{"id":466,"title":"CLAIM FORM FOR PUBLIC LIABILITY INSURANCE NON - INDUSTRIAL RISK","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/public-liability-non-industrial-risks-commercial.pdf","sha256":"25afee4291718753d3e2f170e144f0d9b72c64b3dec8c67d5edc76123686cfec","pages":1,"collected":"2026-10-20","instructions":{"about":"This form is for the insured to notify and provide information to the insurer about a claim under the Public Liability Insurance Non-Industrial Risk policy.","notes":["The insured must not settle or admit liability for any claim without prior written consent from the insurer.","The form includes a definition of Politically Exposed Persons (PEPs)."],"title":"CLAIM FORM FOR PUBLIC LIABILITY INSURANCE NON - INDUSTRIAL RISK","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 any applicant is a Politically Exposed Person or related to one.","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":"Provide details about the relationship and position if the answer above is Yes.","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Public Liability Insurance Non-Industrial Risk","attachments":[],"declarations":["The insured must provide information and cooperation as reasonably required by the insurer.","The insured agrees not to settle or incur costs related to any claim without the insurer's prior written consent.","The intimation is without prejudice and the insurer’s rights are reserved.","Consent is given to the company to verify identity/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/466-claim-form-for-public-liability-insurance-non-industrial-risk"}