{"id":217,"title":"VIVAH 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/vivah-suraksha-policy/claim-forms/vivah-suraksha-policy-claim-form.pdf","sha256":"700818bf5c2e9ded6057ed00c7e4eff7d9fc0adfe29d8df879abc8aa43948b24","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Vivah Suraksha Policy for various types of losses including all risk, burglary, money, and event insurance claims.","notes":["The issue of this claim form is not to be taken as an admission of liability.","Signatures must be accompanied by the company seal where indicated.","Answer all questions fully and accurately."],"title":"VIVAH SURAKSHA POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Section 1 - All risk","fields":[{"help":"","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No:","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Full address of the insured","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Telephone :","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"e-mail:","options":[],"required":null,"pdf_field":""},{"help":"Date and time when loss occurred","type":"date","label":"Date & Time of Loss Incidence","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident briefly","type":"text","label":"Brief description of Incidence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Type of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of Loss / Damage","options":[],"required":null,"pdf_field":""},{"help":"Provide witness details","type":"text","label":"Details of witness (name, address, Mob. No.)","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Approximate value of loss","options":[],"required":null,"pdf_field":""},{"help":"Specify claim section","type":"text","label":"Section under which claim is preferred:","options":[],"required":null,"pdf_field":""},{"help":"Date of re-shooting if applicable","type":"date","label":"Date of Re-shooting (if claim is for extra expenses)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Actor / Crew member (in case of illness )","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of illness","options":[],"required":null,"pdf_field":""},{"help":"Provide FIR details if filed","type":"text","label":"Is FIR filed with police authorities? if Yes please provide details","options":[],"required":null,"pdf_field":""},{"help":"Any other relevant information","type":"text","label":"Provide additional details relevant to claim , if any","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Give details of other Insurance, if any, covering the present loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Give details of previous Claims, if any, on the project","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration for Section 1","fields":[{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign and affix company seal","type":"signature","label":"Signature of insured with companies seal","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Section 2 - Burglary Insurance Claim Form","fields":[{"help":"Name of insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Full address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Telephone :","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"e-mail:","options":[],"required":null,"pdf_field":""},{"help":"Date and time of burglary","type":"date","label":"Date & time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"Describe burglary incident","type":"text","label":"Brief description of accident","options":[],"required":null,"pdf_field":""},{"help":"Details of discovery","type":"text","label":"When the loss was discovered and by whom. Place of discovery","options":[],"required":null,"pdf_field":""},{"help":"Describe entry and exit","type":"text","label":"How the entrance and exit effected in the premises","options":[],"required":null,"pdf_field":""},{"help":"Occupancy details","type":"text","label":"Whether the premises were occupied at the time of the Burglary ? If not, at what date and time was it last occupied?","options":[],"required":null,"pdf_field":""},{"help":"Purpose of premises","type":"text","label":"What was the premises used for?","options":[],"required":null,"pdf_field":""},{"help":"Police complaint and FIR details","type":"text","label":"Details of police complaint When was FIR Filed ?","options":[],"required":null,"pdf_field":""},{"help":"Suspect details if known","type":"text","label":"Give the details of suspects ? if any","options":[],"required":false,"pdf_field":""},{"help":"Details of any detentions","type":"text","label":"Did police authorities detained any one? if yes please provide details","options":[],"required":false,"pdf_field":""},{"help":"Security details","type":"text","label":"Provide details of the security arrangements for the premises affected","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you the sole owner of the property stolen","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Please provide total Value of property up on the premises at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Give details of other Insurance, if any, covering the present loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Give details of previous Claims, if any, on the project","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you wish to Reinstate the Policy : Yes/ No :","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration for Section 2","fields":[{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign and affix company seal","type":"signature","label":"Signature of insured with companies seal","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Section 3 - Money Insurance Claim Form","fields":[{"help":"","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Zone or Branch Office","type":"text","label":"Z. O/B.O","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured","type":"text","label":"Name of Insured (in full)","options":[],"required":null,"pdf_field":""},{"help":"Full address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""},{"help":"Date and time loss was discovered","type":"date","label":"When was the loss discovered? (Give time & date).","options":[],"required":null,"pdf_field":""},{"help":"Transit route details","type":"text","label":"What were the places between which money was in transit?","options":[],"required":null,"pdf_field":""},{"help":"Describe circumstances of loss","type":"text","label":"How and where did the loss occur?","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"What was the amount being carried?