{"id":264,"title":"Motor - Claim Form","purpose":"claim","insurer":{"slug":"iffco-tokio-general-insurance","name":"IFFCO TOKIO General Insurance Company Limited"},"source_pdf":"https://www.iffcotokio.co.in/content/dam/iffcotokio/iffco-pdf/sites/default/files/pdf/Motor%20Claim%20form.pdf","sha256":"21b9908879215dc1e284a975780f5f4d12f9162a6c9162d72827218f63e4cdc5","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for filing a motor vehicle insurance claim by the insured (registered owner) of the vehicle or an authorized signatory if the insured is a partnership or corporate body.","notes":["Fill all details in capital letters.","Do not leave any column unanswered.","Attach all required documents for faster claim processing.","Use original documents for verification where specified.","Attach a blank cancelled cheque for electronic payment.","Use the diagram to show how the accident occurred if applicable.","The claim discharge voucher must be signed and stamped by the garage and signed by the insured.","The form is to be signed by the insured or authorized signatory with office seal if applicable."],"title":"Motor - Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"Fill in capital letters","type":"text","label":"Insured Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Fill in capital letters","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Fill in capital letters","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Fill in capital letters","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Vehicle","fields":[{"help":"","type":"text","label":"Policy No","options":[],"required":true,"pdf_field":""},{"help":"Year only","type":"number","label":"Year of Manufacture","options":[],"required":true,"pdf_field":""},{"help":"Vehicle registration number","type":"text","label":"Registration No","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date of Registration","options":[],"required":true,"pdf_field":""},{"help":"Vehicle manufacturer","type":"text","label":"Make","options":[],"required":true,"pdf_field":""},{"help":"Vehicle model","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"Vehicle chassis number","type":"text","label":"Chassis No","options":[],"required":true,"pdf_field":""},{"help":"Vehicle engine number","type":"text","label":"Engine No","options":[],"required":true,"pdf_field":""},{"help":"If vehicle is under loan/hypothecation","type":"text","label":"Hypothecation","options":[],"required":false,"pdf_field":""},{"help":"Fuel type of vehicle","type":"text","label":"Type of Fuel","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Incident (Accident / Theft)","fields":[{"help":"DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Use 00:00 AM/PM format","type":"text","label":"Time","options":[],"required":true,"pdf_field":""},{"help":"Speed at time of incident","type":"number","label":"Speed Km/hr","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":false,"pdf_field":""},{"help":"Location of incident","type":"text","label":"Exact Place Where incident occurred","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place to which the vehicle was heading for before incident","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Purpose for which vehicle was being used/parked at the time of incident","options":[],"required":false,"pdf_field":""},{"help":"For commercial vehicles only","type":"text","label":"Nature & Weight of goods carried at the time of incident (Comm. Veh) GVW/KG","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"No of people travelling at time of incident","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is it reported to the Police? Yes ☐ No ☐","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide if reported to police","type":"text","label":"(If Yes, Name & Address of Police Station)","options":[],"required":false,"pdf_field":""},{"help":"Provide FIR or crime number and date","type":"text","label":"Gen. Diary/Crime No/FIR No and Date","options":[],"required":false,"pdf_field":""},{"help":"Estimated claim amount","type":"amount","label":"Estimated Loss Amount Rs.","options":[],"required":false,"pdf_field":""},{"help":"Location where vehicle is kept post-accident","type":"text","label":"Address of the place where Insured vehicle is parked after accident","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Add-ons as per claim details","fields":[{"help":"Serial number of add-on","type":"number","label":"S. No.","options":[],"required":false,"pdf_field":""},{"help":"Name of benefit/add-on","type":"text","label":"Benefits","options":[],"required":false,"pdf_field":""},{"help":"Details of the add-on","type":"text","label":"Details","options":[],"required":false,"pdf_field":""},{"help":"Claim amount for the add-on","type":"amount","label":"Claim Amount","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Driver","fields":[{"help":"Driver's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Relation to insured","type":"text","label":"Relation with Insured","options":[],"required":false,"pdf_field":""},{"help":"Driver's address","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Driver's city","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"Driver's state","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Driver's postal code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Driver's email","type":"email","label":"Email Address","options":[],"required":false,"pdf_field":""},{"help":"Driver's phone number","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Driver's license number","type":"text","label":"Driving License No","options":[],"required":true,"pdf_field":""},{"help":"Regional Transport Office that issued license","type":"text","label":"Issuing RTO","options":[],"required":false,"pdf_field":""},{"help":"License expiry date","type":"date","label":"License Expiry Date DD/MM/YYYY","options":[],"required":false,"pdf_field":""},{"help":"Tick one","type":"choice","label":"Type Permanent ☐/ Learners ☐","options":["Permanent","Learners"],"required":true,"pdf_field":""},{"help":"Tick applicable class","type":"choice","label":"Class MCycle ☐ / LMV ☐ / HGV☐ / Transport ☐ / Non-Transport ☐","options":["MCycle","LMV","HGV","Transport","Non-Transport"],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Incident Description and Other Insurance","fields":[{"help":"Describe the accident or theft details","type":"text","label":"Please describe how the incident occurred","options":[],"required":true,"pdf_field":""},{"help":"Details of any other insurance on the vehicle","type":"text","label":"Other