{"id":2399,"title":"HOME SECURE PLUS 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/Annexure_9_Claim_Form_Home_Secure_Plus_27cd5509b7.pdf","sha256":"c381a10b909d81280eb0d65e8044b0c28a8285cdbf0f0b55905d8ae477218799","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Home Secure Plus insurance policy for losses related to their property.","notes":["Proof of tenancy is required for claims related to loss of rent.","Claims for rent for alternative accommodation, loss of rent, and temporary resettlement expenses are admissible only if claim on insured structure is accepted and structure declared unfit for occupation.","Claims for items 1-12 under Extensions/Optional Covers are payable only if claim under Section A is accepted.","Use separate sheets if more space is needed to provide claim details.","Submission of documents or bank details does not imply admission of liability.","Terms and conditions apply for payments through RTGS/NEFT as detailed in the form."],"title":"HOME SECURE PLUS CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claim Details and Insured Information","fields":[{"help":"Enter your insurance policy number","type":"text","label":"POLICY NO:","options":[],"required":null,"pdf_field":""},{"help":"Enter claim number if available","type":"text","label":"CLAIM NO:","options":[],"required":null,"pdf_field":""},{"help":"Select the applicable section under which claim is made","type":"choice","label":"Claim under Section:","options":["Griha Raksha Plus","All Risk Cover – Structure and Contents","Claim under Extensions/ Optional Covers"],"required":null,"pdf_field":""},{"help":"Enter policy start and end dates","type":"date","label":"Policy Period From: …………………..to ………………..","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the insured","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter full address of the insured","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter residential phone number","type":"phone","label":"Contact Number (R)","options":[],"required":null,"pdf_field":""},{"help":"Enter date and time when loss occurred","type":"date","label":"Date and Time of Loss DD/MM/YY _____________________ hrs. min ___________","options":[],"required":null,"pdf_field":""},{"help":"Enter date and time when loss was discovered","type":"date","label":"Date and Time of Discovery DD/MM/YY _____________________ hrs. min ___________","options":[],"required":null,"pdf_field":""},{"help":"Briefly describe cause or nature of loss","type":"text","label":"Cause/Reason/Nature of Loss","options":[],"required":null,"pdf_field":""},{"help":"Provide a short description of the incident","type":"text","label":"Brief description of incident","options":[],"required":null,"pdf_field":""},{"help":"Indicate if other insurance covers this loss","type":"yes-no","label":"Other insurance on same Loss:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other insurance if applicable","type":"text","label":"If yes kindly share the details of the same:","options":[],"required":false,"pdf_field":""},{"help":"List any previous losses claimed under this policy","type":"text","label":"Previous losses under the policy:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Information for Griha Raksha Plus or All Risk Cover – Structure and Contents Claims","fields":[{"help":"Select if premises was occupied; if No, provide vacancy date and time","type":"choice","label":"Whether the premises was occupied at the time of fire / loss? Yes /No, if No, Please provide the date from when it was vacant.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date and time premises became vacant if applicable","type":"date","label":"Date ____________ Time _____","options":[],"required":false,"pdf_field":""},{"help":"Location of premises","type":"text","label":"Location ___________________","options":[],"required":false,"pdf_field":""},{"help":"Reason why premises was vacant","type":"text","label":"Reason for removal :","options":[],"required":false,"pdf_field":""},{"help":"Indicate if fire brigade and police were informed","type":"choice","label":"Has the fire / loss been reported to fire brigade and Police? Yes /No, if no, give reasons.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide FIR number if reported","type":"text","label":"FIR No.","options":[],"required":false,"pdf_field":""},{"help":"Indicate if property is under hypothecation, lease or hire purchase","type":"yes-no","label":"State whether the property damaged, is Hypothecated / Lease / Hire purchase, If yes give details?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of hypothecation party if applicable","type":"text","label":"Hypothecation Party Name :","options":[],"required":false,"pdf_field":""},{"help":"Duration of hypothecation","type":"text","label":"Period of such Hypothecation :","options":[],"required":false,"pdf_field":""},{"help":"Loan amount secured by hypothecation","type":"amount","label":"Value of such loan :","options":[],"required":false,"pdf_field":""},{"help":"Estimate the loss amount as of loss date","type":"amount","label":"State the estimated loss amount on date of loss.","options":[],"required":null,"pdf_field":""},{"help":"Value of any salvage recovered","type":"amount","label":"State the value of Salvage, if any?","options":[],"required":false,"pdf_field":""},{"help":"Total insured property value at loss time","type":"amount","label":"State the total value of the property insured upon the premises at the time of loss.