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Brief Detail as to exact circumstances under which loss occurred?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"In whose custody was the money at the time of loss?","options":[],"required":null,"pdf_field":""},{"help":"Date employees joined service","type":"text","label":"When did the employees concerned entered your service?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was anyone of them involved in similar loss before?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Do you hold any cash deposit or any other security from them?","options":[],"required":null,"pdf_field":""},{"help":"Security details during transit","type":"text","label":"Were the persons conveying the money accompanied by an armed guard? If not, state what protection if any, was provided?","options":[],"required":null,"pdf_field":""},{"help":"Describe carrying method and quantity","type":"text","label":"How was the money being carried? (i.e. whether in bags, boxes trunks, etc, and in how many of them)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether such bags, boxes, trunks securely locked/closed?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"What means of transport was being used by the persons conveying the money?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Give the circumstances of the loss or damage (full particulars must be given).","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"What is the amount of loss?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the total amount checked at the time of handing over to the messenger?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain if no acknowledgement","type":"text","label":"Was any acknowledgement received from him? If not reasons.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Have you informed the policy authorities? If so when and where?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If police authority is informed, Case. No?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Has the perpetrator been caught by the police?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"What steps have been taken to recover the lost money?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Were the persons conveying the money covered under Fidelity Guarantee Policy / Policies? If so, for what sums and with which office/s?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Are there any other insurance upon the same money? If so, give full particulars.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Have you ever before sustained loss of the same nature? If so give particulars.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration for Section 3","fields":[{"help":"Name of witness","type":"text","label":"Witness","options":[],"required":null,"pdf_field":""},{"help":"Signature of insured","type":"signature","label":"Insured's Signature (Signature)","options":[],"required":true,"pdf_field":""},{"help":"Name of insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Section 4 - Event Insurance Claim Form","fields":[{"help":"","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No:","options":[],"required":null,"pdf_field":""},{"help":"Name of insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Full address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Telephone :","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"e-mail:","options":[],"required":null,"pdf_field":""},{"help":"Date and time of loss","type":"date","label":"Date & Time of Loss Incidence","options":[],"required":null,"pdf_field":""},{"help":"Describe incident","type":"text","label":"Brief description of Incidence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Type of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of Loss / Damage","options":[],"required":null,"pdf_field":""},{"help":"Witness details","type":"text","label":"Details of witness (name, address, tel no’s)","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Approximate value of loss","options":[],"required":null,"pdf_field":""},{"help":"FIR details if filed","type":"text","label":"Is FIR filed with police authorities? if Yes please provide details","options":[],"required":null,"pdf_field":""},{"help":"Other relevant info","type":"text","label":"Provide additional details relevant to claim , if any","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Give details of other Insurance, if any, covering the present loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Give details of previous Claims, if any, on the project","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration for Section 4","fields":[{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign and affix company seal","type":"signature","label":"Signature of insured with companies seal","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Claims under Vivah Suraksha Policy for all risk, burglary, money, and event insurance","attachments":["Please attach policy copy for fire insurance (Section 2)","Any other documents supporting the claim as relevant"],"declarations":["The insured agrees to provide additional information if required by the company.","The insured warrants the truth of all statements made to the best of their knowledge and belief.","If any false or fraudulent statement, suppression or concealment is made, the policy shall be void and rights to recover under it forfeited."],"dropped_labels":1},"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/217-vivah-suraksha-policy-claim-form"}