{"id":2245,"title":"CLAIM Form- OFFICE & PROFESSIONAL ESTABLISHMENT PROTECTOR INSURANCE POLICY","purpose":"claim","insurer":{"slug":"iffco-tokio-general-insurance","name":"IFFCO TOKIO General Insurance Company Limited"},"source_pdf":"https://www.iffcotokio.co.in/content/dam/iffcotokio/iffco-pdf/sites/default/files/pdf/Claim-Form-Office-Establishment-Protector.pdf","sha256":"3fc7d0a2c1f6c7cb6fb18396634749c7522db8c2abb259cbb450337295ad14e7","pages":20,"collected":"2026-10-17","instructions":{"about":"This form is for filing various types of insurance claims under the Office & Professional Establishment Protector Insurance Policy. It is filled by the insured or claimant to report losses or damages and request claim settlement.","notes":["Fill in all blanks and give complete details; use separate sheet if space is insufficient.","The issue of the claim form does not constitute admission of liability.","Attach original documents and vouchers as required.","Use capital letters to fill the form.","Return the form duly signed and dated.","Attach copies of police complaints and medical reports as applicable."],"title":"CLAIM Form- OFFICE & PROFESSIONAL ESTABLISHMENT PROTECTOR INSURANCE POLICY","submit":{"to":"Our Policy Issuing Office (mentioned in the Policy Schedule)","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured's Details and Material Damage Claim","fields":[{"help":"Enter your insurance policy number.","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Provide the date and time when the loss occurred.","type":"date","label":"Date and time of loss","options":[],"required":null,"pdf_field":""},{"help":"Full address where the insured risk is located.","type":"text","label":"Complete risk location address.","options":[],"required":null,"pdf_field":""},{"help":"City of the risk location.","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of the risk location.","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of the risk location.","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Name of the contact person for the claim.","type":"text","label":"Contact Person’s name","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of the contact person.","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Designation of the contact person.","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"Email address of the contact person.","type":"email","label":"Email Address","options":[],"required":null,"pdf_field":""},{"help":"Office landline number and availability hours.","type":"phone","label":"Telephone no. (O) (Landline) Availability between - ___ hrs to ___hrs","options":[],"required":null,"pdf_field":""},{"help":"Residence landline number and availability hours.","type":"phone","label":"Telephone no. (R) (Landline) Availability between - ___ hrs to ___hrs","options":[],"required":null,"pdf_field":""},{"help":"Describe the nature of the insured event and the claim amount.","type":"text","label":"Nature of Insured Event and Claim Amount","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss happened and what was done to control it.","type":"text","label":"Details of Incident – Material Damage Claim: Circumstances of loss (Brief details as to how loss took place and how it spread, how loss minimization efforts made & how finally if could be controlled)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the premises was occupied during the loss.","type":"yes-no","label":"Was the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide your opinion on what caused the loss.","type":"text","label":"Your Opinion about the cause of loss","options":[],"required":null,"pdf_field":""},{"help":"List items affected with details as per columns.","type":"table","label":"Fire Insurance Claim - Estimate of Loss (Please provide details as per schedule): S No., Block Name, Building, Plant & Machinery, Stocks, Packing Material","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Item affected (Plant & Machinery)","fields":[{"help":"Describe the item including make, model, and manufacturing year.","type":"text","label":"Description of Item affected (Plant & Machinery) Make / Model/ Year of Mfg.","options":[],"required":null,"pdf_field":""},{"help":"Serial number of the item if available.","type":"text","label":"Serial No of item if any","options":[],"required":null,"pdf_field":""},{"help":"Identification number of the item.","type":"text","label":"Identification No of Item","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the item was used according to manufacturer instructions.","type":"yes-no","label":"Was the Item used as prescribed by the Manufacture?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Location where the item can be inspected.","type":"text","label":"Where can it be examined now?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the item has been dismantled.","type":"yes-no","label":"Has item been dismantled?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if the item is under Annual Maintenance Contract.","type":"yes-no","label":"Is Item covered under any A.M.C","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if the item is under warranty.","type":"yes-no","label":"Is Item under warranty?