options":[],"required":null,"pdf_field":""},{"help":"Witness details","type":"text","label":"If possible, please provide the names and addresses of all witnesses to the accident","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the accident been reported to any authority?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Authority details and report copy","type":"text","label":"If YES, please state to whom and attach a copy of the report submitted","options":[],"required":false,"pdf_field":""},{"help":"Action taken by authority","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":false,"pdf_field":""},{"help":"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":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Legal Action Details","fields":[{"help":"Type of legal action and attach notice copy","type":"text","label":"What is the type of action? (e.g. Claim only, Law suit) Please attach the copy of Notice of claim letter or legal notice that is received.","options":[],"required":false,"pdf_field":""},{"help":"Court name where case is filed","type":"text","label":"Name of The Court:","options":[],"required":false,"pdf_field":""},{"help":"Case number","type":"text","label":"Case No.:","options":[],"required":false,"pdf_field":""},{"help":"Plaintiff's name","type":"text","label":"Name of the plaintiff:","options":[],"required":false,"pdf_field":""},{"help":"Notice period for the case","type":"text","label":"Notice period:","options":[],"required":false,"pdf_field":""},{"help":"Date when hearing is scheduled","type":"date","label":"Date of Hearing:","options":[],"required":false,"pdf_field":""},{"help":"Claimed amount in INR","type":"amount","label":"Amount Claimed:","options":[],"required":false,"pdf_field":""},{"help":"Date when case was disposed","type":"date","label":"Date of Disposition","options":[],"required":false,"pdf_field":""},{"help":"Outcome of the case","type":"text","label":"Type of Disposition (e.g. settlement, judgment, dismissal, claim dropped, etc.)","options":[],"required":false,"pdf_field":""},{"help":"Amount settled or awarded","type":"amount","label":"Amount of Disposition: INR","options":[],"required":false,"pdf_field":""},{"help":"Whether an appeal has been filed","type":"yes-no","label":"Appeal:","options":["YES","NO"],"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","type":"signature","label":"Proposer Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Public Liability Policy – Non Industrial Risks (Retail)","attachments":["Copy of notification received and bill if claim has been made in writing","Copy of the 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 details given are true and correct to the best of the proposer's knowledge.","If any information is found incorrect, all rights under the policy will be forfeited.","The proposer agrees to provide additional information if required.","No person shall offer or accept any rebate of commission or premium except as allowed by the insurer.","Non-compliance with rebate provisions is punishable with a fine up to ten lakh rupees."],"dropped_labels":2},"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/203-public-liability-policy-non-industrial-risks-retail-claim-form"}