{"id":2391,"title":"Business Secure (Bharat Laghu Udyam Suraksha) Claim Form","purpose":"claim","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://www.zurichkotak.com/docs/documents/commercial/claim-forms/business-secure-bharat-laghu-udyam-suraksha-claim-form-zk-v1-24-25-16072024.pdf","sha256":"b6584c83df345916774799faee65c4369a85b4a6a509ca6c64b3f4c8c6bc69b0","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to notify and claim loss or damage under the Business Secure (Bharat Laghu Udyam Suraksha) insurance policy.","notes":["For certain sections like Business Interruption (Fire), Burglary & Housebreaking, Electronic Equipments, Machinery Breakdown, All Risk, Baggage, Signage, Plate Glass, Money, Fidelity Guarantee, Employee Compensation, Public Liability, Personal Accident, a supplementary form has to be filled.","Attach original blank cancelled cheque and PAN card copy for EFT mandate.","Use separate annexure if space provided is insufficient for details.","Submission of documents or bank details does not imply admission of liability."],"title":"Business Secure (Bharat Laghu Udyam Suraksha) Claim Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai - 400063. Maharashtra, India"},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number and/or email","type":"text","label":"Contact Number / Email ID","options":[],"required":null,"pdf_field":""},{"help":"List applicable insurance sections","type":"text","label":"Please state the sections under which you are making a claim","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details Of Loss / Damage","fields":[{"help":"Complete address including unit or block number","type":"text","label":"Situation of risk where accident/loss/damage occurred","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time","type":"date","label":"Date and time of accident/ loss/ damage/Incident","options":[],"required":null,"pdf_field":""},{"help":"Name of police station","type":"text","label":"In the event of loss caused by Burglary, Theft, Fire, Fidelity Guarantee, Liability, GPA which police station has been notified?","options":[],"required":null,"pdf_field":""},{"help":"Describe main cause","type":"text","label":"Cause of Accident - Please state the Primary Cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe how loss occurred; attach sketch if possible","type":"text","label":"Brief circumstances of accident - (with sketch)","options":[],"required":null,"pdf_field":""},{"help":"Include mobile numbers and email IDs","type":"text","label":"Names and addresses of witnesses to the accident","options":[],"required":null,"pdf_field":""},{"help":"Attach detailed list","type":"attachment","label":"Details of items destroyed /damaged. Attach a list of items with nature of damages. Also give, make & model of these equipments","options":[],"required":null,"pdf_field":""},{"help":"Attach detailed schedule","type":"attachment","label":"Estimates of repairs and replacements (item-wise). Attach a detailed schedule","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Particulars/Details of component repairers / suppliers (Name, Address, Phone number etc.)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Serial No. of property as per Schedule attached to Policy","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of original supplier for machinery, spares etc. damaged and date of supply.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Cost of replacement of the item of the same kind, size and capacity","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was the damaged item new or second hand?","options":["New","Second hand"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location of the Property","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there any business interruption anticipated? If so please fill in the FLOP claim form as a supplementary form","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date (before this accident) when the machines was last overhauled / attended for maintenance","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Is there any warranty / guarantee from manufacturer / supplier covering the present loss/damage? If so, details","options":[],"required":null,"pdf_field":""},{"help":"Provide details of previous incidents","type":"text","label":"Details of accidents/loss/damage during the past 3 years (whether claim preferred or not)","options":[],"required":null,"pdf_field":""},{"help":"Provide insurer name, policy number, period, sum insured","type":"text","label":"Is the property insured under any other Policy with any other insurer? If so, details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of consequential loss / liability, if any, on account of this accident.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Are you getting compensation in respect of the present loss/damage from any other insurance? If so, details.","options":[],"required":null,"pdf_field":""},{"help":"Provide repairer details","type":"text","label":"Have the repair been put in hand? If so give name and address of repairs.","options":[],"required":null,"pdf_field":""},{"help":"Provide estimate and duration","type":"text","label":"Indicate the estimated repair charges and repair time.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"State salvage value of the damage item.","options":[],"required":null,"pdf_field":""},{"help":"Provide location","type":"text","label":"Where can the damaged items to be inspected?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Any other particular relevant to the damages.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Are there any other insurance affected by you or any other person(s) covering the loss sustained or any part thereof? If so, give details.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Personal Accident Insurance","fields":[{"help":"","type":"text","label":"Name of the insured person who had sustained injury/Died","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the insured person under the influence of intoxicating drugs/liquor","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of injuries sustained","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of treatment","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Disability Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Attach copy if available","type":"text","label":"Police Report details, if any","options":[],"required":null,"pdf_field":""},{"help":"Provide duration","type":"text","label":"Period of stay in hospital for Hospital cash benefit","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Public Liability / Tenant’s Legal Liability","fields":[{"help":"","type":"date","label":"Date & Time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Brief description of the kind and history of the occurrence","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When was the accident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When was the claim first notified to the Insurer?