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the extent of damage or loss to the item.","type":"text","label":"Extent of damage / Loss","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated repair cost or quote if available.","type":"amount","label":"Estimated amount for repair / Quote if any","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of other Existing Insurances","fields":[{"help":"Name and address of other insurers covering the same risk.","type":"text","label":"Name & Address of Insurance Company","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance.","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policies.","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Expiry date of other insurance policies.","type":"date","label":"Policy Expiry date","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration","fields":[{"help":"Date of signing the declaration.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place where the form is signed.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Full name of the claimant signing the form.","type":"text","label":"Name of the claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Burglary & Allied Perils Claim Form","fields":[{"help":"Claim number if available.","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"Policy number.","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured person or entity.","type":"text","label":"Name of Insured (in full)","options":[],"required":true,"pdf_field":""},{"help":"Address of the insured.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Business details of the insured.","type":"text","label":"Business","options":[],"required":null,"pdf_field":""},{"help":"Describe loss nature and when it happened.","type":"text","label":"Describe the nature of loss along with date / time of occurrence of the loss.","options":[],"required":true,"pdf_field":""},{"help":"Date when loss was discovered.","type":"date","label":"Date of discovery of loss?","options":[],"required":true,"pdf_field":""},{"help":"Location of loss.","type":"text","label":"Address of the premises where loss occurred?","options":[],"required":true,"pdf_field":""},{"help":"Details on occupancy at time of loss.","type":"text","label":"How was the premises occupied?","options":[],"required":null,"pdf_field":""},{"help":"Last occupancy date if premises was not occupied.","type":"text","label":"If not occupied when was it last occupied.","options":[],"required":null,"pdf_field":""},{"help":"Person reporting the loss and attach statement.","type":"text","label":"By whom was the loss reported? (A copy of written statement to be attached).","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss happened.","type":"text","label":"How did the loss occur?","options":[],"required":true,"pdf_field":""},{"help":"Cause of impact damage if applicable.","type":"text","label":"If due to impact damage what caused the object to fall?","options":[],"required":null,"pdf_field":""},{"help":"Details of entry/exit in case of burglary.","type":"text","label":"If due to burglary, how was entry/exit to the premises done?","options":[],"required":null,"pdf_field":""},{"help":"State if you are responsible for repairs.","type":"yes-no","label":"Are you responsible for repair to premises?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of persons involved in the loss.","type":"number","label":"How many persons were involved?","options":[],"required":null,"pdf_field":""},{"help":"Provide details if you suspect anyone.","type":"text","label":"Do you suspect anyone? If so give details.","options":[],"required":null,"pdf_field":""},{"help":"Police complaint details if filed.","type":"text","label":"Has complaint been lodged with the Police? If so, by whom & when at which Police Station?","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of police complaint.","type":"attachment","label":"Please attach a copy of the Police Complaint","options":[],"required":null,"pdf_field":""},{"help":"Confirm if police report will be filed.","type":"checkbox","label":"If not reported, please do so immediately and copy given to us.","options":["Yes"],"required":null,"pdf_field":""},{"help":"Provide loss amount and total value of assets.","type":"amount","label":"State the amount of loss & the total value of Building & Contents at the time of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Describe loss minimization efforts.","type":"text","label":"What steps have been taken to minimize the loss?","options":[],"required":null,"pdf_field":""},{"help":"Details of previous similar losses if any.","type":"text","label":"Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurances on same assets.","type":"text","label":"Are there any other insurances upon the same assets? If so, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Sign the form to declare correctness of information.","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Money Insurance Claim Form","fields":[{"help":"Claim number if available.","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"Policy number.","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured.","type":"text","label":"Name of Insured (in full)","options":[],"required":true,"pdf_field":""},{"help":"Address of insured.