{"id":2246,"title":"CLAIM FORM- OFFICE & PROFESSIONAL ESTABLISHMENT PROTECTOR INSURANCE POLICY –LAGHU UDYAM","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-Laghu-Udyam-Office-Establishment-Protector.pdf","sha256":"33eb3c439f117b286f0c9d35e3c1f3547f2acce08b62a3151fb5853dd2ce65a9","pages":20,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders to file various types of insurance claims under the Office & Professional Establishment Protector Insurance Policy – Laghu Udyam.","notes":["Use capital letters to fill in the form.","Attach copies of police complaints and relevant vouchers as applicable.","In case space is insufficient, annex a separate sheet.","The issue of this form does not constitute admission of liability.","Original bills and documents may be required for claim processing.","For death claims, attach Death Certificate, Post Mortem Certificate, and Police Panchanama if any.","If delay in obtaining documents, return the form first to the policy issuing office."],"title":"CLAIM FORM- OFFICE & PROFESSIONAL ESTABLISHMENT PROTECTOR INSURANCE POLICY –LAGHU UDYAM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured's Details and Material Damage Claim","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time when the loss occurred","type":"date","label":"Date and time of loss","options":[],"required":null,"pdf_field":""},{"help":"Full address of the insured premises","type":"text","label":"Complete risk location address.","options":[],"required":null,"pdf_field":""},{"help":"City of the insured premises","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of the insured premises","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of the insured premises","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person for claim follow-up","type":"text","label":"Contact Person’s name","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of contact person","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Designation of contact person","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"Email address of 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 claim amount","type":"text","label":"Nature of Insured Event and Claim Amount","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident and loss circumstances","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 premises were occupied during 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 cause of loss","type":"text","label":"Your Opinion about the cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Fill details of loss estimate for each category","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":"Plant & Machinery Details","fields":[{"help":"Describe the affected item","type":"text","label":"Description of Item affected (Plant & Machinery)","options":[],"required":null,"pdf_field":""},{"help":"Provide make, model and manufacturing year","type":"text","label":"Make / Model/ Year of Mfg.","options":[],"required":null,"pdf_field":""},{"help":"Serial number 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":"Confirm if item was used as per 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 item can be inspected","type":"text","label":"Where can it be examined now?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if item has been dismantled","type":"yes-no","label":"Has item been dismantled?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate 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":"Indicate if item is under warranty","type":"yes-no","label":"Is Item under warranty?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe extent of damage or loss","type":"text","label":"Extent of damage / Loss","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated repair cost or quote","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 insurer","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 policy","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Expiry date of other policy","type":"date","label":"Policy Expiry date","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration","fields":[{"help":"Date of signing declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the claimant","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Print claimant's full name","type":"text","label":"Name of the claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Burglary & Allied Perils Claim Form","fields":[{"help":"","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured","type":"text","label":"1.(a) Name of Insured (in full)","options":[],"required":null,"pdf_field":""},{"help":"Describe loss nature and date/time","type":"text","label":"2.(a) Describe the nature of loss along with date / time of occurrence of the loss.","options":[],"required":null,"pdf_field":""},{"help":"Explain cause of loss","type":"text","label":"3.(a) How did the loss occur?","options":[],"required":null,"pdf_field":""},{"help":"Police complaint details","type":"text","label":"4.(a) Has complaint been lodged with the Police? If so, by whom & when at which Police Station?","options":[],"required":null,"pdf_field":""},{"help":"Provide loss amount and total value","type":"amount","label":"5. 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 steps","type":"text","label":"6. What steps have been taken to minimize the loss?","options":[],"required":null,"pdf_field":""},{"help":"Previous similar loss details","type":"text","label":"7. Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Other insurance details","type":"text","label":"8. Are there any other insurances upon the same assets? 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Brief details as to the exact circumstances under which the loss occurred.","options":[],"required":null,"pdf_field":""},{"help":"Method of carrying money","type":"text","label":"5.(a) How was the money carried? (whether in pocket, bag, box etc.)","options":[],"required":null,"pdf_field":""},{"help":"Total amount carried","type":"amount","label":"6.(a) What was the amount of money being carried?","options":[],"required":null,"pdf_field":""},{"help":"Amount lost","type":"amount","label":"7. What was the amount of loss?","options":[],"required":null,"pdf_field":""},{"help":"Confirm police complaint and attach copy","type":"checkbox","label":"8. Has a complaint been made to the Police? If so, attach a copy thereof, If not, this may be done immediately.","options":["Complaint made"],"required":null,"pdf_field":""},{"help":"Recovery efforts details","type":"text","label":"9. What steps have been taken to recover the lost money?","options":[],"required":null,"pdf_field":""},{"help":"Employee joining date","type":"date","label":"10.(a) When did the employee concerned enter your service?","options":[],"required":null,"pdf_field":""},{"help":"Previous similar loss details","type":"text","label":"11. Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Other insurance details","type":"text","label":"12. Are there any other insurances upon the same money? 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please list out the type of data lost and the way the same is being replaced/reconstructed","options":[],"required":null,"pdf_field":""},{"help":"Details of increased working costs","type":"text","label":"19 Increased Cost of working (if applicable); specific details of the increased cost likely to be incurred may please be provided","options":[],"required":null,"pdf_field":""},{"help":"Other insurance details","type":"text","label":"20 Details of Other Existing Insurances - Name & Address of Company, Policy No., Sum Insured","options":[],"required":null,"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":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Personal Accident Insurance Claim Form","fields":[{"help":"Policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Policy liability limits","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":null,"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":null,"pdf_field":""},{"help":"Claimant's postal address","type":"text","label":"Full Postal Address","options":[],"required":null,"pdf_field":""},{"help":"Relationship to deceased","type":"text","label":"Relationship of Claimant with the deceased (in case of a death claim)","options":[],"required":null,"pdf_field":""},{"help":"Benefit type claimed","type":"text","label":"State the benefit under which the claim is preferred","options":[],"required":null,"pdf_field":""},{"help":"Name of insured person","type":"text","label":"Particulars of the Insured Person - i) Name (in full)","options":[],"required":null,"pdf_field":""},{"help":"Address of insured person","type":"text","label":"ii) Postal Address","options":[],"required":null,"pdf_field":""},{"help":"Occupation of insured person","type":"text","label":"iii) Occupation","options":[],"required":null,"pdf_field":""},{"help":"Age at accident time","type":"number","label":"iv) Age at the time of the accident","options":[],"required":null,"pdf_field":""},{"help":"Date and time of accident","type":"date","label":"When did the accident happen? 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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 signer","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Address of signer","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Baggage Insurance Claim Form","fields":[{"help":"","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured","type":"text","label":"1.(a) Name of Insured (in full)","options":[],"required":null,"pdf_field":""},{"help":"Date and time loss occurred","type":"date","label":"2.(a) Date and time of occurrence of loss.","options":[],"required":null,"pdf_field":""},{"help":"Custodian of baggage","type":"text","label":"3.(a) In whose custody was the baggage at the time of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Describe loss circumstances","type":"text","label":"4. 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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. 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