{"id":417,"title":"CLAIM FORM CIVIL ENGINEERING COMPLETED RISKS (CECR) 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/civil-engineering-completed-risks-insurance--commercial.pdf","sha256":"924cbe0953dc1a0ae8546fdae76b17932358b1972d04055d611449fccb0e602c","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to claim insurance for losses under the Civil Engineering Completed Risks Insurance Policy.","notes":[],"title":"CLAIM FORM CIVIL ENGINEERING COMPLETED RISKS (CECR) INSURANCE","submit":{"to":"ICICI Lombard General Insurance Company Limited","how":"","address":"601 / 602, 6th Floor, Interface Building No. 16, New Link Road, Malad (West), Mumbai - 400 064."},"purpose":"claim","sections":[{"title":"Insured Details and Loss Information","fields":[{"help":"","type":"text","label":"Area Office Code/Service Center Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Broker/Agent Name & code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Plot No/Door No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Road","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Building Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Customer ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal PIN code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of insurance: From","options":[],"required":null,"pdf_field":""},{"help":"Date and time when the loss occurred","type":"date","label":"Date & time of loss","options":[],"required":null,"pdf_field":""},{"help":"Policy number related to the loss","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Describe the risk covered under the policy","type":"text","label":"Risk Covered","options":[],"required":null,"pdf_field":""},{"help":"Details of the insured item and its location","type":"text","label":"Insured item & Location","options":[],"required":null,"pdf_field":""},{"help":"Sum insured amount in rupees","type":"amount","label":"Sum Insured (Rs)","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount in rupees","type":"amount","label":"Estimated amount of loss (Rs)","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss happened","type":"text","label":"Nature & cause of loss (please describe the circumstances leading to the loss)","options":[],"required":null,"pdf_field":""},{"help":"Provide details if insured elsewhere for this risk","type":"text","label":"Give details of insurance with any other insurance company on the risk involved in the loss/accident","options":[],"required":null,"pdf_field":""},{"help":"Explain ownership and other interests if applicable","type":"text","label":"If insured is not sole owner, the nature of his/their interest in the property and details of other interests","options":[],"required":null,"pdf_field":""},{"help":"Indicate if loss was reported to Police and/or Fire Brigade","type":"choice","label":"Whether the loss is intimated to a. Police b. Fire Brigade","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide past claim details if any","type":"text","label":"Was any claim reported in the past on the same property during current policy period? If so, give details regarding a. Cause b. Date of accident c. Claim number d. Policy issuing office e. Amount of claim paid/outstanding","options":[],"required":null,"pdf_field":""},{"help":"Answer if you or related persons are Politically Exposed Persons","type":"yes-no","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":"Describe relationship and position if PEP applies","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":"Declaration by Insured","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place where the declaration is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign the form here","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Civil Engineering Completed Risks Insurance Policy claims","attachments":[],"declarations":["The statements made in this claim form are true to the best of the insured's knowledge and belief.","The insured consents to the company verifying identity and 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/417-claim-form-civil-engineering-completed-risks-cecr-insurance"}