{"id":409,"title":"CLAIM FORM – REMOTELY PILOTED AIRCRAFT INSURANCE","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/20240507009-claim-form-remotely-piloted-aircraft-insurance-policy-forms.pdf","sha256":"d094523d123ec9cc18906bbb22cfac3dd8e5b4806b777aca79c3abce4f092fd2","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is for filing a claim under the Remotely Piloted Aircraft Insurance policy and is to be filled by the insured claimant.","notes":["Attach copy of FIR with the form.","Attach copies of court documents if applicable.","Use the bank details as per bank records and cheque leaf for EFT.","Signature of claimant and account holder required.","The issuance of this form is not an admission of liability."],"title":"CLAIM FORM – REMOTELY PILOTED AIRCRAFT INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of the Insured","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for Correspondence:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Nature of loss/damage","fields":[{"help":"Provide the Operator Authorization Number","type":"text","label":"OAN Number","options":[],"required":null,"pdf_field":""},{"help":"Provide the Drone Authorization Number","type":"text","label":"DAN Number","options":[],"required":null,"pdf_field":""},{"help":"Provide the serial number of the drone","type":"text","label":"Drone Serial Number","options":[],"required":null,"pdf_field":""},{"help":"Provide the Unique Identification Number","type":"text","label":"UIN Number","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of damaged property","fields":[{"help":"Describe the damaged property","type":"text","label":"Details of damaged property","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Loss location and timing","fields":[{"help":"Provide full address of loss location","type":"text","label":"Place & address where loss took place","options":[],"required":null,"pdf_field":""},{"help":"Provide date, time and location last seen","type":"text","label":"When and where was the missing RPA last seen?","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time of discovery","type":"date","label":"Date and time when loss was first discovered","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Circumstances and value of loss","fields":[{"help":"Explain how the loss or damage occurred","type":"text","label":"State the circumstances of the loss or damage","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated monetary value","type":"amount","label":"Estimated value of items lost or damaged","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Police reporting details","fields":[{"help":"Provide date and time of police report and attach FIR copy","type":"date","label":"Date & time of reporting the loss to the police station. (Please furnish copy of FIR)","options":[],"required":null,"pdf_field":""},{"help":"Provide police station details","type":"text","label":"Name and address of the police station","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Ownership and insurance history","fields":[{"help":"","type":"yes-no","label":"Are you the sole owner of the RPA?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of previous similar losses if any","type":"text","label":"Have you ever before sustained loss of the same nature? If so, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other insurance if applicable","type":"text","label":"Is there any other insurance on the same RPA? If so, give full particulars","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Additional information","fields":[{"help":"Provide any other relevant details","type":"text","label":"Any additional information relevant to processing of claim.","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Compromise Details","fields":[{"help":"","type":"yes-no","label":"Do you agree that you are liable for the accident and the consequential loss/damage either to persons/property or livestock?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain reasons and strategy for compromise or settlement","type":"text","label":"Reasons for compromise / settlement Please provide comprehensive detail of all reasons, game-plans/strategy for the same.","options":[],"required":null,"pdf_field":""},{"help":"Describe current status of negotiations","type":"text","label":"What is the present status of compromise/ settlement negotiations?","options":[],"required":null,"pdf_field":""},{"help":"State the amount of liability proposed","type":"amount","label":"What is the quantum of liability, you are proposing to agree to?","options":[],"required":null,"pdf_field":""},{"help":"Provide supporting circumstances or evidence","type":"text","label":"What are the circumstances /Evidence that favor a Compromise?","options":[],"required":null,"pdf_field":""},{"help":"Provide any additional relevant evidence","type":"text","label":"Any other circumstance/evidence.","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Court Procedure","fields":[{"help":"","type":"yes-no","label":"Has any case been filed in any court of law/tribunal against you, in relation to the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide status and next hearing date","type":"text","label":"If yes, what is the present status of the proceedings? Also give the next date of hearing.","options":[],"required":null,"pdf_field":""},{"help":"Attach copies if yes","type":"yes-no","label":"Have any notices / summons of the court been received by you? If yes, please provide copies of the same.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach copies if yes","type":"yes-no","label":"Has the court passed any interim or final order? If yes, please provide copies of the same.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach all court-related documents","type":"attachment","label":"Also provide copies of all the documents that have been submitted to the Court either by you or the Claimants, and copies of all the documents.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Claimant Declaration 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 Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Direct Fund Transfer/EFT Mandate Form","fields":[{"help":"Select Yes or No","type":"choice","label":"Would you like to opt for Electronic Fund Transfer as mode of payment?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter name as per bank records","type":"text","label":"Claimant/Insured Person’s name(as per bank records)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Claimant /Insured Person’s bank account no.","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"Enter branch name","type":"text","label":"Branch name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch address","type":"text","label":"Address of the bank","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code as per cheque leaf","type":"text","label":"IFSC code no. of the bank","options":[],"required":null,"pdf_field":""},{"help":"Sign to authorize EFT","type":"signature","label":"Signature of Account Holder","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Claims related to loss or damage of Remotely Piloted Aircraft (RPA) insured under this policy","attachments":["Copy of FIR","Copies of court notices/summons if any","Copies of court orders if any","Copies of all documents submitted to the court"],"declarations":["The information given in this claim form is true, correct and complete.","All persons having interest in the property are disclosed as per the proposal or policy endorsements.","No similar claim has been made with any other insurer except as disclosed.","No material information relevant to the claim has been withheld.","False or fraudulent statements or concealment of material information will void the policy and claims.","Receipt of this form or documents does not imply admission of liability by the company.","Consent is given to verify identity/address proofs through Central KYC Registry, 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/409-claim-form-remotely-piloted-aircraft-insurance"}