{"id":469,"title":"CLAIM FORM KIDNAP AND RANSOM LIABILITY 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/27-kidnap-and-ransom-liability-retail8c0007ff45fd68ff8a0df0055faee28e.pdf","sha256":"a4278a4da32efcaabfa83c922aea6fc7fc4a95c6601d6dadef16a633d83e1833","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for insured persons to report and claim under the Kidnap and Ransom Liability Insurance policy.","notes":["Intimation is without prejudice and insurer’s rights are reserved.","File an FIR if applicable as per policy terms and conditions.","A licensed surveyor will be appointed within 24 hours of claim reporting.","Submit all necessary documents to the assigned Claims Manager or Surveyor.","Assessment report will be furnished within 15 days of receipt of claim form and documents.","Claim decision will be made within 7 days of receipt of assessment report."],"title":"CLAIM FORM KIDNAP AND RANSOM LIABILITY INSURANCE","submit":{"to":"Connect with us via: Toll-free no.: 1800 2666, Email ID: customersupport@icicilombard.com, on our website: https://coclaims.icicilombard.com/claimstracker/CommercialClaims/ccplandingpage.aspx","how":"Register the claim and submit claim related documents along with claim form via phone, email or online portal","address":""},"purpose":"claim","sections":[{"title":"Policy Details","fields":[{"help":"","type":"text","label":"Type of Cover:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy period","options":[],"required":null,"pdf_field":""},{"help":"Start date of the policy period","type":"date","label":"From","options":[],"required":null,"pdf_field":""},{"help":"End date of the policy period","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Date from which coverage is effective retroactively","type":"date","label":"Retroactive Date","options":[],"required":null,"pdf_field":""},{"help":"Sum insured limit under the policy","type":"amount","label":"Limit (sum Insured)","options":[],"required":null,"pdf_field":""},{"help":"Deductible amount applicable","type":"amount","label":"Deductible","options":[],"required":null,"pdf_field":""},{"help":"Date when the incident occurred","type":"date","label":"Date of Occurrence of Circumstances leading to loss","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Claim Details","fields":[{"help":"Describe the claim in detail","type":"text","label":"Description of the Claim","options":[],"required":null,"pdf_field":""},{"help":"Specify the jurisdiction where the claim applies","type":"text","label":"Jurisdiction affected","options":[],"required":null,"pdf_field":""},{"help":"Explain the type of kidnapping alleged","type":"text","label":"The nature of the alleged kidnapping","options":[],"required":null,"pdf_field":""},{"help":"Date when the kidnapping was committed","type":"date","label":"The date it was committed,","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage caused","type":"text","label":"The nature of the alleged damage,","options":[],"required":null,"pdf_field":""},{"help":"List all claimants involved","type":"text","label":"The names of the claimants","options":[],"required":null,"pdf_field":""},{"help":"List the defendants involved","type":"text","label":"Defendants","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any other insurance covering this risk","type":"text","label":"Details of Other Insurance covering same risk","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","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 the 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":""},{"help":"Provide the estimated claim amount","type":"amount","label":"Estimated amount of claim:","options":[],"required":null,"pdf_field":""},{"help":"Describe the sequence of events in date order","type":"text","label":"Chain of Events (in chronological date wise)","options":[],"required":null,"pdf_field":""},{"help":"Current status date of legal proceedings","type":"date","label":"Status of proceedings as on date:","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Attachments","fields":[{"help":"Attach copy of legal notice or written intimation","type":"attachment","label":"Copy of the legal notice/Written Intimation received by the insured","options":[],"required":null,"pdf_field":""},{"help":"Attach any legal opinion obtained","type":"attachment","label":"Any legal opinion considered by the insured","options":[],"required":false,"pdf_field":""},{"help":"Attach all correspondence related to the claim","type":"attachment","label":"Copy of the complete correspondence till date.","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"Declaration and Consent","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of authorised person","type":"signature","label":"Authorised Signatory","options":[],"required":true,"pdf_field":""},{"help":"Consent for 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":["Consent given"],"required":true,"pdf_field":""}],"filled_by":"Authorised Signatory"}],"deadlines":[],"applies_to":"Kidnap and ransom insurance","attachments":["Copy of the legal notice/Written Intimation received by the insured","Any legal opinion considered by the insured","Copy of the complete correspondence till date."],"declarations":["The insured must provide information and cooperation as reasonably required by the insurer.","The insured agrees not to settle or admit liability without insurer's prior written consent.","Consent is given to verify identity and address proofs through KYC registries."],"dropped_labels":1},"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/469-claim-form-kidnap-and-ransom-liability-insurance"}