{"id":470,"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-retail.pdf","sha256":"340356ac4ce9fe18606715e23b2547c84414eac764a204908188149878e8215d","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for the insured to notify and claim under the Public Liability Insurance Non-Industrial Risk policy.","notes":["Use original documents and provide all necessary supporting documents as listed","File FIR if applicable as per policy terms","Claim reference number will be provided upon claim registration for future correspondence","Contact toll-free number, email or website for claim intimation and tracking"],"title":"CLAIM FORM FOR PUBLIC LIABILITY INSURANCE NON - INDUSTRIAL RISK","submit":{"to":"Assigned Claims Service Manager (CSM) or Surveyor","how":"Submit documents to assigned CSM/Surveyor via contact details provided","address":""},"purpose":"claim","sections":[{"title":"Insured and Claim Information","fields":[{"help":"Select Yes or No if you or related persons are Politically Exposed Persons","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 details if other insurance covers the same risk","type":"text","label":"Details of Other Insurance covering same risk","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Consent for KYC Verification","fields":[{"help":"Tick to give 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":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim Intimation and Process Instructions","fields":[{"help":"Contact toll-free 1800 2666, email customersupport@icicilombard.com or use the website claim portal to register claim and submit documents","type":"text","label":"Claim Intimation","options":[],"required":null,"pdf_field":""},{"help":"File FIR if third-party property damage, bodily injury, fire etc. as per policy terms","type":"text","label":"File an FIR","options":[],"required":null,"pdf_field":""},{"help":"Claims Manager will appoint a licensed surveyor within 24 hours of claim reporting","type":"text","label":"Surveyor Appointment","options":[],"required":null,"pdf_field":""},{"help":"Submit claim form, photos/videos, supporting documents, FIR, repair/replacement quotes, KYC/NEFT details, invoices, and any other documents requested by surveyor","type":"table","label":"Documents","options":[],"required":null,"pdf_field":""},{"help":"Repair/replacement details will be assessed and approved by Claims Manager or surveyor","type":"text","label":"Assessment Approval","options":[],"required":null,"pdf_field":""},{"help":"Amount assessed for damaged asset's salvage value where applicable","type":"text","label":"Salvage","options":[],"required":null,"pdf_field":""},{"help":"Assessment report within 15 days of claim form receipt; claim decision within 7 days of assessment","type":"text","label":"Turnaround Time (TAT)","options":[],"required":null,"pdf_field":""}],"filled_by":""}],"deadlines":["Assessment sheet / Survey report will be furnished within 15 days of receipt of claim form and documents","Claim will be decided within 7 days of receipt of the assessment sheet / survey report"],"applies_to":"Public Liability Insurance Non-Industrial Risk policies","attachments":["Claim bill / Claim Form duly filled up","Photographs / Video of damaged property/item under claim","Documents supporting admissibility of the claim (court proceedings, communications, invoices, payment proofs, investigation reports, counsel opinions, engagement letter)","FIR / Final Police investigation report wherever applicable","Repair/replacement quotation, invoice and payment proofs for items to be repaired or reinstated","Documents substantiating quantum & value of items under claim not to be repaired or reinstated","Offer for retention of salvage, if any","KYC / NEFT Details as per AML guidelines","Invoice copy / Goods Receipt Note / Monetary Claim on carrier / Damage Certificate","Any other document specified by the surveyor post initial survey"],"declarations":["The insured must provide information and cooperation as reasonably required by the insurer","The insured agrees not to settle or admit liability for any claim without insurer’s prior written consent","The intimation is without prejudice and insurer’s rights are reserved","Consent is given to verify identity/address proof through Central KYC Registry or 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/470-claim-form-for-public-liability-insurance-non-industrial-risk"}