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Business details.","type":"text","label":"Business","options":[],"required":null,"pdf_field":""},{"help":"When the loss occurred.","type":"date","label":"Date and time of occurrence of loss.","options":[],"required":true,"pdf_field":""},{"help":"When the loss was discovered.","type":"date","label":"Date of discovery of loss.","options":[],"required":true,"pdf_field":""},{"help":"Transit route of the money.","type":"text","label":"What were the places between which money was in transit?","options":[],"required":null,"pdf_field":""},{"help":"Location of loss.","type":"text","label":"Where did the loss occur?","options":[],"required":null,"pdf_field":""},{"help":"Person reporting loss and attach statement.","type":"text","label":"By whom was the loss reported? (A copy of written statement to be attached).","options":[],"required":null,"pdf_field":""},{"help":"Name of person responsible for money.","type":"text","label":"In whose custody was the money at the time of the loss?","options":[],"required":true,"pdf_field":""},{"help":"Names of accompanying persons.","type":"text","label":"Who were the other persons accompanying the person carrying the money?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if armed guards were present.","type":"yes-no","label":"Did armed guards with fire arms accompanying the money?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of persons accompanying.","type":"number","label":"How many persons accompanied him?","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss happened.","type":"text","label":"Brief details as to the exact circumstances under which the loss occurred.","options":[],"required":true,"pdf_field":""},{"help":"Method of carrying the money.","type":"text","label":"How was the money carried? (whether in pocket, bag, box etc.)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if containers were locked.","type":"yes-no","label":"Whether such bags, boxes , etc. were securely locked?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mode of transport used.","type":"text","label":"By what conveyance was the money carried?","options":[],"required":null,"pdf_field":""},{"help":"Total amount of money carried.","type":"amount","label":"What was the amount of money being carried?","options":[],"required":true,"pdf_field":""},{"help":"Confirm if amount was checked.","type":"yes-no","label":"Was the total amount checked at the time of handing it over to the messenger?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm if acknowledgement was received.","type":"yes-no","label":"Was any acknowledgement received from him.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Amount lost.","type":"amount","label":"What was the amount of loss?","options":[],"required":true,"pdf_field":""},{"help":"Confirm if police complaint filed and attach copy.","type":"checkbox","label":"Has a complaint been made to the Police? If so, attach a copy thereof, If not, this may be done immediately.","options":["Yes"],"required":null,"pdf_field":""},{"help":"Describe recovery efforts.","type":"text","label":"What steps have been taken to recover the lost money?","options":[],"required":null,"pdf_field":""},{"help":"Date employee joined service.","type":"date","label":"When did the employee concerned enter your service?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if employee had prior similar incidents.","type":"yes-no","label":"Was any one of them involved in a similar loss before?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm if you believe employee's explanation.","type":"yes-no","label":"Are you satisfied the version given by them is correct?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of any fidelity guarantee coverage.","type":"text","label":"Are any of them covered under any Fidelity Guarantee Policy? If so, give details.","options":[],"required":null,"pdf_field":""},{"help":"Details of any security held from employees.","type":"text","label":"Do you hold any cash deposit or any other security from them?","options":[],"required":null,"pdf_field":""},{"help":"Details of previous similar losses.","type":"text","label":"Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurances on the money.","type":"text","label":"Are there any other insurances upon the same money? If so, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Sign to declare correctness of information.","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Electronic Equipment Insurance (EEI) Claim Form","fields":[{"help":"Full name and address of insured.","type":"text","label":"Name & Address of Insured","options":[],"required":true,"pdf_field":""},{"help":"Email address of insured.","type":"email","label":"Email id","options":[],"required":null,"pdf_field":""},{"help":"Residence phone and availability hours.","type":"phone","label":"Telephone Numbers (R) Available bet. _______ hrs to _____hrs","options":[],"required":null,"pdf_field":""},{"help":"Insurance policy number.","type":"text","label":"Policy Number","options":[],"required":true,"pdf_field":""},{"help":"Policy coverage period.","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Details of the electronic equipment affected.","type":"text","label":"Description of Item affected Make / Model / Year of Mfr.","options":[],"required":true,"pdf_field":""},{"help":"Serial number as per schedule.","type":"text","label":"Serial No. of item in schedule","options":[],"required":null,"pdf_field":""},{"help":"Identification number of the item.","type":"text","label":"Identification No. of item","options":[],"required":null,"pdf_field":""},{"help":"Date and time of loss or accident.","type":"date","label":"Date of Loss / accident / incident Time","options":[],"required":true,"pdf_field":""},{"help":"Confirm if item was used as per manufacturer instructions.","type":"yes-no","label":"Was the item used as prescribed by the manufacturer?