{"id":287,"title":"Claim Form: Cyber Security Insurance Policy (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-Cyber.pdf","sha256":"09100832a7ad8a70c2de8fea1a257bd86eb91b6fd44ef15cc3c736f367ed8251","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for notifying a claim or a circumstance that may lead to a claim under a Cyber Security Insurance policy. It is 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.","If a cyber-attack is suspected, isolate affected machines and inform security head and local CERT immediately.","Make physical copies of infected drives to preserve data integrity.","All press enquiries must be handled by one representative.","Maintain copies of all documents handed over to agencies."],"title":"Claim Form: Cyber Security Insurance Policy (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":""},{"help":"","type":"text","label":"Occupation/Business","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 policy coverage period","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"If applicable, enter your claim reference number","type":"text","label":"Insured’s Claim Ref No","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is there any other insurance that may be applicable to this notification? Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Only if other insurance applies","type":"text","label":"If YES, please provide the following details: Policy Holder","options":[],"required":null,"pdf_field":""},{"help":"Only if other insurance applies","type":"text","label":"Insurer","options":[],"required":null,"pdf_field":""},{"help":"Only if other insurance applies","type":"text","label":"Type of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Only if other insurance applies","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Has the matter been notified to that insurer? Yes / No","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 3: DETAILS OF THE CLAIM OR CIRCUMSTANCE","fields":[{"help":"Date of the cyber breach","type":"date","label":"CYBER BREACH Date","options":[],"required":null,"pdf_field":""},{"help":"Time of the cyber breach","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"Location of the cyber breach","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Describe the cyber attack in detail","type":"text","label":"1. Describe fully the nature of Cyber Attack","options":[],"required":null,"pdf_field":""},{"help":"Explain when and how you became aware of the event","type":"text","label":"2. When and how did you first come to know the event/circumstances","options":[],"required":null,"pdf_field":""},{"help":"Give your opinion on the cause of the breach","type":"text","label":"3. In your opinion what is the main cause of breach","options":[],"required":null,"pdf_field":""},{"help":"Describe any preventive measures taken","type":"text","label":"4. Have you taken any steps to prevent a similar breach","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"5. Was the breach reported to the police? Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why the breach was not reported to police if applicable","type":"text","label":"If no, why?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of impact assessment if done","type":"text","label":"6. Has the impact of the breach been assessed? If yes, by whom? Please share details","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF FIRST PARTY LOSS (OWN DAMAGE)","fields":[{"help":"Describe your own losses or damages in detail","type":"text","label":"Describe fully your own loss or damage","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated repair or loss cost","type":"amount","label":"Estimated cost of repair/loss","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time of last backup before breach","type":"text","label":"At what date and time was the last pre-breach back up made by you","options":[],"required":null,"pdf_field":""},{"help":"Describe the interruption caused by the breach","type":"text","label":"Was your business partially or fully interrupted by the cyber breach? If yes, provide: Detailed nature of the interruption","options":[],"required":null,"pdf_field":""},{"help":"Estimate the percentage of business affected","type":"number","label":"Estimated percentage of business impacted","options":[],"required":null,"pdf_field":""},{"help":"Provide start date and time of business interruption","type":"text","label":"Estimated date & time the interruption started","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated date and time when business will fully resume","type":"text","label":"Estimated date & time the business can fully resumed","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"THIRD PARTY LOSS OR DAMAGE","fields":[{"help":"Describe losses or damages to third parties","type":"text","label":"Describe fully the third party loss or damage","options":[],"required":null,"pdf_field":""},{"help":"Provide details of third parties affected","type":"text","label":"Details of the third parties most probably impacted by the cyber breach","options":[],"required":null,"pdf_field":""},{"help":"Estimate the cost of third party loss or damage","type":"amount","label":"Estimated cost of loss/damage","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Additional Third Party Claim Details","fields":[{"help":"Provide name and address of third party if notice received","type":"text","label":"Did you already receive notice of claim? If yes please provide: name & address of the third party","options":[],"required":null,"pdf_field":""},{"help":"Describe your relationship with the third party","type":"text","label":"relationship between you and the third party","options":[],"required":null,"pdf_field":""},{"help":"Provide details of the loss or damage claimed","type":"text","label":"details on loss / damage claimed","options":[],"required":null,"pdf_field":""},{"help":"Give your opinion on liability and reasons","type":"text","label":"your opinion on whether you are liable and reasons","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of written notice if available","type":"attachment","label":"if in writing, please attach a copy of this notice","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 authorized signatory","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 authorized signatory"}],"deadlines":[],"applies_to":"Cyber Security Insurance Policy claims","attachments":["copies of your retainer","any written demands","court documents","copy of notice of claim if in writing","other relevant documentation as needed"],"declarations":["The insured warrants the truth of the 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":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/287-claim-form-cyber-security-insurance-policy-notification-of-claim-or-circumstance"}