{"id":408,"title":"TRADE CREDIT INSURANCE - NOTIFICATION OF OVERDUE ACCOUNT","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/trade-credit-insurance-retail.pdf","sha256":"c318447f872df487943f0b5b1b3d0dcde015e416173eb8d6f2be8752a22e470c","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to notify ICICI Lombard General Insurance Company about overdue accounts under their trade credit insurance policy.","notes":["Insured must submit the specified documents together with this notification form.","Intervention fee is payable.","Use the exact invoice and account details as per your records."],"title":"TRADE CREDIT INSURANCE - NOTIFICATION OF OVERDUE ACCOUNT","submit":{"to":"ICICI LOMBARD GENERAL INSURANCE COMPANY LTD.","how":"mail","address":"414, Veer Savarkar Marg, Near Siddhivinayak Temple, Prabhadevi, Mumbai – 400025."},"purpose":"claim","sections":[{"title":"Notification Details","fields":[{"help":"","type":"date","label":"Date of Notification:","options":[],"required":null,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Enter the buyer's identification number","type":"text","label":"Buyer No:","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name and address of the buyer","type":"text","label":"Buyer’s full name and address :-","options":[],"required":null,"pdf_field":""},{"help":"Enter contact person's name and telephone number","type":"text","label":"Name of contact person & Tel :-","options":[],"required":null,"pdf_field":""},{"help":"Enter the GST number of the buyer","type":"text","label":"GST Number :","options":[],"required":null,"pdf_field":""},{"help":"Enter your full name and address as the insured","type":"text","label":"Insured full name and address :-","options":[],"required":null,"pdf_field":""},{"help":"Enter invoice address if different from insured address","type":"text","label":"Address of Invoices (if different from above) :-","options":[],"required":false,"pdf_field":""},{"help":"Enter name of invoice issuer if different from insured","type":"text","label":"Invoice Issued by (if different from above) :-","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details on Overdues","fields":[{"help":"List invoice reference, invoice date, due date, currency, amount, payments or credit notes (amount, date), and remarks","type":"table","label":"Invoice Ref","options":[],"required":null,"pdf_field":""},{"help":"Enter the net outstanding amount excluding tax or VAT","type":"amount","label":"Net Outstanding Amount (Excluding tax/VAT if any) (As per the Statement Of Account)","options":[],"required":null,"pdf_field":""},{"help":"Select the reason(s) for non-payment; specify if 'Others'","type":"choice","label":"Reasons for Non Payment","options":["Cash Flow problem","Insolvency","Bank transfer delay","Trade Dispute","Others (specify)"],"required":null,"pdf_field":""},{"help":"Provide any other relevant details","type":"text","label":"Other details","options":[],"required":false,"pdf_field":""},{"help":"Describe actions taken to recover the overdue amount","type":"text","label":"Measures taken so far to effect recovery:","options":[],"required":false,"pdf_field":""},{"help":"List any securities held against the debtor","type":"text","label":"Securities held against the debtor:","options":[],"required":false,"pdf_field":""},{"help":"Enter the usual payment terms in days","type":"number","label":"What is the usual terms of payment given to the buyer?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Additional Information","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Have you applied for an extension of terms with this buyer previously?","options":["Yes","No"],"required":null,"pdf_field":""},{"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 of PEP*?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","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":"Consent and Signature","fields":[{"help":"Authorized signatory to sign and stamp","type":"signature","label":"Please sign and stamp below for intervention.","options":[],"required":null,"pdf_field":""},{"help":"Enter name of authorized signatory","type":"text","label":"Name of signatory:","options":[],"required":null,"pdf_field":""},{"help":"Enter designation of authorized signatory","type":"text","label":"Designation:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"","attachments":["Invoices","Statement of account","Sales contract/purchase order","Bill of Lading / Delivery Receipt"],"declarations":["The insured consents to the company verifying identity and address proof through Central KYC Registry or UIDAI or other modes for KYC purposes.","The insured must declare the full debt exposure on the buyer even for invoices that are not yet due."],"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/408-trade-credit-insurance-notification-of-overdue-account"}