{"id":2253,"title":"INDUSIND MOTOR VEHICLE EXTENDED WARRANTY AND PROTECTION FOR TWO WHEELER (ICE & EV) - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/motor-vehicle-extended-warranty-for-two-wheeler-ice-and-ev","sha256":"1fee5d6b3df9d8ba8d2be72aa51c7f30a4397d42276b123eeacb190b9f1e0d6d","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim benefits under the Motor Vehicle Extended Warranty and Protection policy for two wheelers, including ICE and EV vehicles.","notes":["Please answer all questions fully and correctly; mention 'not applicable' where needed.","Issuance of this form does not imply acceptance of liability.","For any service reimbursement, a copy of the bill is required.","Attach a copy of signed cancelled cheque for bank payments.","Attach self-attested Aadhaar card copy if using Aadhaar based payment.","Claim must be intimated immediately to the call centre; delay may lead to denial.","Use only authorized locations for inspection and repair of the insured asset.","Failure to produce proper service records or comply with requirements may lead to claim repudiation.","Preferred cashless garage list is available on the website; cashless claims only at network garages.","You will receive SMS updates on claim status if mobile number is provided."],"title":"INDUSIND MOTOR VEHICLE EXTENDED WARRANTY AND PROTECTION FOR TWO WHEELER (ICE & EV) - CLAIM FORM","submit":{"to":"Call Centre at 022 48903009 (paid No.)","how":"Call immediately to intimate claim","address":""},"purpose":"claim","sections":[{"title":"Vehicle Details","fields":[{"help":"","type":"text","label":"MASTER POLICY HOLDER NUMBER","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Form No.","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of Vehicle Type","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Make","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Model & Variant","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Cubic Capacity","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"RTO Authority","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Registration Number","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Registration","options":[],"required":null,"pdf_field":""},{"help":"Complete number","type":"text","label":"Engine Number / EV Motor Number (Please fill in complete number)","options":[],"required":null,"pdf_field":""},{"help":"Complete number","type":"text","label":"Chassis Number (Please fill in complete number)","options":[],"required":null,"pdf_field":""},{"help":"Complete number","type":"text","label":"EV Battery Number (Please fill in complete number)","options":[],"required":null,"pdf_field":""},{"help":"Enter battery capacity in kilowatt-hours","type":"number","label":"EV Battery Capacity in kWh","options":[],"required":null,"pdf_field":""},{"help":"Complete number","type":"text","label":"EV Charger Number (Please fill in complete number)","options":[],"required":null,"pdf_field":""},{"help":"State of Health percentage","type":"number","label":"Battery SOH at the time of claim","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Body Type","options":[],"required":null,"pdf_field":""},{"help":"Current odometer reading","type":"number","label":"Odometer Reading","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Purchase of the Vehicle by the proposer","options":[],"required":null,"pdf_field":""},{"help":"Select who drives the vehicle","type":"choice","label":"Vehicle Driven By","options":["Self","Driver"],"required":null,"pdf_field":""},{"help":"Select new or second hand","type":"choice","label":"Whether the vehicle at the time of purchase was","options":["New","Second Hand"],"required":null,"pdf_field":""},{"help":"Select fuel type","type":"choice","label":"Vehicle Fuel Type","options":["Petrol","Electric"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Insured Details","fields":[{"help":"Select insured type","type":"choice","label":"Insured Type","options":["Individual","Company"],"required":null,"pdf_field":""},{"help":"Select title and enter full name","type":"text","label":"Insureds Full Name","options":["Mr.","Mrs.","Ms.","M/S (If Company is selected above)"],"required":null,"pdf_field":""},{"help":"Enter full permanent address","type":"text","label":"Address - Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Enter correspondence address","type":"text","label":"Correspondence Address (Where vehicle is going to be kept)","options":[],"required":null,"pdf_field":""},{"help":"Part of address","type":"text","label":"Flat / Building","options":[],"required":null,"pdf_field":""},{"help":"Part of address","type":"text","label":"Road/Street/Sector","options":[],"required":null,"pdf_field":""},{"help":"Part of address","type":"text","label":"Area/Village/Taluka","options":[],"required":null,"pdf_field":""},{"help":"Nearby landmark","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"City name","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"State name","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Landline","options":[],"required":false,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Select applicable claim category","type":"choice","label":"Please tick the Category of Claim - Section I","options":["Extended Warranty","Enhancement Cover"],"required":null,"pdf_field":""},{"help":"Select applicable addon cover","type":"choice","label":"Please tick the addon cover you wish to claim under","options":["Cosumable Expenses","Daily Allowance Benefit","Assistance Covers"],"required":null,"pdf_field":""},{"help":"Provide full and detailed particulars; attach separate sheet if needed","type":"text","label":"How and when did the breakdown occur?","options":[],"required":null,"pdf_field":""},{"help":"Provide servicing and repair details","type":"text","label":"Please provide details of the routine maintenance servicing and any other servicing/repair that have been conducted","options":[],"required":null,"pdf_field":""},{"help":"Date of claim reporting","type":"date","label":"When