{"id":284,"title":"Carrier’s Legal Liability 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/Carrier-Legal-Liability-Claim-Form.pdf","sha256":"aadf7154d53a2464b974e9f14d347781e457c49f93f98145b1244a984d45e125","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to claim for loss or damage under the Carrier’s Legal Liability policy.","notes":["Attach original documents as proof where required.","Attach written notice of claim and delivery receipt as indicated.","The issue of this form is not an admission of liability."],"title":"Carrier’s Legal Liability Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant and Policy Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Fax Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name and address of Consignor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name and address of Consignee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of driver","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle details","options":[],"required":null,"pdf_field":""},{"help":"Enter date of loss","type":"date","label":"Date of loss","options":[],"required":null,"pdf_field":""},{"help":"Select am or pm","type":"choice","label":"Time: am/ pm","options":["am","pm"],"required":null,"pdf_field":""},{"help":"Describe location of loss or damage","type":"text","label":"Address of premises/description of place where loss or damage occurred","options":[],"required":null,"pdf_field":""},{"help":"Date when loss was reported by phone","type":"date","label":"When were you advised of the loss? a) Date by phone","options":[],"required":null,"pdf_field":""},{"help":"Location for inspection of damaged goods","type":"text","label":"Where can the damaged goods be inspected?","options":[],"required":null,"pdf_field":""},{"help":"Phone number for inspection location","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Describe the goods carried","type":"text","label":"Nature of the goods being carried","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss occurred","type":"text","label":"Full description of the cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage to goods","type":"text","label":"What damage did the goods sustain?","options":[],"required":null,"pdf_field":""},{"help":"Attach invoice or document giving proof of value","type":"amount","label":"Estimated value of loss/damage or amount being claimed","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Number of packages/units damaged/lost","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Goods Handling and Recovery","fields":[{"help":"Describe packaging condition at receipt","type":"text","label":"What/how was the preparation/packaging of the goods when received for transport?","options":[],"required":null,"pdf_field":""},{"help":"Explain how goods were secured","type":"text","label":"How were the goods secured to the vehicle/trailer?","options":[],"required":null,"pdf_field":""},{"help":"Describe recovery or loss minimisation steps","type":"text","label":"What action has been taken to recover the goods or minimise loss?","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was any salvage obtained?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide salvage details and attach receipts if any","type":"text","label":"If Yes, please give details/attach receipts","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Did the driver sign a clean receipt when collecting the goods?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain if driver did not sign clean receipt","type":"text","label":"If No, please give details","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of delivery receipt","type":"choice","label":"Did the Consignee sign a clean receipt upon delivery?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain if consignee did not sign clean receipt","type":"text","label":"If No, please give details","options":[],"required":null,"pdf_field":""},{"help":"Provide insurer details if motor accident involved","type":"text","label":"If involved in a Motor Vehicle accident, state the name and Policy Number of Insurer of the vehicle","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was FIR filed with Police?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide FIR details if filed","type":"text","label":"If yes, please give details","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Attachments","fields":[{"help":"Attach initial written notice of claim","type":"attachment","label":"Written notice of claim (Initial Notice of Claim)","options":[],"required":true,"pdf_field":""},{"help":"Attach delivery receipt copy","type":"attachment","label":"Copy of delivery receipt signed by Consignee","options":[],"required":true,"pdf_field":""},{"help":"Attach invoice or proof of value","type":"attachment","label":"Copy of invoice or document giving proof of value","options":[],"required":true,"pdf_field":""},{"help":"Attach claimant's statement of claim if applicable","type":"attachment","label":"Statement of claim made by claimant to you","options":[],"required":null,"pdf_field":""},{"help":"Attach credit note or salvage value documents if any","type":"attachment","label":"Copy of credit note/salvage value","options":[],"required":null,"pdf_field":""},{"help":"Attach contract of carriage if applicable","type":"attachment","label":"Contract of Carriage","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Sign the form","type":"signature","label":"Insured’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Carrier Legal Liability policy claims","attachments":["Written notice of claim (Initial Notice of Claim)","Copy of delivery receipt signed by Consignee","Copy of invoice or document giving proof of value","Statement of claim made by claimant to you","Copy of credit note/salvage value","Contract of Carriage"],"declarations":["The claimant warrants the truth of all statements to the best of their knowledge and belief.","If any false or fraudulent statement or concealment is made, the claim shall be forfeited and the policy void."],"dropped_labels":1},"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/284-carriers-legal-liability-claim-form"}