{"id":422,"title":"CLAIM FORM FOR DETERIORATION OF STOCKS 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/deterioration-of-stocks-commercial.pdf","sha256":"80149435096ba6cfd1b366619164595548916ffe765ad1c64445115ef470971c","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to claim insurance for deterioration of stocks under a commercial policy. The policyholder fills this form to provide details of the loss and related information.","notes":["Issue of this form is not to be taken as an admission of liability.","Attach all required supporting documents as specified.","Fill all details clearly and accurately."],"title":"CLAIM FORM FOR DETERIORATION OF STOCKS 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":"Policy and Insured Details","fields":[{"help":"Enter the date when the claim form is being registered","type":"date","label":"Date of registration","options":[],"required":null,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the area office or service center code","type":"text","label":"Area Office Code/Service Center Code","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy number of the related machinery insurance if applicable","type":"text","label":"Policy no. of corresponding Machinery Insurance","options":[],"required":null,"pdf_field":""},{"help":"Enter the name and code of your insurance broker or agent","type":"text","label":"Broker/Agent Name & code","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name of the insured person or entity","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter your address plot or door number","type":"text","label":"Plot No/Door No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the road name of your address","type":"text","label":"Road","options":[],"required":null,"pdf_field":""},{"help":"Enter the building name of your address","type":"text","label":"Building Name","options":[],"required":null,"pdf_field":""},{"help":"Enter the area/locality of your address","type":"text","label":"Area","options":[],"required":null,"pdf_field":""},{"help":"Enter the full address of the insured","type":"text","label":"Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter your customer ID if available","type":"text","label":"Customer ID","options":[],"required":null,"pdf_field":""},{"help":"Enter the city of your address","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Enter the state of your address","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 your contact phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Machine Affected","fields":[{"help":"Provide detailed description including make, type, serial number, year of manufacture and function","type":"text","label":"a. Description of machine, make, type. Sr No. year of make and function.","options":[],"required":null,"pdf_field":""},{"help":"Enter the item number as per the machinery insurance policy schedule","type":"text","label":"b. Item no. in Machinery Insurance policy schedule.","options":[],"required":null,"pdf_field":""},{"help":"Provide the date and time when the damage occurred","type":"date","label":"c. Date and time of damage.","options":[],"required":null,"pdf_field":""},{"help":"Describe the nature of damage and attach inspection report","type":"text","label":"d. Nature of damage (enclose copy of inspection report issued by the Plant Engineer Or Service Engineer)","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time when the machine was put back into operation","type":"date","label":"e. Date & time of re-commissioning the machine after completion of repairs.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Machinery Breakdown Notification","fields":[{"help":"Indicate if you informed the insurance company about the machinery breakdown","type":"yes-no","label":"Did you notify the above Machinery Breakdown to the Insurance company? If so:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter the date when the insurance company was notified","type":"date","label":"a. Date of intimation","options":[],"required":null,"pdf_field":""},{"help":"Provide the claim number if any under the machinery insurance policy","type":"text","label":"b. Claim number under Machinery policy","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Power Failure (if applicable)","fields":[{"help":"Provide details below if power failure caused the loss","type":"text","label":"If the loss or damage is due to failure of Public Electricity supply, then please give following details:","options":[],"required":null,"pdf_field":""},{"help":"Enter date, time and duration of power failure","type":"text","label":"a. Date and time of power failure, duration of interruption period","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of power failure","type":"text","label":"b. Cause of the failure- prearranged shut down, sudden stoppage, etc.","options":[],"required":null,"pdf_field":""},{"help":"Attach certificate from electric supply authority confirming the power failure","type":"attachment","label":"Copy of the certificate received from the Electric supply authority to the above effect Should be enclosed.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"History of Breakdown or Power Interruption","fields":[{"help":"Provide a summary of breakdowns or power interruptions in last 3 months","type":"text","label":"Give brief details and history of breakdown or power interruption experienced during the past 3 months which affected normal working of cold storage plant.