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any person sustained any injuries in the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Occupation of injured person(s)","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State where such person(s) was/were at the time of accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If so, Give name(s) of such Person(s):","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address(es)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Provide hospital or medical details","type":"text","label":"Has/Have the injured person(s) been removed to hospital or medically attended? If so, give particulars","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the accident/Loss caused damage to property or livestock?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any claim been made upon you by any person?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide estimates per section","type":"amount","label":"Estimated amount of Claim separately under each section","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of report","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":"","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Give details of Statute/Law under which in your opinion, liability may arise","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Fidelity Guarantee","fields":[{"help":"","type":"text","label":"In what capacity was the employee working and where?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the defaulting employee in full","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"His present address","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount of loss sustained","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of discovery","options":[],"required":null,"pdf_field":""},{"help":"Describe the act","type":"text","label":"How exactly was the act committed","options":[],"required":null,"pdf_field":""},{"help":"Provide audit frequency, auditor and last audit date","type":"text","label":"How often were the Account Books/Stock Books at the place of the defaulting employee’s employment audited and by whom? When was the last audit done?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Have you any moneys, estate, or effects of the employee in your possession? If so, give particulars with amounts.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Do you hold any other security from the employee? If so, state its nature and amount.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Have you taken any action against the employee? If so, state the nature of action taken.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Baggage","fields":[{"help":"Describe baggage lost or damaged","type":"text","label":"Details of Baggage lost/ damaged","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Value of the items lost","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Money","fields":[{"help":"","type":"date","label":"Date of discovery of loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"What were the places between which money was in transit","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Where did the loss occur","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"By whom was the loss reported","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"In whose custody was the money at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Who were the other persons accompanying the person carrying the money","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were armed guards accompanying the money","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Brief details of the exact circumstances leading to the loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"How was the money carried","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"By what conveyance was the money carried","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"What was the total amount of money that was being carried","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Steps taken to recover lost money","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When did the employees concerned enter your service?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was any one of them involved in a similar loss before?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you satisfied that the version given by them is correct?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Are any of them covered under any Fidelity Guarantee Policy? If so, give details.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Do you hold any cash deposit or any security from them?","options":[],"required":null,"pdf_field":""},{"help":"Attach relevant medical or legal documents","type":"attachment","label":"Has the money carrying employee been assaulted during burglary or holdup resulting in death / bodily injury / physical separation of a limb or the loss of an eye or causing him to be prevented from engaging in his usual employment? If so, please provide copy of relevant medical papers / disability certificate / post mortem report, as the case maybe.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Plate Glass / Signage","fields":[{"help":"","type":"text","label":"Address where neon sign/plate glass is situated (Please state the precise position)","options":[],"required":null,"pdf_field":""},{"help":"Provide dimensions","type":"text","label":"Size of the plate glass/neon sign broken","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of breakage","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Brief description of occurrence","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Value of items damaged","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Directors and Officers Liability","fields":[{"help":"","type":"text","label":"Brief Description of the Claim Circumstances","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of notice","type":"date","label":"When did you receive the notice of Claim? (Kindly provide the copy of the Notice so received)","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"When was the claim first notified to ZKGICL","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of the insured person against whom the Notice is served?","options":[],"required":null,"pdf_field":""},{"help":"Attach annexure if needed","type":"attachment","label":"Details