was the claim reported to the Insurance Company?","options":[],"required":null,"pdf_field":""},{"help":"Estimated claim amount in INR","type":"amount","label":"Estimated cost of claim","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Details of any other motor extended warranty policy","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Details of any other motor own damage product","options":[],"required":false,"pdf_field":""},{"help":"Name of garage or repairer","type":"text","label":"Garage/ Repairer details - Name","options":[],"required":null,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Any additional information relevant to processing of claim","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Hire Purchase / Hypothecation / Lease","fields":[{"help":"Select applicable agreement","type":"choice","label":"Please state if the vehicle is under","options":["Hire purchase","Lease Agreement","Hypothecation Agreement"],"required":null,"pdf_field":""},{"help":"Name of party","type":"text","label":"If so, give name and address of concerned parties - Full Name M/s","options":[],"required":false,"pdf_field":""},{"help":"Address of party","type":"text","label":"Address","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Assistance Covers - Emergency Medical Assistance","fields":[{"help":"Select applicable assistance cover","type":"choice","label":"Claim is being registered under","options":["Emergency Road Ambulance","Emergency Air Ambulance","Transportation Benefit"],"required":false,"pdf_field":""},{"help":"Name of injured person","type":"text","label":"Name of the Injured Person","options":[],"required":false,"pdf_field":""},{"help":"Relationship to insured","type":"text","label":"Relationship with the Insured","options":[],"required":false,"pdf_field":""},{"help":"Describe injury","type":"text","label":"Nature of Injury","options":[],"required":false,"pdf_field":""},{"help":"Medical establishment details","type":"text","label":"Name and address of the Medical Establishment","options":[],"required":false,"pdf_field":""},{"help":"Amount claimed in INR","type":"amount","label":"Claim Reimbursement Amount","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Assistance Covers - Accidental Medical and Companion Accommodation","fields":[{"help":"Select applicable assistance cover","type":"choice","label":"Claim is being registered under","options":["Accidental Medical Hospitalization","Accidental Medical OPD","Reimbursement towards Blood Transfusion"],"required":false,"pdf_field":""},{"help":"Name of injured person","type":"text","label":"Name of the Injured Person","options":[],"required":false,"pdf_field":""},{"help":"Relationship to insured","type":"text","label":"Relationship with the Insured","options":[],"required":false,"pdf_field":""},{"help":"Describe injury","type":"text","label":"Nature of Injury","options":[],"required":false,"pdf_field":""},{"help":"Medical establishment details","type":"text","label":"Name and address of the Medical Establishment","options":[],"required":false,"pdf_field":""},{"help":"Amount claimed in INR","type":"amount","label":"Claim Reimbursement Amount","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Assistance Covers - Missed Travel / Event Cover","fields":[{"help":"Select applicable travel/event cover","type":"choice","label":"Claim is being registered under the following heads","options":["Air Ticket","Train Ticket","Bus Ticket","Event passes"],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY and HH:MM am/pm","type":"date","label":"Date and Time of journey and or Event","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY and HH:MM am/pm","type":"date","label":"Date and time of ticket booking","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Assistance Covers - Physical Wallet Assure","fields":[{"help":"Date FIR was filed","type":"date","label":"Police FIR Filed Date","options":[],"required":false,"pdf_field":""},{"help":"Police station details","type":"text","label":"Police Station Name and Address where FIR has been filed","options":[],"required":false,"pdf_field":""},{"help":"Amount lost in INR","type":"amount","label":"Amount Lost","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Assistance Covers - Payment Card Protection","fields":[{"help":"Date FIR was filed","type":"date","label":"Police FIR Filed Date","options":[],"required":false,"pdf_field":""},{"help":"Police station details","type":"text","label":"Police Station Name and Address where FIR has been filed","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY and HH:MM am/pm","type":"date","label":"Date and Time of last transaction (If Multiple Transactions, please provide so)","options":[],"required":false,"pdf_field":""},{"help":"Amount of last transaction in INR","type":"amount","label":"Transaction Amount","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Bank Details for NEFT Payment (For Reimbursement Claims)","fields":[{"help":"Select title and enter full name","type":"text","label":"Name of the Bank Account Holder","options":["Mr.","Mrs.","Ms."],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account Type","options":["Saving","Current"],"required":null,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Bank branch","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"9 digit MICR code","type":"text","label":"MICR Code (9 digit MICR code number of the bank and branch appearing on the cheque issued by the bank)","options":[],"required":null,"pdf_field":""},{"help":"11 character IFSC code","type":"text","label":"IFSC Code (11 character code appearing on your cheque leaf)","options":[],"required":null,"pdf_field":""},{"help":"Confirm understanding","type":"checkbox","label":"I understand that any refund due on the premium payment / any payment / claims to be directly credited to my aforesaid Bank Account.","options":[],"required":null,"pdf_field":""},{"help":"Attach cancelled cheque copy","type":"attachment","label":"Please attach a copy of signed cancelled cheque of the Bank Account of the insured only","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Aadhar Based Payment (For Reimbursement Claims)","fields":[{"help":"Enter Aadhaar number and attach self-attested copy","type":"text","label":"Aadhar Card No.","options":[],"required":null,"pdf_field":""},{"help":"Confirm to receive payment via Aadhaar linked bank account","type":"checkbox","label":"I Wish to collect Claim reimbursement directly in my Bank account linked with aforementioned Aadhar Card.