{"id":471,"title":"Claims Intimation Form Commercial and Political Risks Insurance Format of Proof of Loss","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/commercial-and-political-risks-insurance.pdf","sha256":"1e498b14fa8f63bbeda5c1dbe87bca846dc8db6f9d30d50821a8f352d01f0dee","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to notify ICICI Lombard General Insurance Company Ltd. of a loss or unpaid insured payment under a Political Risk Insurance policy and to claim the insured amount.","notes":["The insured must advise promptly of any advice/communication from the Buyer regarding non-payment or calling of the Insured Guarantee.","The insured must advise promptly of any payments or reimbursements received from the Buyer after claim submission.","The insured should request confirmation of receipt of the claim notice from the insurer."],"title":"Claims Intimation Form Commercial and Political Risks Insurance Format of Proof of Loss","submit":{"to":"ICICI Lombard General Insurance Company Limited","how":"","address":"601/602, 6th Floor, Interface Building No.16, New Link Road Malad (W), Mumbai - 400 064"},"purpose":"claim","sections":[{"title":"Claim Details","fields":[{"help":"Enter your insurance policy number.","type":"text","label":"Insurance Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of the loss or unpaid payment.","type":"text","label":"Cause of Loss:","options":[],"required":null,"pdf_field":""},{"help":"Enter the overdue amount in INR.","type":"amount","label":"Amount overdue:","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when the loss occurred or payment was due.","type":"date","label":"Date of Loss (due date of Insured Payment):","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when you first contacted the buyer after payment was due.","type":"date","label":"Date of first post-maturity approach to Buyer for payment:","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No to indicate if any party is a Politically Exposed Person or related.","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 if any party is a PEP.","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Supporting Documentation","fields":[{"help":"Attach correspondence with the buyer about non-payment.","type":"attachment","label":"Correspondence with the Buyer relating to the non-payment of the Insured Payment","options":[],"required":null,"pdf_field":""},{"help":"Attach correspondence regarding calling the insured guarantee.","type":"attachment","label":"Correspondence with the Buyer with reference to the calling of the Insured Guarantee","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim Amount and Payment Details","fields":[{"help":"Provide the insured's or loss payee's bank account details for payment.","type":"text","label":"Please make payment in accordance with the Policy to the following account:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Consent","fields":[{"help":"Consent to KYC verification.","type":"checkbox","label":"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":["I consent"],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Commercial and Political Risks Insurance","attachments":["Copies of appropriate documentation evidencing the occurrence of the applicable cause of loss plus, where appropriate, evidence of the Insured Payment and of its non-payment","Correspondence with the Buyer relating to the non-payment of the Insured Payment","Correspondence with the Buyer with reference to the calling of the Insured Guarantee"],"declarations":["The insured is not aware of any legal or valid reason for non-payment by the Buyer or for calling of the Insured Guarantee.","The insured has complied with all conditions and warranties of the Policy.","Consent is given to the Company to verify identity and address proof through Central KYC Registry or UIDAI or other modes."],"dropped_labels":3},"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/471-claims-intimation-form-commercial-and-political-risks-insurance-format-of-proof-"}