{"id":406,"title":"CLAIM FORM FOR JEWELLER'S PACKAGE 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/20221217005-claim-form-for-jewellers-package-insurance-policy.pdf","sha256":"ee8370893738c40e8d4cd2fc8d55ed1eb0603f5dfa808dca0b002b5c94660745","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Jeweller's Package Policy for loss or damage to insured items.","notes":["In case of third-party property damage/bodily injury, fire etc., file an FIR as per policy terms","Contact toll-free number 1800 2666 or email customersupport@icicilombard.com to register claim and receive claim reference number","Claims Manager will appoint a licensed surveyor within 24 hours of claim reporting","Submit original bills and documents as listed","Use the website https://coclaims.icicilombard.com/claimstracker/CommercialClaims/ccplandingpage.aspx for claim registration"],"title":"CLAIM FORM FOR JEWELLER'S PACKAGE POLICY","submit":{"to":"Assigned Claims Manager (CSM) or Surveyor","how":"Submit documents to the assigned CSM/Surveyor as instructed","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"Enter the start and end dates of the insurance coverage","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter claim number if already assigned","type":"text","label":"Claim No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter the name of the insured","type":"text","label":"Insured Name","options":[],"required":null,"pdf_field":""},{"help":"Enter the address where correspondence should be sent","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number or email for contact","type":"text","label":"Insured’s Contact Details","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Enter the date when the loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"List the items that were lost or damaged","type":"text","label":"Item/s affected by loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the loss briefly","type":"text","label":"Brief Description of loss","options":[],"required":null,"pdf_field":""},{"help":"Explain the cause of the loss","type":"text","label":"Cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the loss was reported to police","type":"yes-no","label":"Has the matter been reported to the Police","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter the police station name if reported","type":"text","label":"Name of the Police Station","options":[],"required":null,"pdf_field":""},{"help":"Provide FIR number and date; attach copy","type":"text","label":"FIR No. and date (Please enclose original or certified copy of FIR)","options":[],"required":null,"pdf_field":""},{"help":"Enter carrier or authority name if applicable","type":"text","label":"Name of the Carrier/Authority in whose custody the loss has taken place (if applicable)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if claim was lodged with carrier/authority","type":"yes-no","label":"Has the claim been lodged on the Carrier/Authority","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide date of claim lodged with carrier/authority; attach correspondence","type":"date","label":"Date when the claim has been lodged on the Carrier/Authority (Please enclose copies of the correspondence exchanged with them)","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed estimate of loss with breakup","type":"text","label":"Estimate of loss (with complete breakup)","options":[],"required":null,"pdf_field":""},{"help":"Optional additional information","type":"text","label":"Any other information which you would like to provide","options":[],"required":false,"pdf_field":""},{"help":"Provide details if other insurance covers the same risk","type":"text","label":"Details of Other insurance covering same risk","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No regarding Politically Exposed Person status","type":"choice","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/Close relatives/Associates of PEP*?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answer to previous question is Yes","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signature","fields":[{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""},{"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":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["Assessment sheet / Survey report will be furnished within 15 days of receipt of claim form and documents","Claim will be decided within 7 days of receipt of the assessment sheet / survey report"],"applies_to":"Jeweller's Package Policy claims","attachments":["Original or certified copy of FIR","Photographs / Video of damaged property/item under claim","Document/s in support of admissibility of the claim (e.g. Service Engineer’s Report, Fire Brigade Report)","Final Police investigation report wherever applicable","Repair/replacement quotation, invoice and payment proofs for each item claimed","Documents substantiating the quantum & value of items under claim if not repaired or reinstated","Offer for retention of salvage, if any","KYC / NEFT Details as per AML guidelines","Invoice copy / Goods Receipt Note / Monetary Claim on carrier / Damage Certificate","Any other document specified by the surveyor post initial survey"],"declarations":["The information given in this claim form is true, correct and complete","All persons having interest in the property are disclosed as per proposal or policy endorsement","No material information relevant to the claim has been withheld or undisclosed","False or fraudulent statements or concealment of material information will void the policy and claims","Receipt of claim form and documents does not constitute agreement to the claim; company may require further information","Consent is given to verify identity/address proof through Central KYC Registry, UIDAI or other modes for KYC purposes"],"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/406-claim-form-for-jeweller-s-package-policy"}