Insurance","options":[],"required":false,"pdf_field":""},{"help":"Details of past claims on this vehicle","type":"text","label":"Past Claim History","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Was any claim reported in the past on the same vehicle during current year policy? Yes ☐ No ☐","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe nature of past loss if any","type":"text","label":"If Yes, Please confirm nature of Loss","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Accident Diagram","fields":[{"help":"Draw or attach diagram showing accident details","type":"photo","label":"Show how the Accident occurred (if any) by using below Diagram","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Mandate Form for Electronic Transfer of Claim Payment","fields":[{"help":"","type":"text","label":"Insured Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Registration No","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Branch","options":[],"required":true,"pdf_field":""},{"help":"Type of bank account","type":"text","label":"Account Type","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code*","options":[],"required":true,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR Code*","options":[],"required":false,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Account Number","options":[],"required":true,"pdf_field":""},{"help":"Bank branch address","type":"text","label":"Bank Address","options":[],"required":false,"pdf_field":""},{"help":"Attach a blank cancelled cheque","type":"attachment","label":"Please also attach one Blank Cancelled Cheque for NEFT/RTGS Payment","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"List of Documents Required for Claim Settlement","fields":[{"help":"Attach all listed additional documents for theft claims","type":"attachment","label":"Additional Documents for Theft Claims","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim Discharge Cum Satisfaction Voucher","fields":[{"help":"","type":"text","label":"Insured Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Registration No","options":[],"required":true,"pdf_field":""},{"help":"Date of discharge","type":"date","label":"Discharge Date DD/MM/YYYY","options":[],"required":true,"pdf_field":""},{"help":"Fill vehicle number, amount, and garage name","type":"text","label":"My vehicle number ________________ having been repaired to my complete satisfaction, I am henceforth taking delivery of the same and authorise my insurer IFFCO TOKIO GENERAL INSURANCE COMPANY to make payment of Rs ____________ to the ________________ garage in respect of my aforementioned vehicle.","options":[],"required":true,"pdf_field":""},{"help":"Amount paid by insured","type":"amount","label":"I also confirm having paid Rs ________________ in lieu of depreciation, policy excess and any additional work carried out at the garage.","options":[],"required":true,"pdf_field":""},{"help":"Sign or thumb impression","type":"signature","label":"Signature/Thumb impression of Insured","options":[],"required":true,"pdf_field":""},{"help":"Garage signature and stamp","type":"signature","label":"Signature and Stamp of Garage","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"","attachments":["Blank Cancelled Cheque for NEFT/RTGS Payment","Proof of insurance-Policy/Cover note copy","Copy of Registration Book, Tax Receipt","Copy of Motor Driving License [With original]","Police Panchanama/FIR (in case of Third Property damage/Death/Body Injury)","Estimate for repairs from the repairer","Repair Bill and payment receipts after the job is completed","Claims Discharge Cum Satisfaction Voucher Signed across a Revenue Stamp","Documents as required by AML Guidelines","Permit, Fitness and Load Challan (in case of Commercial Vehicle)","NOC of Financer if claim is to be settled in your favour","Blank and undated “Vakalatnama”","Additional documents for Theft Claims as listed"],"declarations":["The issuance of this form is not an admission of liability.","The insured or authorized signatory must sign the form with office seal if applicable.","All facts and statements must be factual and unbiased.","The damaged vehicle must be parked safely to avoid further damage; company not responsible for subsequent damage.","All documents provided must be self-attested.","If space is insufficient, attach a separate sheet.","False or fraudulent statements or concealment of facts will forfeit the claim.","The insured agrees to provide all required documents and understands delays may occur if requirements are not met.","The insured agrees to provide additional information/documents if required.","No Claim Bonus (NCB) is subject to no prior own damage claims; incorrect NCB basis may lead to forfeiture of benefits and damages.","By signing the discharge voucher, the insured agrees to full and final settlement and subrogates rights to the insurer."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"policy issuing Branch","label":"Walk in claim intimation","level":null,"hours":"Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays)","applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"65 days.\nToll No. 1800-103-5499\nWalk in\nShall you wish to intimate your claim in person, please feel free to visit your policy issuing Branch Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays). Please refer to our\nBranch Locator\nfor information on our","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@iffcotokio.co.in","label":"Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"se\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-103-5499","label":"Toll free","level":null,"hours":"24 X 7","applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"engali\nKannada\nAssamese\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengal","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"56161","label":"SMS “CLAIM” to 56161","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"avor to take customer service at newer heights, we now bring claim Intimation at your fingertips. Please SMS “CLAIM” to 56161 and one of our Claims representatives will get in touch with you in 4 Working Hours.\n* Note:\nPlease have all the detail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"whatsapp","value":"7993407777","label":"Say Hi to IRA","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"est\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya\nCustomer Login\nAgent Login","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/iffco-tokio-general-insurance/264-motor-claim-form"}