{"id":2248,"title":"Claim Form-Industry 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-Industry-Protector-Insurance-Policy-Laghu-Udyam.pdf","sha256":"9cca0cad9eab5e720b0edbf738ef5094aec9b28f2a0b3a154dd3754d2f9b7bed","pages":20,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders to file various types of insurance claims under the Industry Protector Insurance Policy - Laghu Udyam. It collects detailed information about the insured event and the loss incurred.","notes":["Fill all details in CAPITAL letters where specified.","Attach separate sheets if space provided is insufficient.","Attach all relevant vouchers, police complaints, medical reports, and quotations as applicable.","Use original bills and documents where required.","The issue of the claim form does not constitute admission of liability.","Return the form to the Policy Issuing Office mentioned in the Policy Schedule."],"title":"Claim Form-Industry Protector Insurance Policy-Laghu Udyam","submit":{"to":"Policy Issuing Office mentioned in the Policy Schedule","how":"post / in person","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 where the insured risk is located","type":"text","label":"Complete risk location address.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of the 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 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 contact person","type":"email","label":"Email Address","options":[],"required":null,"pdf_field":""},{"help":"Office landline number and availability time","type":"phone","label":"Telephone no. (O) (Landline) Availability between - ___ hrs to ___hrs","options":[],"required":null,"pdf_field":""},{"help":"Residence landline number and availability time","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":"Explain how the loss happened and was controlled","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 what caused the 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":"policyholder/claimant"},{"title":"Burglary & Allied Perils Claim","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 how loss happened","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 efforts","type":"text","label":"6. What steps have been taken to minimize the loss?","options":[],"required":null,"pdf_field":""},{"help":"Details of previous similar losses","type":"text","label":"7. Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurances","type":"text","label":"8. Are there any other insurances upon the same assets? If so, give particulars.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder/claimant"},{"title":"Machinery Breakdown Claim","fields":[{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Date form issued","type":"date","label":"Date of Issue","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Date and time when breakdown occurred","type":"date","label":"Date & Time of breakdown","options":[],"required":null,"pdf_field":""},{"help":"Full address of machine location","type":"text","label":"Machine which broke down was installed at (Complete Address of Location)","options":[],"required":null,"pdf_field":""},{"help":"Your opinion on cause","type":"text","label":"Your opinion about the Cause of Breakdown","options":[],"required":null,"pdf_field":""},{"help":"Policy schedule item details","type":"text","label":"Schedule Item of Policy","options":[],"required":null,"pdf_field":""},{"help":"Describe the machine","type":"text","label":"Description of Machine","options":[],"required":null,"pdf_field":""},{"help":"Machine specifications","type":"text","label":"Specification of Machine","options":[],"required":null,"pdf_field":""},{"help":"Describe damage extent","type":"text","label":"Extent of Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated repair cost with quotation","type":"amount","label":"Cost of Repair (attach copy of Quotation)","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurances","type":"text","label":"Details of Other Existing Insurances - Name & Address of Company, Policy No., Sum Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder/claimant"},{"title":"Electronic Equipment Insurance (EEI) Claim Form","fields":[{"help":"Full name and address","type":"text","label":"1 Name & Address of Insured","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"2 Email id","options":[],"required":null,"pdf_field":""},{"help":"Residence phone and availability","type":"phone","label":"Telephone Numbers (R) Available bet. _______ hrs to _____hrs","options":[],"required":null,"pdf_field":""},{"help":"Policy number","type":"text","label":"3 Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Details of affected equipment","type":"text","label":"4 Description of Item affected Make / Model / Year of Mfr.","options":[],"required":null,"pdf_field":""},{"help":"Serial number","type":"text","label":"5 Serial No. of item in schedule","options":[],"required":null,"pdf_field":""},{"help":"Identification number","type":"text","label":"6 Identification No. of item","options":[],"required":null,"pdf_field":""},{"help":"Date and time of loss","type":"date","label":"7 Date of Loss / accident / incident Time","options":[],"required":null,"pdf_field":""},{"help":"Confirm if item was used as per instructions","type":"yes-no","label":"8 Was the item used as prescribed by the manufacturer?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain circumstances of loss","type":"text","label":"9 Circumstance of Loss (Brief write up on circumstances under which the equipment broke down and how & when it was detected)","options":[],"required":null,"pdf_field":""},{"help":"Your opinion on cause","type":"text","label":"10 Your opinion about the cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Where item was located","type":"text","label":"11 Location of item at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"Current location for examination","type":"text","label":"12 Where can it be examined now?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if dismantled","type":"yes-no","label":"13 Has item been dismantled?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Is item under Annual Maintenance Contract","type":"yes-no","label":"14 Is item covered under any A.M.C.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Is item under warranty","type":"yes-no","label":"15 Is the item under warranty?