{"id":472,"title":"COMMERCIAL GENERAL LIABILITY INSURANCE CLAIM FORM","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/comprehensive-general-liability-commercial.pdf","sha256":"e36a710df80c61ab5d9b47ac58143e3f54a61971161a4727f09e8b053e7e05b1","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is for insured policyholders to report and claim under their commercial general liability insurance policy.","notes":["The issue of this form is not an admission of liability","Do not delay returning the form if some particulars are not immediately available; they may be sent later","In case of third-party property damage/bodily injury, file an FIR if applicable as per policy terms","Your Claims Manager will appoint a licensed surveyor within 24 hours of claim reporting","Submit all relevant documents to the assigned Claims Manager or Surveyor","Assessment and approval of repair/replacement details will be done by Claims Manager or Surveyor","Salvage value will be assessed where applicable"],"title":"COMMERCIAL GENERAL LIABILITY INSURANCE CLAIM FORM","submit":{"to":"the Company via Claims Manager (CSM) or Surveyor as assigned","how":"submit claim form and documents via toll-free number, email, website or to assigned CSM/Surveyor","address":"Email ID: customersupport@icicilombard.com; Website: https://coclaims.icicilombard.com/claimstracker/CommercialClaims/ccplandingpage.aspx; Toll-free no.: 1800 2666"},"purpose":"claim","sections":[{"title":"DETAILS OF INSURED","fields":[{"help":"","type":"text","label":"a. Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"b. Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"c. Contact Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"d. Limits of Indemnity under the Policy","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of accident","fields":[{"help":"","type":"date","label":"a. Date and time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"b. Place of accident","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident briefly; attach extra sheets if needed","type":"text","label":"c. Brief description of the accident (attach separate sheets if necessary)","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"d. When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Accident Reporting to Authority","fields":[{"help":"State authority name and attach report copy if applicable","type":"text","label":"Has the accident been reported to any authority? If so, state by whom and attach a copy of the report submitted (like","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signature","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":"Official stamp of the insured","type":"signature","label":"Stamp of the insured","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"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":"Commercial General Liability Insurance claims","attachments":["Claim bill / Claim Form duly filled up","Photographs / Video of damaged property/item under claim","Document/s in support of admissibility of the claim, for instance, all proceedings filed before the courts, communications exchanged with the insured, invoices, payment proofs, internal/external investigation report of the insured, Insureds counsel opinion on merits and demerits of the case, insured counsel engagement letter etc.","FIR / Final Police investigation report wherever applicable","Repair/ replacement quotation, invoice and payment proofs for each and every item as claimed (for items to be repaired or reinstated)","Documents substantiating the quantum & value of the items under claim (for items 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 which may be specified by the surveyor post completion of initial survey"],"declarations":["The statements/information given in this form are true, correct and complete","No material information relevant to the claim has been withheld or not disclosed","If any false or fraudulent information is given, the policy shall be void and no claim rights will exist","Receipt of this form and documents does not mean the claim is accepted; the Company may require further information or reject the claim"],"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/472-commercial-general-liability-insurance-claim-form"}