{"id":456,"title":"BAGGAGE GROUP 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/20221216009-claim-form-for-baggage-group-insurance-policy-forms-rev-18c0007ff45fd68ff8a0df0055f6a601a.pdf","sha256":"28bfe8b3f0c544da030d88fd55f886745f2aa78cfbbd815942b345afcaa525d1","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is for insured persons to report and claim loss or delay of baggage under the Group Baggage Insurance Policy.","notes":["The issue of this form is not an admission of liability by the Company.","Do not delay submission of the form if all particulars are not immediately available; forward missing information as soon as possible.","Insured shall not enter into compromise or settlement without written permission of the Company.","Claims for total loss and delay of the same baggage item will be paid only for the higher claim.","Claims will be adjusted for any compensation received from carriers."],"title":"BAGGAGE GROUP 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":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City/Town","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter postal PIN code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Fax No.","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Claim","fields":[{"help":"","type":"text","label":"Name of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"Enter the claimed amount","type":"amount","label":"Amount of claim","options":[],"required":null,"pdf_field":""},{"help":"Tick if claim is for loss of baggage","type":"checkbox","label":"Loss of Baggage","options":["Loss of Baggage"],"required":false,"pdf_field":""},{"help":"Tick if claim is for delay of baggage","type":"checkbox","label":"Delay in Baggage","options":["Delay in Baggage"],"required":false,"pdf_field":""},{"help":"Enter start and end dates (DD/MM/YYYY)","type":"date","label":"Period during which the incident leading to claim occurred","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country in which the incident occurred","options":[],"required":null,"pdf_field":""},{"help":"Tick the nature of claim","type":"choice","label":"a. Kind of loss","options":["Theft","Fire","Accident","Any other"],"required":null,"pdf_field":""},{"help":"Enter passport number of claimant","type":"text","label":"Passport number","options":[],"required":null,"pdf_field":""},{"help":"List all items lost or damaged with brand and model numbers","type":"text","label":"Description of baggage*","options":[],"required":null,"pdf_field":""},{"help":"Provide purchase date or year for each item","type":"text","label":"Date/year of purchase","options":[],"required":null,"pdf_field":""},{"help":"Estimated value at time of loss for each item","type":"amount","label":"Value of contents","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Additional Details","fields":[{"help":"Enter date of claim (DD/MM/YYYY)","type":"date","label":"Date of claim","options":[],"required":null,"pdf_field":""},{"help":"Politically Exposed Persons status","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 applicable","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Signature","fields":[{"help":"Sign to confirm declaration","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing (DD/MM/YYYY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of the Alleged Claim (Page 2 continuation)","fields":[{"help":"Enter claimant's email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter claimant's passport number","type":"text","label":"Passport number of the Claimant","options":[],"required":false,"pdf_field":""},{"help":"Provide details of claim event","type":"text","label":"Date, amount, place and nature of claim","options":[],"required":false,"pdf_field":""},{"help":"List or attach evidence documents","type":"text","label":"Evidence in support of claim (Please refer to the section on claim documentation below)","options":[],"required":false,"pdf_field":""},{"help":"Provide details of other insurance if any","type":"text","label":"Give particulars of any other insurance, in respect of the same risk.","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":["Deliver detailed statement of loss or damage within 14 days of knowledge of the event","Police report to be made within 24 hours of becoming aware of loss"],"applies_to":"claims for loss or delay of baggage under the Group Baggage Insurance Policy","attachments":["Receipts for items lost","Copy of police report made within 24 hours of loss","Property Irregularity Report or carrier's report of loss","Proof of ownership for baggage valued over INR equivalent of $100","Written proof of delay from carrier for baggage delay over 12 hours","Receipts of essential personal items purchased due to baggage delay","Any other documents required by the Company"],"declarations":["The information given in this form is true, correct and complete.","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 form or documents does not constitute acceptance of the claim by the Company.","Consent is given to the Company to verify identity/address proof through official registries 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/456-baggage-group-insurance-policy"}