{"id":2396,"title":"Group Smart Travel Claim Form","purpose":"claim","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Group_Smart_Travel_Claim_Form_ZK_v1_25_26_09052025_3b6de45655.pdf","sha256":"727ba96c6c25731ec0820466fcff76d4de116cc4e4d623e1382c8db247c1cf12","pages":14,"collected":"2026-10-17","instructions":{"about":"This form is used by insured persons or claimants to file claims under the Group Smart Travel insurance policy. It collects details about the insured, trip, medical treatment, and various types of travel-related claims.","notes":["Use original bills only","Attach additional sheets if space is insufficient","Fill and print only relevant annexure pages as per coverage opted","Every claim must be accompanied by original ticket/boarding pass or passport copy indicating travel dates","Fill form completely and use block letters where applicable"],"title":"Group Smart Travel Claim Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"post / e-mail / upload (not explicitly stated, implied by contact details)","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai - 400063, Maharashtra, India; Email: care@zurichkotak.com"},"purpose":"claim","sections":[{"title":"Section 1 - Details of Insured","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Passport Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Reference No, if any","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Policy Start Date","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Policy End Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured Person / Corporate (in whose name the policy is issued)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Claimant Person / Employee (in respect of whom the claim is made)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Employee ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Numbers (INDIA)","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Numbers (Overseas)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Residential Address (INDIA)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Section 2 - Trip Details","fields":[{"help":"","type":"text","label":"Trip Destination","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Departure","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Flight No.","options":[],"required":false,"pdf_field":""},{"help":"Departure location","type":"text","label":"From","options":[],"required":false,"pdf_field":""},{"help":"Arrival location","type":"text","label":"To","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Arrival","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Flight No.","options":[],"required":false,"pdf_field":""},{"help":"Departure location","type":"text","label":"From","options":[],"required":false,"pdf_field":""},{"help":"Arrival location","type":"text","label":"To","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Declaration by Insured","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"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","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":"","type":"text","label":"IFSC Code of the bank","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"MICR code of the Bank","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Attach original cancelled cheque","type":"attachment","label":"Original Blank Cancelled Cheque signed by the payee","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"PAN Card copy of Payee","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Medical Covers","fields":[{"help":"","type":"text","label":"Nature of Injury/sickness","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of incidence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Diagnosis and Treatment given","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Out Patient Treatment","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Hospitalization","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is illness due to any pre-existing condition","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"If Injury, give cause","options":["Self Inflicted","Road Traffic Accident","Substance Abuse/Alcohol Abuse"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Medico Legal","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Reported to Police","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"MLC report attached","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Explain how, where, when and reason for evacuation","type":"text","label":"Medical Evacuation - Reason for Evacuation","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Evacuation Date","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Original Travel Dates From","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Dental Expenses","fields":[{"help":"","type":"text","label":"Nature of Ailment","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State Diagnosis and nature of treatment taken","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Dates of treatment From","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of onset of symptoms","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name, address & telephone number of consulting physician/dentist/hospital where treatment was taken","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you ever been treated for this illness before","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, provide name, address & telephone number of consulted physician","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Provide name, address & telephone number of your family / regular doctor in India","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Repatriation of Mortal Remains","fields":[{"help":"","type":"text","label":"Cause / Circumstances of death","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of death of insured","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Evacuation Date","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Original Travel Dates From","options":[],"required":false,"pdf_field":""},{"help":"Fill details of expenses with dates and amounts","type":"table","label":"Details of expenses incurred for repatriation of Remains / Funeral (table with columns: Sr. No., Details of expenses, Date, Expenses in Foreign Currency)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Compassionate Visit and Other Covers","fields":[{"help":"","type":"text","label":"Treating Doctor's opinion on how many more days the patient will need to be hospitalized","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Treating Doctor's opinion on why the patient cannot be sent back to Country of Residence of the Insured Person for further treatment","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Treating Doctor's opinion on need for an attendant","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Attendant/ Staff","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Sports Injury / Illness","fields":[{"help":"","type":"text","label":"Details of Sport","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Event Organizer details","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Incident","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Claim amount","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Attending Doctor’s Report","fields":[{"help":"","type":"text","label":"Name of the Patient and Age","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of accident/ Sickness","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Details of the insured’s injury/ sickness","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Diagnosis and nature of treatment provided","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the ailment due to Pregnancy","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the ailment aggravated due to any pre-existing condition?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"If yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the attending Physician","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Phone no","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the attending Physician with Stamp","options":[],"required":true,"pdf_field":""}],"filled_by":"attending physician"},{"title":"Lifestyle Support","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Claimant's/ Insured's Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Trip Delay and Travel Covers","fields":[{"help":"Explain how, where, when, what was lost and reason","type":"text","label":"Reason for Trip Delay","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Original Travel Dates From","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Trip delayed on","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"No. of Hour's delay","options":[],"required":false,"pdf_field":""},{"help":"If not the Insured, provide address and contact details","type":"text","label":"Person affected and relationship with the Insured","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name the common carrier","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place of Delay / Loss","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Actual Date & Time when Bags were delivered","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"No. of Hours of bag delay","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Property Irregularity Report (PIR) number from Airline/ Common Carrier","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of compensation received from carrier","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Hotel Over Booking","fields":[{"help":"Explain how, where, when and