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe damage extent","type":"text","label":"16 Extent of damage / loss","options":[],"required":null,"pdf_field":""},{"help":"Repair cost estimate","type":"amount","label":"17 Estimated amount for repair / Quote if any.","options":[],"required":null,"pdf_field":""},{"help":"Details of data loss and recovery","type":"text","label":"18 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":null,"pdf_field":""},{"help":"Details of increased working cost","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":""}],"filled_by":"policyholder/claimant"},{"title":"Money 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 when loss occurred","type":"date","label":"2.(a) Date and time of occurrence of loss.","options":[],"required":null,"pdf_field":""},{"help":"Custodian of money","type":"text","label":"3.(a) In whose custody was the money at the time of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Explain circumstances of loss","type":"text","label":"4 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":"Attach police complaint copy if made","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":"Describe recovery efforts","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":"Details of previous similar losses","type":"text","label":"11 Have you ever before sustained a loss of this nature? If so give particulars","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurances","type":"text","label":"12 Are there any other insurances upon the same money? If so, give particulars.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder/claimant"},{"title":"Personal Accident Insurance Claim Form","fields":[{"help":"","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":"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 in years","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? (Please give date and exact time)","options":[],"required":null,"pdf_field":""},{"help":"Location of accident","type":"text","label":"Where did the accident happen?","options":[],"required":null,"pdf_field":""},{"help":"Describe accident and injuries","type":"text","label":"Please give full description of the accident, its cause and injuries sustained","options":[],"required":null,"pdf_field":""},{"help":"Death details 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 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 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 influence of substances","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 cause of death","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":"Attending doctor details","type":"text","label":"The Medical Practioner / Surgeon who attended on the Insured Person after the accident","options":[],"required":null,"pdf_field":""},{"help":"Regular doctor details if any","type":"text","label":"Regular Physician of the Insured Person, if any","options":[],"required":false,"pdf_field":""},{"help":"Other accident insurance details","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":false,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Public and Personal Liability Claim Form","fields":[{"help":"Name of insured","type":"text","label":"1.(a) Name of Insured","options":[],"required":null,"pdf_field":""},{"help":"Date first aware of accident","type":"date","label":"2.(c) When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""},{"help":"Witness details","type":"text","label":"4.(a) Give, if possible, the names and addresses of all witnesses to the accident.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder/claimant"},{"title":"Workmen's Compensation (W.C) Claim Form","fields":[{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Employer/insured name","type":"text","label":"1 (A) Name","options":[],"required":null,"pdf_field":""},{"help":"Details of insurance policies","type":"text","label":"2 Insurances Effected - Company, Policy No., Full Description of Interest covered","options":[],"required":null,"pdf_field":""},{"help":"Name of injured person","type":"text","label":"3 Injured Person - (a) Name","options":[],"required":null,"pdf_field":""},{"help":"Accident location","type":"text","label":"4 Accident - (a) Premises at which accident occurred","options":[],"required":null,"pdf_field":""},{"help":"Injury description","type":"text","label":"5 Loss - (a) Describe the nature of injury and part of body affected","options":[],"required":null,"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 this form, duly filled & signed, within 14 days from the date of loss (Burglary & Allied Perils, Machinery Breakdown, Electronic Equipment Insurance, Money Insurance)","Return this form, duly filled & signed, within 15 days from the date of occurrence (Public and Personal Liability)","Return this form, duly filled & signed, within 14 days from the date of occurrence (Workmen's Compensation)"],"applies_to":"Claims under Industry Protector Insurance Policy - Laghu Udyam for material damage, burglary, machinery breakdown, electronic equipment insurance, money insurance, personal accident, public and personal liability, and workmen's compensation.","attachments":["Copy of written statement (Burglary & Allied Perils)","Copy of Police Complaint (Burglary & Allied Perils)","Copy of Quotation for repair (Machinery Breakdown)","Copy of Police Complaint (Money Insurance)","Death Certificate, Post Mortem Certificate, Police Panchanama (Personal Accident death claim)","Copy of notification and bill if claim made in writing (Public and Personal Liability)","Copy of report submitted to authority (Public and Personal Liability)","Copy of police or labour report (Workmen's Compensation)","Copy of preliminary Medical Report (Workmen's Compensation)","Fitness certificate of attendant doctor (Workmen's Compensation)","Copy of all policies if insurance effected with companies other than IFFCO-Tokio (Workmen's Compensation)"],"declarations":["Information furnished in this claim form is true and correct to the best of my knowledge and belief.","False or untrue statements, suppression or concealment of material facts will forfeit the right to claim reimbursement.","I have included all the documents for the purpose of this claim.","Statements made in the claim form are true to the best of my knowledge and belief and no material information has been withheld.","If any false or fraudulent statement is made, the claim shall be forfeited and the policy null and void."],"dropped_labels":80},"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/2248-claim-form-industry-protector-insurance-policy-laghu-udyam"}