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signatures","fields":[{"help":"Name of person completing form","type":"text","label":"This Claim form was completed by - Name","options":[],"required":null,"pdf_field":""},{"help":"Date of completion","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the 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":"For insurer use","type":"signature","label":"Signature of Insurer & Company Seal","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"PEP Declaration","fields":[{"help":"Select yes or no","type":"choice","label":"Are you a Politically Exposed Person (PEP)?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify position if yes","type":"text","label":"If yes, please mention the position held","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"Is any of your close relation or family member a PEP?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"If yes, please mention the name and relation and the position held by such close relative/family member.","options":[],"required":false,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","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":""}],"filled_by":"insured"}],"deadlines":["The event shall be intimated, in writing, to the Company within Fifteen (15) days of its occurrence.","Information/documents requested by the Company must be furnished within 30 days of the date of such request."],"applies_to":"Motor Vehicle Extended Warranty and Protection for Two Wheeler (ICE & EV)","attachments":["Copy of signed cancelled cheque of the Bank Account of the insured","Self attested Aadhaar card copy","Duly signed completed Claim form","Manufacturer Warranty Copy","Copy of Motor Extended Warranty Policy","Original documents indicating the purchase invoice price of the Insured Asset or documents of transfer of ownership","NOC from finance company, if hypothecated","Copy of all the maintenance/service invoices/ records of the Insured Asset, prior to the loss event","All documentary evidence pertaining to transfer of ownership of the Insured Asset, if applicable","Any other document as maybe appropriately applicable against the warranty claim registered","Copy of bill for any service where reimbursement is required"],"declarations":["The details given are true and correct to the best of my belief and knowledge.","If any information is found incorrect, all rights under the policy will be forfeited.","I have received and read the Claim Procedure and retained it.","I agree to provide additional information if required.","I will indemnify and hold harmless the Company due to any loss arising out of misstatement in this form.","I confirm that all premiums have been/will be paid from bonafide sources and not from proceeds of crime.","The Company has the right to call for documents to establish sources of funds.","The Company can cancel the insurance contract if found guilty under money laundering laws.","I agree and consent to policy issuance with details as per my proposal form and accept responsibility for any mismatch.","I understand that any refund or claim payment will be credited directly to my bank account via electronic mode.","I will inform the Company if I or my close relatives become Politically Exposed Persons in future."],"dropped_labels":12},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"services@indusindinsurance.com","label":"Health Insurance Claims Email","level":1,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"nce Claim\nTravel Insurance Claim\nCommercial Insurance Claim\nSupport\nSign In\nSelf Help\nVideo Chat\nContact Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"indusind@europ-assistance.in","label":"Travel Insurance Claims Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance App\nWebsite:\nOnline Claim Intimation\nOffline Visit:\nLocate your nearest branch\nh","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91 22 48903009","label":"Car Insurance Claim Intimation","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934189","label":"Motor Claims Helpline","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"ation.\nNeed Guidance on Car Coverage?\nTalk to Our Professional Advisors\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nSteps to Take After a Car ​Accident\nThe following steps can expedite the road accident insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934188","label":"Health Claims Helpline","level":null,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"your nearest location.\nExpert health advice you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934184","label":"Travel Claims Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"e you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation\nYour claim gets rejected when you don't gi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+912248903009","label":"Inland Travel Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"rds your registered bank account.\nHow to Contact Us For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 552","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"91-22-67347843","label":"International Travel Helpline (abroad)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 209 5522","label":"International Travel Helpline (in India)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance","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/indusind-general-insurance/2253-indusind-motor-vehicle-extended-warranty-and-protection-for-two-wheeler-ice-and-"}