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain how and when the equipment failed.","type":"text","label":"Circumstance of Loss (Brief write up on circumstances under which the equipment broke down and how & when it was detected)","options":[],"required":true,"pdf_field":""},{"help":"Your view on what caused the loss.","type":"text","label":"Your opinion about the cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Where the item was located when loss occurred.","type":"text","label":"Location of item at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"Current location for inspection.","type":"text","label":"Where can it be examined now?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if item dismantled.","type":"yes-no","label":"Has item been dismantled?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if item is under Annual Maintenance Contract.","type":"yes-no","label":"Is item covered under any A.M.C.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if item is under warranty.","type":"yes-no","label":"Is the item under warranty?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe damage extent.","type":"text","label":"Extent of damage / loss","options":[],"required":null,"pdf_field":""},{"help":"Estimated repair cost or quote.","type":"amount","label":"Estimated amount for repair / Quote if any.","options":[],"required":null,"pdf_field":""},{"help":"Details of data loss and recovery method if applicable.","type":"text","label":"Loss to External Data Media (if applicable); please list out the type of data lost and the way the same is being replaced/reconstructed","options":[],"required":false,"pdf_field":""},{"help":"Details of increased working costs if applicable.","type":"text","label":"Increased Cost of working (if applicable); specific details of the increased cost likely to be incurred may please be provided","options":[],"required":false,"pdf_field":""},{"help":"Details of other insurances covering the item.","type":"text","label":"Details of Other Existing Insurances: Name & Address of Company, Policy No., Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Sign to declare correctness of information.","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Personal Accident Insurance Claim Form","fields":[{"help":"Policy number.","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"State policy limits applicable.","type":"text","label":"Limits of Liability under the Policy","options":[],"required":null,"pdf_field":""},{"help":"Date and time of accident.","type":"date","label":"Date & Time of Loss","options":[],"required":true,"pdf_field":""},{"help":"Full name(s) of claimant(s).","type":"text","label":"Name of Claimant (in full) [If more than one, state names of all]","options":[],"required":true,"pdf_field":""},{"help":"Claimant's postal address.","type":"text","label":"Full Postal Address","options":[],"required":true,"pdf_field":""},{"help":"Relationship to deceased if applicable.","type":"text","label":"Relationship of Claimant with the deceased (in case of a death claim)","options":[],"required":null,"pdf_field":""},{"help":"Specify the benefit claimed under policy.","type":"text","label":"State the benefit under which the claim is preferred","options":[],"required":true,"pdf_field":""},{"help":"Details of the insured person involved in accident.","type":"text","label":"Particulars of the Insured Person: i) Name (in full), ii) Postal Address, iii) Occupation, iv) Age at the time of the accident","options":[],"required":true,"pdf_field":""},{"help":"Date and time of accident.","type":"date","label":"When did the accident happen? (Please give date and exact time)","options":[],"required":true,"pdf_field":""},{"help":"Location of accident.","type":"text","label":"Where did the accident happen?","options":[],"required":true,"pdf_field":""},{"help":"Describe accident and injuries.","type":"text","label":"Please give full description of the accident, its cause and injuries sustained","options":[],"required":true,"pdf_field":""},{"help":"Details of death if applicable.","type":"text","label":"State date, time and place of death (in case of a death claim)","options":[],"required":null,"pdf_field":""},{"help":"Date and source of accident information.","type":"text","label":"On which date did the claimant receive information with regard to the accident and from whom?","options":[],"required":null,"pdf_field":""},{"help":"Witness details.","type":"text","label":"Please give the names and addresses of two persons who witnessed the accident","options":[],"required":null,"pdf_field":""},{"help":"Health condition of insured at accident time.","type":"text","label":"Was the Insured person free from infirmity at the time of accident? If not, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if under influence.","type":"yes-no","label":"Was