{"id":413,"title":"Claim Form for Jeweller’s Package Policy Sookshma","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/claim-form-for-jeweller-s-package-policy-sookshma-retail.pdf","sha256":"6db805319d86970c88c04e3f30426561139d0b5c26b42349a5d2668b2495e5de","pages":5,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Jeweller’s Package Policy Sookshma for loss or damage to insured items.","notes":["Attach original or certified copies of FIR and other supporting documents as specified.","Use the toll-free number, email, or website portal to register and submit claims.","A licensed surveyor will be appointed within 24 hours of claim reporting.","Assessment report will be furnished within 15 days of receipt of claim form and documents; claim decision within 7 days thereafter.","For policies on reinstatement value basis, some conditions may not apply.","Provide KYC and NEFT details as per AML guidelines."],"title":"Claim Form for Jeweller’s Package Policy Sookshma","submit":{"to":"Assigned Claims Service Manager (CSM) or Surveyor","how":"Submit claim form and documents via toll-free number, email, or website claim portal","address":"Email: customersupport@icicilombard.com; Website: https://coclaims.icicilombard.com/claimstracker/CommercialClaims/ccplandingpage.aspx; Toll free no.: 1800 2666"},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Claim No","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No","options":[],"required":true,"pdf_field":""},{"help":"Start date of insurance coverage","type":"date","label":"Period of Insurance From:","options":[],"required":true,"pdf_field":""},{"help":"End date of insurance coverage","type":"date","label":"To:","options":[],"required":true,"pdf_field":""},{"help":"Name of the insured person or entity","type":"text","label":"Insured Name","options":[],"required":true,"pdf_field":""},{"help":"Address where correspondence should be sent","type":"text","label":"Address for correspondence","options":[],"required":true,"pdf_field":""},{"help":"Phone number or other contact details","type":"phone","label":"Insured’s Contact Details","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Date when the loss occurred","type":"date","label":"Date of Loss","options":[],"required":true,"pdf_field":""},{"help":"Describe the items affected by the loss","type":"text","label":"Item/s affected by loss","options":[],"required":true,"pdf_field":""},{"help":"Provide a short description of the loss event","type":"text","label":"Brief Description of loss","options":[],"required":true,"pdf_field":""},{"help":"Explain the cause of the loss","type":"text","label":"Cause of loss","options":[],"required":true,"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":true,"pdf_field":""},{"help":"Name of police station where FIR was filed","type":"text","label":"Name of the Police Station","options":[],"required":false,"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":false,"pdf_field":""},{"help":"Name of carrier or authority responsible for custody","type":"text","label":"Name of the Carrier/Authority in whose custody the loss has taken place (if applicable)","options":[],"required":false,"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":false,"pdf_field":""},{"help":"Date claim was 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":false,"pdf_field":""},{"help":"Provide detailed estimate of loss amount","type":"amount","label":"Estimate of loss (with complete breakup)","options":[],"required":true,"pdf_field":""},{"help":"Additional relevant information","type":"text","label":"Any other information which you would like to provide","options":[],"required":false,"pdf_field":""},{"help":"Provide details if other insurance policies cover this risk","type":"text","label":"Details of other insurance covering same risk","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Politically Exposed Persons (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 of PEPs*?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe relationship and position 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":"Additional Loss Details","fields":[{"help":"Specify time and date of loss","type":"text","label":"Time & Date of Loss","options":[],"required":true,"pdf_field":""},{"help":"Explain cause of loss","type":"text","label":"Cause of Loss","options":[],"required":true,"pdf_field":""},{"help":"Describe affected policy items","type":"text","label":"Item of Policy affected (give description)","options":[],"required":true,"pdf_field":""},{"help":"Describe use of premises when loss occurred","type":"text","label":"Occupation of the premises at the time of Loss","options":[],"required":false,"pdf_field":""},{"help":"Indicate if fire brigade was informed","type":"yes-no","label":"Has the Fire / Loss been reported to Fire Brigade? (If not, give reasons)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide address for loss inspection","type":"text","label":"Address where the loss can be inspected.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Extent and Additional Information","fields":[{"help":"Describe extent of loss in detail","type":"text","label":"Extent of Loss (as more particularly described in the statement overleaf)","options":[],"required":false,"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":"Declaration and Signature","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Jeweller’s Package Policy Sookshma","attachments":["Original or certified copy of FIR","Copies of correspondence with Carrier/Authority if claim lodged","Photographs / Video of damaged property/item under claim","Service Engineer’s Report, Fire Brigade Report, etc. supporting admissibility","FIR / Final Police investigation report wherever applicable","Repair/replacement quotation, invoice and payment proofs for each item claimed","Documents substantiating 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 provided 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 claim processing 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 or reject claim.","Consent is given to the company to verify identity/address proof of insured and beneficial owner through Central KYC Registry, UIDAI or other modes for KYC purposes."],"dropped_labels":1},"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/413-claim-form-for-jewellers-package-policy-sookshma"}