of the party(s) who have served notice on the Insured person? (Kindly Attach separate annexure if the space provided is not sufficient)","options":[],"required":null,"pdf_field":""},{"help":"Attach annexure if needed","type":"attachment","label":"Heads under which the claim is made : (Kindly Attach separate annexure if the space provided is not sufficient)","options":[],"required":null,"pdf_field":""},{"help":"Attach additional information if any","type":"attachment","label":"Do you wish to provide any additional information with respect to the claim: If yes, please attach the same in annexure","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Employee Compensation","fields":[{"help":"Name of injured person","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Provide age and address","type":"text","label":"Age and address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of work of the injured person at the time of accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the injured person in your direct employment","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date injured person joined service","type":"date","label":"When did you enter the service","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If not in your direct employment In what capacity was he working at the time of accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the hospital where the injured person was treated","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details and period of treatment","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State the details of Injury","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was he under the influence of drink or drugs at the time of accident","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State due to whose neglect the accident occurred","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"What was the monthly wages that was being paid at the time of accident","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature and Stamp of the Insured / Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured / claimant"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"help":"","type":"choice","label":"Would you like to continue with the NEFT details provided in the proposal form for Claim payment?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Fill only if answer above is No","type":"group","label":"If No, Kindly provide the below mentioned details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payee name (as per bank records):","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Payee account no.:","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Type of account : Saving Current Others","options":["Saving","Current","Others"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of the bank:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Name:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address of the bank:","options":[],"required":true,"pdf_field":""},{"help":"Provide IFSC code","type":"text","label":"IFSC Code of the bank:","options":[],"required":true,"pdf_field":""},{"help":"Provide MICR code","type":"text","label":"MICR code of the Bank:","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"text","label":"PAN of the payee:","options":[],"required":true,"pdf_field":""},{"help":"Attach cancelled cheque","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the payee. (Mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"Please attach a PAN Card copy of Payee (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"insured / claimant"}],"deadlines":[],"applies_to":"Claims under Business Secure (Bharat Laghu Udyam Suraksha) including Business Interruption (Fire), Burglary & Housebreaking, Electronic Equipments, Machinery Breakdown, All Risk, Baggage, Signage, Plate Glass, Money, Fidelity Guarantee, Employee Compensation, Public Liability, Personal Accident","attachments":["List of items destroyed/damaged with nature of damages","Estimates of repairs and replacements (item-wise)","Copy of police report if accident reported","Copy of medical papers / disability certificate / post mortem report if applicable","Copy of Notice of Claim for Directors and Officers Liability","Annexure for additional information if space insufficient","Original Blank Cancelled Cheque signed by the payee","PAN Card copy of Payee"],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having interest in the property are disclosed as per proposal or policy endorsement.","No material information relevant to the claim has been withheld or not disclosed.","False or fraudulent statements or concealment of material information will void the policy and claim rights.","Receipt of this claim form or documents does not constitute admission of liability by the company.","The company reserves the right to process, reject or require further information for the claim."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Family Health Plan Insurance TPA Limited, Srinilaya – Cyber Spazio, Suite # 101,102,109&110, Ground Floor,Road No. 2, Banjara Hills, Hyderabad : 500034, Telangana , India","label":"Health claims department address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.zurichkotak.com/services/claims","quote":"g address as early as possible, but no later than 30 days from the date of discharge.\nHealth claims department address:\nFamily Health Plan Insurance TPA Limited, Srinilaya – Cyber Spazio, Suite # 101,102,109&110, Ground Floor,Road No. 2, Banjara Hills, Hyderabad : 500034, Telangana , India\nIs there any time period for filing pre and post hospital claims?\nThe pre-hospitalisation claim documents duly complete","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"care@zurichkotak.com","label":"Email Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/services/claims","quote":"in\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is chat only number.\nAccessibility\nZoom in page\nZoom out page\nIncrea","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 2120","label":"Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/services/claims","quote":"age claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is cha","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91-22-69417220","label":"Toll Number (INDIA And Overseas)","level":null,"hours":"IST 8 am to 8 pm","applies_to":"all","source_url":"https://www.zurichkotak.com/services/claims","quote":"Download policy\nManage policy\nManage claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be","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/zurich-kotak-general-insurance/2391-business-secure-bharat-laghu-udyam-suraksha-claim-form"}