the Insured person under the influence of drugs or alcohol at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm if death was accident related.","type":"yes-no","label":"Is the Claimant satisfied that the death was directly due to the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Treatment facility details.","type":"text","label":"Please give the names and addresses of the Hospital, Clinic or Nursing Home where the Insured Person was treated after the accident.","options":[],"required":null,"pdf_field":""},{"help":"Name of attending doctor.","type":"text","label":"The Medical Practioner / Surgeon who attended on the Insured Person after the accident","options":[],"required":null,"pdf_field":""},{"help":"Name of regular doctor if any.","type":"text","label":"Regular Physician of the Insured Person, if any","options":[],"required":null,"pdf_field":""},{"help":"Details of other accident insurance.","type":"text","label":"Does the Insured Person have any other Accident Insurance on his life? If so, state the name of the Insurer/s and amount/s claimed.","options":[],"required":null,"pdf_field":""},{"help":"Witness signature.","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Claimant signature.","type":"signature","label":"Signature of Claimant","options":[],"required":true,"pdf_field":""},{"help":"Name of claimant.","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Claimant address.","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Baggage Insurance Claim Form","fields":[{"help":"Claim number if available.","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"Policy number.","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured.","type":"text","label":"Name of Insured (in full)","options":[],"required":true,"pdf_field":""},{"help":"Address of insured.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Business details.","type":"text","label":"Business","options":[],"required":null,"pdf_field":""},{"help":"When loss occurred.","type":"date","label":"Date and time of occurrence of loss.","options":[],"required":true,"pdf_field":""},{"help":"When loss was discovered.","type":"date","label":"Date / Time of discovery of loss.","options":[],"required":true,"pdf_field":""},{"help":"Person reporting loss and attach statement.","type":"text","label":"By whom was the loss reported? (A copy of written statement to be attached).","options":[],"required":null,"pdf_field":""},{"help":"Person responsible for baggage.","type":"text","label":"In whose custody was the baggage at the time of the loss?","options":[],"required":true,"pdf_field":""},{"help":"Names of accompanying persons.","type":"text","label":"Were there other persons accompanying the person carrying the baggage?","options":[],"required":null,"pdf_field":""},{"help":"Explain how loss happened.","type":"text","label":"Brief details as to the exact circumstances under which the loss occurred.","options":[],"required":true,"pdf_field":""},{"help":"Amount of money in baggage.","type":"amount","label":"What was the amount of money being carried in the baggage?","options":[],"required":null,"pdf_field":""},{"help":"List items and approximate costs.","type":"text","label":"What were the items in the baggage along with approximate costs?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if baggage was locked.","type":"yes-no","label":"Were the baggage locked?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Total loss amount.","type":"amount","label":"What was the total amount of loss?","options":[],"required":true,"pdf_field":""},{"help":"Confirm if police complaint filed and attach copy.","type":"checkbox","label":"Has a complaint been made to the Police? If so, attach a copy thereof, If not, this may be done immediately.","options":["Yes"],"required":null,"pdf_field":""},{"help":"Describe recovery efforts.","type":"text","label":"What steps have been taken to recover the lost baggage?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if employee involved.","type":"yes-no","label":"Is any employee involved in the incident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if prior similar incidents.","type":"yes-no","label":"Was any one of them involved in a similar loss before?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm if employee's explanation is satisfactory.","type":"yes-no","label":"Are you satisfied the version given by them is correct?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of fidelity guarantee coverage.","type":"text","label":"Are any of them covered under any Fidelity Guarantee Policy? If so, give details.","options":[],"required":null,"pdf_field":""},{"help":"Details of security held from employees.","type":"text","label":"Do you hold any cash deposit or any other security from them?","options":[],"required":null,"pdf_field":""},{"help":"Details of previous similar losses.","type":"text","label":"Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurances on baggage.","type":"text","label":"Are there any other insurances upon the same baggage? If so, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Sign to declare correctness of information.","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Public and Personal Liability Claim Form","fields":[{"help":"Full name of insured.","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""},{"help":"Address of insured.