{"id":421,"title":"CLAIM FORM ERECTION ALL RISK INSURANCE Notification of Physical Loss or Damage","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-erection-all-risk-insurance-retail.pdf","sha256":"4d486be7d840040ba973fcd1de897bfdbeb1c567f17477a1a805173290058326","pages":6,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to notify and claim for physical loss or damage under the Erection All Risks Insurance policy.","notes":["Use original bills and documents as specified","Attach all required documents listed for claim processing","In case of third-party property damage or bodily injury, file an FIR if applicable","Claim intimation can be done via toll-free number, email, or website","Surveyor will be appointed within 24 hours of claim reporting","RTGS/NEFT payment terms and conditions apply as stated in the mandate form"],"title":"CLAIM FORM ERECTION ALL RISK INSURANCE Notification of Physical Loss or Damage","submit":{"to":"assigned Claims Manager (CSM) / Surveyor","how":"submit documents to the assigned CSM/Surveyor","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name of the insured","type":"text","label":"i) Name","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal address for communication","type":"text","label":"ii) Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"iii) Contact Number","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss or Damage Details","fields":[{"help":"Provide the exact date and time of the loss or damage","type":"date","label":"2. When did the loss or damage occur? (State date and time)","options":[],"required":null,"pdf_field":""},{"help":"Enter the location address of the insured property","type":"text","label":"3. The address where the property (item) covered is situated.","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage to the insured erection property","type":"text","label":"4. Particulars of damage to erection property.","options":[],"required":null,"pdf_field":""},{"help":"Describe any third party property damage","type":"text","label":"5. a) Nature & extent of damage, if any, belonging to third party.","options":[],"required":null,"pdf_field":""},{"help":"Explain the cause and circumstances of the damage","type":"text","label":"6. What was the cause of the damage and how did it occur? (eg. Defective material, faulty design, mention particulars of parts)","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"7. a) Has damage occurred during testing?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide witness details","type":"text","label":"8. Give name & address of the witness to the occurrence.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if someone is responsible","type":"yes-no","label":"9. a) Is any one responsible for damage?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide inspection location","type":"text","label":"10. Address where the damaged items can be inspected.","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated financial loss","type":"amount","label":"11. What is the estimated amount of loss or damage?","options":[],"required":null,"pdf_field":""},{"help":"Describe repair plans and parts replacement","type":"text","label":"12. How will the damages be repaired?(state the details whether any parts must be replaced)","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed explanation of damage occurrence","type":"text","label":"13. How did the damage occur? (This question must be answered in detail)","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated salvage or scrap value","type":"amount","label":"14. The estimate salvage or scrap value of damaged parts to be replaced.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other insurance policies if any","type":"text","label":"15. Details of any other insurance under which you are entitled to recover in respect of the loss or damage.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if you will do repairs yourself","type":"yes-no","label":"16. Do you wish to carry out repairs yourself?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide repairer details if applicable","type":"text","label":"17. Name & address of the repairer, if entrusted for repairs.","options":[],"required":null,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"18. Any additional information relevant to processing of claim:","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Politically Exposed Person (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 close relative of a 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":"Declarations 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 Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Direct Fund Transfer/EFT Mandate Form","fields":[{"help":"Sign to authorize fund transfer","type":"signature","label":"Signature of the Account Holder","options":[],"required":true,"pdf_field":""},{"help":"Attach original cancelled cheque with signature","type":"attachment","label":"Please attach an Original Blank Cancelled Cheque signed by the Payee.","options":[],"required":true,"pdf_field":""},{"help":"Attach PAN card copy","type":"attachment","label":"Please attach a PAN Card copy of Payee","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":"Erection All Risks Insurance claims","attachments":["Claim bill / Claim Form duly filled up","Photographs / Video of damaged property/item under claim","Document/s in support of admissibility of the claim, for instance, Service Engineer’s Report, Fire Brigade Report, etc.","FIR / Final Police investigation report wherever applicable","Repair/ replacement quotation, invoice and payment proofs for each and every item as claimed (for items to be repaired or reinstated)","Documents substantiating the quantum & value of the items under claim (for items not to be 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 which may be specified by the surveyor post completion of initial survey","Original Blank Cancelled Cheque signed by the Payee","PAN Card copy of Payee"],"declarations":["The statements/information given in this claim form are true, correct and complete","All persons having an 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 information will void the policy and claims","Receipt of this claim form or documents does not constitute admission of claim liability","Consent is given to verify identity/address proof through Central KYC Registry, UIDAI or other modes for KYC"],"dropped_labels":3},"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/421-claim-form-erection-all-risk-insurance-notification-of-physical-loss-or-damage"}