reason","type":"text","label":"Reason for Bounced Booking","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Original Travel/ Accommodation Dates From","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Days on which the booking was bounced","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Trip Cancellation / Interruption / Curtailment","fields":[{"help":"Explain how, where, when and reason","type":"text","label":"Reason for Trip Cancellation/ Trip Interruption/ Curtailment","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Trip Cancellation / Interruption date","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Original Travel Dates From","options":[],"required":false,"pdf_field":""},{"help":"If not the Insured, provide address and contact details","type":"text","label":"Person affected and relationship with the Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Hijack Distress Allowance and Loss of Passport","fields":[{"help":"","type":"text","label":"Name of Common Carrier","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Port of Hijack","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Port of Release","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Dates & Time of Hijack From","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Date of loss of passport/ international driving license/ Visa/ Temporary Permit","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place of loss of passport/ international driving license / Visa/ Temporary Permit","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Expenses incurred in obtaining new passport/ international driving license/ Visa/ Temporary Permit","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Claimant's/ Insured's Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Other Covers - Personal Liability, Accident Cover, etc.","fields":[{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place of Loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please provide details of injury / property damaged","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of aggrieved Third Party","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Amount of Liability","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Circumstances of accident i.e. how, when, where it took place","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Injury","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State diagnosis and nature of treatment / surgery undertaken","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Provide name, address & telephone number of Hospital / Clinic","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Treating Doctor's Telephone Number (O)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Room / Ward / Bed Number","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Dates of treatment From","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Date doctor contacted","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Ailment","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the accident due to Pregnancy","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the accident due to any pre-existing condition","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Can the patient be evacuated back to the Republic of India?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Loss Incurred (Please tick) Death","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Child Education Cover - Name of child","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Other Covers - Fraud, Burglary, Visa Rejection, Return of Minor Child, etc.","fields":[{"help":"","type":"text","label":"Details of Card(s) lost","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place and address where the loss took place","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place, address and time at which the Card(s) were last seen by Insured","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State the circumstances of the loss or damage in detail","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Date and time of reporting the loss to Police Station (Please furnish copy of FIR)","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Date and time of reporting the loss to the Card issuing authority","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Location and branch of Card issuing authority from where the Card(s) was issued","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there any other insurance on the same card(s)?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If so, give full particulars","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Any other information relevant to processing of claim","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Cause of Loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the loss been reported to the proper authorities?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please give details of where and to whom the loss has been reported along with the date and time","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of any other insurance cover for the property","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the person hospitalized (if not the insured)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the insured","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Provide name, address & telephone number of Hospital / Clinic","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Treating Doctor's Telephone Number (O)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Room / Ward / Bed Number","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Dates of hospitalization From","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of onset of symptoms","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"In case of death of the Insured - Cause/ Circumstances of death","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of death of Insured","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY HH:MM","type":"date","label":"Attending Doctor's Report - Date doctor contacted","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Ailment","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State diagnosis and nature of treatment provided","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the ailment due to Pregnancy","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the ailment aggravated due to any pre-existing condition?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Return of Minor Child - If yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Can the patient be evacuated back to the Republic of India?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Estimated time the patient would continue to be in hospital?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Medical Evacuation back to Republic of India needed?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please give detailed reasons of the ailment and reason for transportation","options":[],"required":false,"pdf_field":""},{"help":"","type":"signature","label":"Medical Doctor's Signature and Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Rental amount (Excluding deposit)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Incident notify by the respective authority?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Date of loss and Place of loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Claim amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Incident notify by the respective authority?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Date of loss and Place of loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Claim amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Event Cancellation - Event Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Event Cancellation Reason","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Claims Not Falling in the Above-Mentioned Sections","fields":[{"help":"","type":"text","label":"Type of claim","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Incidence of claim description","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place of loss","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Claimed amount","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy Number","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Claimant's/ Insured's Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"}],"deadlines":["Submit claim form with original bills and receipts","RTGS/NEFT facility effective within 15 days of receipt of mandate form","Refund any excess amount credited within 7 days of communication"],"applies_to":"Claims under the Group Smart Travel insurance policy including medical, travel delay, baggage loss, personal accident, and other travel-related covers.","attachments":["Original bills & receipts pertaining to your claim","Original ticket/ boarding pass or copy of the passport indicating the travel dates","Original Blank Cancelled Cheque signed by the payee","PAN Card copy of Payee","Copy of FIR for lost card reporting"],"declarations":["Information furnished in this claim form is true and correct to the best of my knowledge and belief","False or untrue statements or concealment of material facts will forfeit claim reimbursement","Authorization to hospital, physician or other persons to furnish medical information to the company","Submission of documents or bank details does not imply admission of liability","Any person who knowingly files a fraudulent claim may be prosecuted for insurance fraud"],"dropped_labels":53},"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/2396-group-smart-travel-claim-form"}