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Policy number.","type":"text","label":"Policy Number","options":[],"required":true,"pdf_field":""},{"help":"Sum insured under this section.","type":"amount","label":"Sum Insured under the Section","options":[],"required":null,"pdf_field":""},{"help":"Date accident occurred.","type":"date","label":"Date of occurrence","options":[],"required":true,"pdf_field":""},{"help":"Time of accident.","type":"text","label":"Time","options":[],"required":true,"pdf_field":""},{"help":"Location of accident.","type":"text","label":"Place of accident","options":[],"required":true,"pdf_field":""},{"help":"Date you learned about accident.","type":"date","label":"When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""},{"help":"Date accident was reported.","type":"date","label":"When was the accident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"Date claim was notified.","type":"date","label":"When was the claim first notified to the Insurer?","options":[],"required":null,"pdf_field":""},{"help":"Name of person liable for compensation.","type":"text","label":"Name of the Insured Person liable to pay compensation to the third party","options":[],"required":null,"pdf_field":""},{"help":"Relationship to insured.","type":"text","label":"Relationship with the Insured","options":[],"required":null,"pdf_field":""},{"help":"Details of injured persons.","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 at accident time.","type":"text","label":"State where such person/s was/were at the time of accident.","options":[],"required":null,"pdf_field":""},{"help":"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":"Details of property damage.","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 livestock and full description of the property and state the nature of and extent of damage.","options":[],"required":null,"pdf_field":""},{"help":"Details of claims made against you.","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":"Indicate if legal expenses incurred.","type":"yes-no","label":"Has the insured incurred legal expenses in defending the claim?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if liable for defense costs.","type":"yes-no","label":"Is the Insured legally liable to pay Third party defense cost?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Estimated claim amounts for each category.","type":"amount","label":"Estimated amount of claim separately under (a), (b), (c), (d) and (e)","options":[],"required":null,"pdf_field":""},{"help":"Witness details.","type":"text","label":"Give, if possible, the names and addresses of all witnesses to the accident.","options":[],"required":null,"pdf_field":""},{"help":"Authority report details and attach 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":"Action taken by authority.","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurance on same risk.","type":"text","label":"Give particulars of any other insurance, if any, in respect of the same risk.","options":[],"required":null,"pdf_field":""},{"help":"Name of claimant.","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Signature of claimant.","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Workmen's Compensation (W.C) Claim Form","fields":[{"help":"Claim number if available.","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Details of insurance policies including other companies if any.","type":"text","label":"Insurances Effected: Company, Policy No., Full Description of Interest covered","options":[],"required":true,"pdf_field":""},{"help":"Address of injured person.","type":"text","label":"Local/Permanent address","options":[],"required":true,"pdf_field":""},{"help":"Age and sex of injured person.","type":"text","label":"Age/Sex","options":[],"required":true,"pdf_field":""},{"help":"Confirm if injured was performing usual work or specify other work.","type":"text","label":"Was the injured person engaged in the occupation when the accident occurred? If not, state exactly nature of work done at that time.","options":[],"required":true,"pdf_field":""},{"help":"Employment details and contractor info if applicable.","type":"text","label":"Is the injured person in your direct employ? If so, state the date of appointment. If not, give name and address of contractor under whom employed and nature of work entrusted to contractor (Copy of the last voucher obtained from the injured person for the wages paid to be attached)","options":[],"required":true,"pdf_field":""},{"help":"Policy item covering injured person.","type":"text","label":"Under what Item of the policy is the injured workman covered?","options":[],"required":true,"pdf_field":""},{"help":"Location of accident.","type":"text","label":"Premises at which accident occurred","options":[],"required":true,"pdf_field":""},{"help":"Description of premises and work.","type":"text","label":"Exact occupation of the premises and general nature of work done","options":[],"required":true,"pdf_field":""},{"help":"When accident happened.","type":"date","label":"Time and date of occurrence of accident","options":[],"required":true,"pdf_field":""},{"help":"Time and person reporting accident.","type":"text","label":"Time when reported and by whom","options":[],"required":true,"pdf_field":""},{"help":"When injured stopped work.","type":"date","label":"Time and date when the injured person actually ceased work","options":[],"required":true,"pdf_field":""},{"help":"Explain accident circumstances.","type":"text","label":"Describe how the accident occurred","options":[],"required":true,"pdf_field":""},{"help":"Confirm if accident was work-related.","type":"yes-no","label":"Are you satisfied that the accident occurred in the course of and arising out of employment?