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if loss was due to earthquake and attach evidence if yes","type":"yes-no","label":"Is case loss reported is due to Earthquake? If Yes, then submit the evidence of it.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if dwelling is uninhabitable post loss","type":"yes-no","label":"Is the dwelling completely unfit for occupation after the occurrence of loss? Yes/ No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter rent amount paid or received","type":"amount","label":"What is the amount of rent paid / received by the insured","options":[],"required":false,"pdf_field":""},{"help":"Enter amount of rent loss (proof of tenancy required)","type":"amount","label":"What is the amount of loss of rent*","options":[],"required":false,"pdf_field":""},{"help":"Duration property was unfit for occupation","type":"text","label":"What is the period of which property remained unfit for occupation","options":[],"required":false,"pdf_field":""},{"help":"Address where loss happened","type":"text","label":"Address of the premises at which loss occurred?","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Information in case of claim under Burglary and Theft","fields":[{"help":"Specify affected area of premises","type":"text","label":"Which portion of the premises affected by the entry / exit?","options":[],"required":null,"pdf_field":""},{"help":"Provide police complaint details","type":"text","label":"Has a complaint been lodged with the police? If so, by whom and when and at which police station?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if premises were occupied during loss","type":"yes-no","label":"Were the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date and time premises were last occupied if unoccupied","type":"text","label":"If not, on what date and at what hour were they last occupied?","options":[],"required":false,"pdf_field":""},{"help":"Duration premises remained unoccupied","type":"text","label":"For how long have the premises been unoccupied?","options":[],"required":false,"pdf_field":""},{"help":"Provide details of any suspected persons","type":"text","label":"Is anybody suspected of theft? If so, state full details.","options":[],"required":false,"pdf_field":""},{"help":"Name of other owners if applicable","type":"text","label":"If no, the property belongs to whom?","options":[],"required":false,"pdf_field":""},{"help":"State if insured is responsible for repairs","type":"yes-no","label":"Is the insured responsible for repairs to the premises?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Total property value at loss time","type":"amount","label":"State the total value of property upon the premises at the time of loss.","options":[],"required":null,"pdf_field":""},{"help":"Describe lost contents and estimated loss amount","type":"text","label":"Estimated loss amount and description of contents lost","options":[],"required":null,"pdf_field":""},{"help":"Additional information relevant to claim","type":"text","label":"Any other relevant information","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claim under Extensions/ Optional Covers","fields":[{"help":"Enter amount claimed for terrorism damage","type":"amount","label":"What is the amount to be paid for damage due to terrorism","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for professional fees","type":"amount","label":"What is the amount to be paid for Architects, Surveyors and Consulting Engineers Fees?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for debris removal","type":"amount","label":"What is the amount to be paid for removal of debris?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for burglary/theft of unoccupied structure contents","type":"amount","label":"What is the amount to be paid for Burglary or Theft of Content of Unoccupied Structure?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for garden or landscaping damage","type":"amount","label":"What is the amount to be paid for Trees and Plants / Garden Cover / Landscaping Damage?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for loss of rent (proof of tenancy required)","type":"amount","label":"What is the amount to be paid against loss of Rent*?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for additional rent for alternate accommodation","type":"amount","label":"What is the amount to be paid as an additional rent for alternate accommodation?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for additional living expenses","type":"amount","label":"What is the amount to be paid for Additional Living Expenses?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for temporary resettlement expenses","type":"amount","label":"What is the amount to be paid for Temporary Resettlement Expenses?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for contents temporarily removed","type":"amount","label":"What is the amount to be paid for Contents Temporarily removed?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for enhanced cover during special occasions","type":"amount","label":"What is the amount of loss for Enhanced cover during Wedding / Other Occasion?