{"id":429,"title":"CLAIM FORM PRODUCT LIABILITY INSURANCE POLICY","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/product-liability-commercial.pdf","sha256":"c634ce3e69b8c947fc7b2af5b1d0cdabecd5c8aa4acf770fb8e443339a0586e1","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for policyholders or claimants to file a claim under the Product Liability Insurance Policy with ICICI Lombard General Insurance Company Limited.","notes":["PEP means Politically Exposed Persons as defined in the form.","Contact details and company addresses are provided for correspondence."],"title":"CLAIM FORM PRODUCT LIABILITY INSURANCE POLICY","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":"PEP Declaration","fields":[{"help":"Select Yes or No to indicate if you or any proposed applicant is a Politically Exposed Person or related to one.","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 of the relationship and position if you answered Yes above.","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":null,"pdf_field":""}],"filled_by":"proposed applicants/beneficial owner"},{"title":"Consent for KYC Verification","fields":[{"help":"Consent to allow the insurer to verify identity and address proofs for KYC purposes.","type":"yes-no","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":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"claimant or policyholder"}],"deadlines":[],"applies_to":"Product Liability Insurance Policy (Commercial)","attachments":[],"declarations":["Consent to allow the company to verify identity and address proofs 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/429-claim-form-product-liability-insurance-policy"}