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loading of Stocks in Cold Storage","fields":[{"help":"Enter the start date of loading stocks","type":"date","label":"a. When did the loading of stocks start in the Cold storage chambers?","options":[],"required":null,"pdf_field":""},{"help":"Provide daily loading rate and temperature recorded during loading","type":"text","label":"b. Rate of loading per day. Temperature recorded during loading operation.","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when loading was completed","type":"date","label":"c. When was loading completed?","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when bags were turned over after loading","type":"date","label":"d. When were the bags turned over after loading was complete?","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when damage to stocks was first noticed","type":"date","label":"e. When did you notice damage to the stocks?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Quantum of Stocks","fields":[{"help":"Provide quantity of stocks in each chamber after loading","type":"text","label":"a. What were the quantum of stocks in each chamber on completion of loading?","options":[],"required":null,"pdf_field":""},{"help":"Provide quantity of stocks in each chamber on the day damage occurred","type":"text","label":"b. What were the quantum of stocks in each of the chambers on the day of occurrence?","options":[],"required":null,"pdf_field":""},{"help":"Attach log book records of stocks for last 3 months","type":"attachment","label":"Please enclose copies of the log book records of stocks held in cold storage chambers for past 3 months","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Temperature and Humidity Records","fields":[{"help":"Attach log book records of temperature and humidity for last 3 months","type":"attachment","label":"a. Please enclose copies of log book records giving four hourly temperatures and humidity reading records for past 3 months.","options":[],"required":null,"pdf_field":""},{"help":"Attach temperature and humidity records during power interruption","type":"attachment","label":"b. Temperature and humidity reading records during the interruption.","options":[],"required":null,"pdf_field":""},{"help":"Attach temperature and humidity records for 15 days after repairs","type":"attachment","label":"c. Temperature and humidity reading records after completion of repairs during ensuing 15 days.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Steps Taken to Minimize Loss","fields":[{"help":"Describe actions taken to maintain temperature after power failure","type":"text","label":"What steps were taken by you following the Breakdown/failure of electric supply to maintain temperature of the cold storage chambers with a view to minimize the loss?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Cause and Extent of Damage","fields":[{"help":"Provide your opinion on cause of stock deterioration","type":"text","label":"a. What, in your opinion, is the cause of deterioration of stocks?","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage and its extent","type":"text","label":"b. What is the nature and extent of damage sustained?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if damaged stocks were declared unfit by an authority","type":"yes-no","label":"c. Have damaged stocks been declared unfit for consumption/use by a recognised statutory inspecting/agricultural authority?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Estimate of Loss","fields":[{"help":"Provide your estimated monetary loss","type":"amount","label":"What is your estimate of loss?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Precautions for Future","fields":[{"help":"Describe measures planned to avoid future losses","type":"text","label":"What precaution and steps you propose to take to prevent similar loss in future?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration by Insured","fields":[{"help":"Confirm that all statements are true","type":"checkbox","label":"I/We hereby declare that the Statements made by me / us in this claim form are true to the best of my / our knowledge and belief.","options":[],"required":true,"pdf_field":""},{"help":"Consent to KYC verification","type":"checkbox","label":"I/We hereby give my/our consent to the Company to verify and obtain my/our identity/address proof as well as the identity /address proof of the Insured / Beneficial Owner through Central KYC Registry or UIDAI or through any other modes for the purpose of undertaking KYC.","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter the place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"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 of PEP*?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answer is Yes","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Deterioration of Stocks Insurance under commercial policies","attachments":["Copy of inspection report issued by the Plant Engineer Or Service Engineer","Copy of the certificate received from the Electric supply authority","Copies of the log book records of stocks held in cold storage chambers for past 3 months","Copies of log book records giving four hourly temperatures and humidity reading records for past 3 months","Temperature and humidity reading records during the interruption","Temperature and humidity reading records after completion of repairs during ensuing 15 days"],"declarations":["Statements made in this claim form are true to the best of the insured's knowledge and belief.","Consent is given to the company to verify identity/address proof through Central KYC Registry or 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/422-claim-form-for-deterioration-of-stocks-insurance"}