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for exploratory and repair costs for water damage","type":"amount","label":"What is the amount of loss for Search & found in for exploratory and repair cost reasonable incurred in locating the source of water damage?","options":[],"required":false,"pdf_field":""},{"help":"Describe item-wise loss and amount for jewellery and valuables","type":"text","label":"What is the amount of loss for Jewellery and Valuables? Kindly describe the item wise loss","options":[],"required":false,"pdf_field":""},{"help":"Describe item-wise loss and amount for curios, art and paintings","type":"text","label":"What is the amount of loss for Curios, Works of Art & Paintings? Kindly describe the item wise loss","options":[],"required":false,"pdf_field":""},{"help":"Describe item-wise loss and amount for portable equipment","type":"text","label":"What is the amount of loss for Portable Equipments? Kindly describe the item wise loss","options":[],"required":false,"pdf_field":""},{"help":"Describe electronic equipment loss with make, model, serial number, and purchase date","type":"text","label":"What is the amount of loss for Electronic Equipment? Kindly describe the item wise loss covering Make & Model ,Serial Number Date of Purchase","options":[],"required":false,"pdf_field":""},{"help":"Describe breakdown loss with item details including make, model, serial number, and purchase date","type":"text","label":"What is the amount of loss for Breakdown of Domestic and Electronic equipment? Kindly describe the item wise loss covering Make & Model , Serial Number, Date of Purchase","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for contents lost during transit","type":"amount","label":"What is the amount of loss of contents during Transit?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for cash lost during transit","type":"amount","label":"What is the amount of loss of Cash Whilst in Transit?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed for keys and locks replacement","type":"amount","label":"What is the amount of loss of Keys & Locks Replacement Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under purchase protection","type":"amount","label":"What is the amount of loss under Purchase Protection Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under pedal cycle cover","type":"amount","label":"What is the amount of loss under Pedal Cycle Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under plate glass cover","type":"amount","label":"What is the amount of loss under Plate Glass Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under baggage cover","type":"amount","label":"What is the amount of loss under Baggage Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under tenant liability cover","type":"amount","label":"What is the amount of loss under Tenant Liability Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under public/personal liability cover","type":"amount","label":"What is the amount of loss under Public /Personal Liability Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under liability to domestic staff cover","type":"amount","label":"What is the amount of loss under Liability to Domestic Staff Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under safety for documents cover","type":"amount","label":"What is the amount of loss under Safety for Documents Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under golf cover","type":"amount","label":"What is the amount of loss under Golf Cover?","options":[],"required":false,"pdf_field":""},{"help":"Enter amount claimed under job loss cover for 3 EMIs","type":"amount","label":"What is the amount of loss under Job Loss covering 3 EMI of Housing loan?","options":[],"required":false,"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":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Direct Fund Transfer / EFT Mandate Form","fields":[{"help":"Select Yes to opt for EFT payment","type":"choice","label":"Would you like to opt for Electronic Fund transfer mode of payment?","options":["Yes"],"required":null,"pdf_field":""},{"help":"Enter payee name as per bank records","type":"text","label":"Payee name (as per bank records)","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Payee account no","options":[],"required":true,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of account : Saving / Current / Others","options":["Saving","Current","Others"],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch address","type":"text","label":"Address of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter MICR code","type":"text","label":"MICR code of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter PAN number of payee","type":"text","label":"PAN of the payee","options":[],"required":true,"pdf_field":""},{"help":"Sign the mandate form","type":"signature","label":"Signature of the Policy Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Claims under Griha Raksha Plus, All Risk Cover – Structure and Contents, and Extensions/Optional Covers","attachments":["Original Blank Cancelled Cheque signed by the payee","PAN Card copy of Payee"],"declarations":["The information provided in this claim form is true, correct and complete.","All persons having interest in the property are disclosed as per the proposal or policy endorsement.","No similar claim has been made with any other insurance company except as disclosed.","No material information relevant to claim processing has been withheld.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this form or documents does not imply admission of liability by the company."],"dropped_labels":2},"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/2399-home-secure-plus-claim-form"}