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if intoxicated.","type":"yes-no","label":"Was the injured person under the influence of drink or drugs at the time of accident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if misconduct occurred.","type":"yes-no","label":"Was the Injured person guilty of misconduct or disobedience to orders or rules?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Confirm if reported and attach copy.","type":"yes-no","label":"Has the accident been reported to police or inspector of Labour? (A copy of the report to be attached)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Injury details.","type":"text","label":"Describe the nature of injury and part of body affected","options":[],"required":true,"pdf_field":""},{"help":"Treatment and hospital details.","type":"text","label":"Describe initial treatment offered. When and whether admitted in hospital? Name of Hosp., whether as inpatient or outdoor patient.","options":[],"required":true,"pdf_field":""},{"help":"Medical opinion and attach report.","type":"text","label":"What is the medical opinion on nature and extent of disablement? (A copy of the preliminary Medical Report to be attached)","options":[],"required":true,"pdf_field":""}],"filled_by":"employer/insured"}],"deadlines":["Return this form, duly filled & signed, within 30 days from the date of its issuance (Material Damage Claim)","Return the Burglary & Allied Perils Claim Form within Fourteen days of the loss","Return the Money Insurance Claim Form within Fourteen days of the loss","Return the Electronic Equipment Insurance Claim Form within 14 days from the date of occurrence","Return the Personal Accident Insurance Claim Form as soon as possible; in case of delay, return form first and documents later","Return the Baggage Insurance Claim Form within Fourteen days of the loss","Return the Public and Personal Liability Claim Form within 15 days from the date of occurrence"],"applies_to":"Claims under Office & Professional Establishment Protector Insurance Policy including material damage, burglary, money insurance, electronic equipment, personal accident, baggage, public and personal liability, and workmen's compensation claims.","attachments":["Copy of written statement for loss report","Copy of Police Complaint","Death Certificate (for death claims)","Post Mortem Certificate (if applicable)","Police Panchanama (if applicable)","Preliminary Medical Report (for Workmen's Compensation claims)","Copy of police or labour inspector report (for Workmen's Compensation claims)"],"declarations":["The information furnished in this claim form is true and correct to the best of my knowledge and belief.","If any false or untrue statement, suppression or concealment of any material fact is made, the right to claim reimbursement shall be forfeited.","I have included all the documents for the purpose of this claim.","If any false or fraudulent statement is made, the claim shall be forfeited and the policy null and void.","I warrant the truth of the foregoing particulars in every respect."],"dropped_labels":10},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"policy issuing Branch","label":"Walk in claim intimation","level":null,"hours":"Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays)","applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"65 days.\nToll No. 1800-103-5499\nWalk in\nShall you wish to intimate your claim in person, please feel free to visit your policy issuing Branch Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays). Please refer to our\nBranch Locator\nfor information on our","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@iffcotokio.co.in","label":"Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"se\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-103-5499","label":"Toll free","level":null,"hours":"24 X 7","applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"engali\nKannada\nAssamese\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengal","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"56161","label":"SMS “CLAIM” to 56161","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"avor to take customer service at newer heights, we now bring claim Intimation at your fingertips. Please SMS “CLAIM” to 56161 and one of our Claims representatives will get in touch with you in 4 Working Hours.\n* Note:\nPlease have all the detail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"whatsapp","value":"7993407777","label":"Say Hi to IRA","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"est\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya\nCustomer Login\nAgent Login","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/iffco-tokio-general-insurance/2245-claim-form-office-and-professional-establishment-protector-insurance-policy"}