{"id":398,"title":"CLAIMS FORM FOR LATENT DEFECTS INSURANCE POLICY","purpose":"claim","insurer":{"slug":"icici-lombard-general-insurance","name":"ICICI LOMBARD General Insurance Company Limited"},"source_pdf":"https://www.icicilombard.com/docs/default-source/default-document-library/claims-form-for-latent-defects-insurance-policy-commercial.pdf","sha256":"37087d76a2ed49cf67ba01bb212520bbb7cd7bd07d229470aeba46dd4ac5673f","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to claim under the Latent Defects Insurance Policy for damages or defects in property covered by the policy.","notes":["Answer all questions fully.","The issue of this form is not an admission of liability.","Apart from standard documents, additional documents may be required based on claim nature.","Insurance is the subject matter of solicitation."],"title":"CLAIMS FORM FOR LATENT DEFECTS INSURANCE POLICY","submit":{"to":"ICICI Lombard General Insurance Company Ltd","how":"post","address":"Interface Building No.16, 601/602, 6th Floor, New Link Road Malad (W), Mumbai - 400 064"},"purpose":"claim","sections":[{"title":"Details of Insured and Policy","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Correspondence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of developer","options":[],"required":null,"pdf_field":""},{"help":"Provide a phone number to contact you","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Developer","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"State the policy coverage period","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time of incident","type":"date","label":"When did the destruction /damage/threat of imminent collapse occurred/noticed (State date and time)","options":[],"required":null,"pdf_field":""},{"help":"Provide full address of the insured property","type":"text","label":"The address where the property (item) covered is situated.","options":[],"required":null,"pdf_field":""},{"help":"Describe the damaged items in detail under each category","type":"text","label":"Particulars of item damaged(please specify in details): a) Structural Components b) Internal Components, Fittings, Installations and Contents c) External Components","options":[],"required":null,"pdf_field":""},{"help":"Describe any damage to surrounding properties","type":"text","label":"Details of surrounding property damages, if any.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Cause and Witness Details","fields":[{"help":"Specify cause(s) of defect","type":"text","label":"What was the cause of the structural defects? a) Design defect b) Workmanship defects c) Materials defects","options":[],"required":null,"pdf_field":""},{"help":"Provide witness details if any","type":"text","label":"Give name & address of the witness to the occurrence","options":[],"required":null,"pdf_field":""},{"help":"Describe third party damage and owner details","type":"text","label":"a) Nature & extent of damage if any belonging to third party. b) Name & addresses of owner of property so damaged?","options":[],"required":null,"pdf_field":""},{"help":"Provide inspection address","type":"text","label":"Address where the damaged items can be inspected.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Repair and Cost Details","fields":[{"help":"Provide estimated repair costs for each category","type":"amount","label":"What is the estimated costs for the repairs of damage to : a) Structural Components b) Internal Components, Fittings, Installations and Contents c) External Components","options":[],"required":null,"pdf_field":""},{"help":"Explain repair method and parts replacement if any","type":"text","label":"How will the destruction /damage/ threat of imminent collapse to be repaired ?(sate the details whether any parts must be replaced)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if any changes will be made during repair","type":"yes-no","label":"Will any alterations or improvements be made to design, construction or material when repairs are carried out?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide estimated salvage or scrap value","type":"amount","label":"The estimate salvage or scrap value of damaged parts to be replaced.","options":[],"required":null,"pdf_field":""},{"help":"Mention other insurance policies if applicable","type":"text","label":"Details of any other insurance under which you are entitled to recover in respect of the loss or damage.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if you will do repairs yourself","type":"yes-no","label":"Do you wish to carry out repairs yourself? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide repairer details if applicable","type":"text","label":"Name & address of the repairer, if entrusted for repairs.","options":[],"required":null,"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":"insured"},{"title":"PEP Declaration","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member / Close relatives / Associates close relative of a PEP*?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answered Yes","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations 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 Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Latent Defects Insurance Policy claims","attachments":["Policy/Underwriting documents","Survey Report with Photographs","Claim Form, duly completed","Log book / Asset register / Capitalized item list","Repair / Replacement invoices with receipt","All Applicable valid Certificates","Any other relevant documents required based on type of loss","KYC documents where settlement amount is over 1 lac"],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having an 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 the claim has been withheld or undisclosed.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this claim form or documents does not mean acceptance of the claim by the company.","Consent is given to verify identity/address proof through Central KYC Registry or UIDAI or other modes."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/icici-lombard-general-insurance/398-claims-form-for-latent-defects-insurance-policy"}