{"id":286,"title":"Claim Form: Crime Insurance (Notification of claim or circumstance out of which a claim may arise)","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/Claim-Form-Crime.pdf","sha256":"619de555494aa8a2333ad76b4f4e5b64fa958041bb0330cf35bcb32200bf93dc","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for notifying a claim or circumstance that may give rise to a claim under a crime insurance policy. It is to be filled by the insured or their authorized representative.","notes":["The form must be signed by a Partner, Director or Principal of the Insured.","All questions must be answered as fully as possible.","Use additional sheets if necessary.","Attach copies of relevant documentation.","The issuance of this form is not an admission of liability.","Notify the insurance company immediately upon knowledge of any incident."],"title":"Claim Form: Crime Insurance (Notification of claim or circumstance out of which a claim may arise)","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"SECTION 1: DETAILS OF THE INSURED","fields":[{"help":"","type":"text","label":"Full Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Insured: Postcode","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Contact person","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone No","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Fax No","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 2: POLICY DETAILS","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the start and end dates of the policy period","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Is there any other insurance that may be applicable to this notification?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details only if other insurance applies","type":"text","label":"If YES, please provide the following details","options":[],"required":null,"pdf_field":""},{"help":"Other insurer's policy holder name","type":"text","label":"Policy Holder","options":[],"required":null,"pdf_field":""},{"help":"Other insurer's name","type":"text","label":"Insurer","options":[],"required":null,"pdf_field":""},{"help":"Type of other insurance","type":"text","label":"Type of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Period of other insurance","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Has the matter been notified to that insurer?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Reference number for claim with other insurer","type":"text","label":"Insured’s Claim Ref No","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 3: DETAILS OF THE CLAIM OR CIRCUMSTANCE","fields":[{"help":"","type":"choice","label":"Do you know the identity of the alleged perpetrator?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide full details of alleged perpetrator if known","type":"text","label":"If you answered YES, please provide details of their name, address, position, dates of employment etc.","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Has the alleged perpetrator admitted to the fraud/embezzlement etc.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain repayment arrangements if any","type":"text","label":"If you answered YES, has the alleged perpetrator arranged to pay back the entire loss or part of the loss?","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Has the matter been reported to the police?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe events in order leading to loss discovery","type":"text","label":"Please provide a chronology of events which led to the discovery of the loss.","options":[],"required":null,"pdf_field":""},{"help":"Explain the method of the crime","type":"text","label":"Please provide a description of how the crime was committed.","options":[],"required":null,"pdf_field":""},{"help":"Attach supporting documents such as police reports, audit reports, statements, receipts, invoices, etc.","type":"text","label":"Please provide affirmative proof that you have sustained a loss.","options":[],"required":null,"pdf_field":""},{"help":"Date when loss was first identified","type":"date","label":"On what date was the loss discovered?","options":[],"required":null,"pdf_field":""},{"help":"Exact amount of loss if known","type":"amount","label":"What is the amount of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount if exact is unknown","type":"amount","label":"If the exact amount is not yet known, please provide an estimate of the amount of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Provide history of similar acts by alleged perpetrator(s) if any","type":"text","label":"Do(es) this/these person/persons had any history of such act?, if yes, please provide the details of such act","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 4: DETAILS OF THE INSURED’S RESPONSE","fields":[{"help":"Provide your response or comments regarding the claim","type":"text","label":"What are your comments in response to the claim or the fact or circumstance that may give rise to a claim?","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are there any other parties which may have contributed to the claim or circumstances which may give rise to a claim?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of other parties involved if any","type":"text","label":"If you answered YES, please provide details:","options":[],"required":null,"pdf_field":""},{"help":"Provide your estimate of claim amount and liability","type":"text","label":"What are your comments on the quantum of the claim and what is your estimate of your potential monetary liability, if any to the claimant?","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are there any additional details about which you wish to advise, or which may be of interest to IFFCO-TOKIO, so that IFFCO-TOKIO will have a better understanding of this matter?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional information and documents if any","type":"text","label":"If you answered YES, please provide details along with supporting documents:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 5: RETAINER OF INVESTIGATOR/ASSESSOR","fields":[{"help":"","type":"choice","label":"Have you retained an investigator/assessor to determine further particulars of the theft?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide investigator/assessor details and attach retainer agreement","type":"text","label":"If you answered YES, please provide details of their name, firm, address and charge rates together with a copy of the retainer agreement:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 6: LIST OF DOCUMENTS ATTACHED","fields":[{"help":"List attached documents here","type":"attachment","label":"1.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"2.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"3.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"4.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"5.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"6.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"7.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"8.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"9.","options":[],"required":null,"pdf_field":""},{"help":"","type":"attachment","label":"10.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 7: DECLARATION","fields":[{"help":"Name of the Partner, Director or Principal signing the form","type":"text","label":"Authorized Signatory (Name)","options":[],"required":true,"pdf_field":""},{"help":"Signature and company stamp of authorized signatory","type":"signature","label":"Signature & Stamp","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Crime Insurance Policy claims","attachments":["copies of your retainer","any written demands","court documents","police reports","loss assessor’s reports","audit reports","statements from witnesses","internal investigation reports","any signed confessions","account statements","receipts","invoices","cheque requisitions","cheques","money orders","cash receipts","copy of the retainer agreement"],"declarations":["The information provided is true to the best of the signer's knowledge and belief.","If any false or fraudulent statement or concealment is made, the claim will be forfeited and the policy void."],"dropped_labels":0},"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/286-claim-form-crime-insurance-notification-of-claim-or-circumstance-out-of-which-a-"}