{"id":475,"title":"CLAIM FORM BUSINESS GUARD PLUS","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/claim-form-business-guard-plus-commercial.pdf","sha256":"d4aa6862fcbce4cfef923aad9d59a9ac57c8982fd471e67320a62647223ffe4a","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to claim for loss or damage under the Business Guard Plus insurance policy.","notes":["Answer all questions fully.","Provide full details as on maker’s plate for damaged equipment.","Include a detailed explanation and sketch of the cause of damage wherever possible.","Provisional repairs will be indemnified.","Politically Exposed Persons (PEPs) are defined as individuals entrusted with prominent public functions."],"title":"CLAIM FORM BUSINESS GUARD PLUS","submit":{"to":"ICICI Lombard General Insurance Company Limited","how":"","address":"Interface Building No.16, 601/602, 6th Floor, New Link Road Malad (W), Mumbai - 400 064"},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number (i)","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number (ii)","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number (iii)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Provide exact date and time of loss or damage","type":"date","label":"When did the loss or damage occur? (State date and time)","options":[],"required":null,"pdf_field":""},{"help":"Provide full address of the property location","type":"text","label":"The address where the property (item) covered is situated.","options":[],"required":null,"pdf_field":""},{"help":"List items damaged with sum insured, description, manufacturer name and year","type":"table","label":"What was damaged? Item of the Inventory, Sum Insured, The description of the equipment, Manufacturer’s name and year of manufacture. (Full details as on maker’s plate to be given)","options":[],"required":null,"pdf_field":""},{"help":"Provide replacement cost for each item listed","type":"table","label":"What is the cost of replacement of the equipment by new equipment of the same size and capacity","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was the property brand new or second hand?","options":["Brand new","Second hand"],"required":null,"pdf_field":""},{"help":"Provide date or details of last service or maintenance","type":"text","label":"What was the last occasion before the damage when the equipment was serviced or attended to for maintenance or damage?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the damaged property totally destroyed?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the damage and parts needing replacement","type":"text","label":"What has occurred and which parts of the property are damaged to such an extent the replacement is necessary?","options":[],"required":null,"pdf_field":""},{"help":"Provide guarantee expiry date if applicable","type":"text","label":"Has the period of guarantee expired? If so, when?","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated loss amount","type":"amount","label":"What is the estimated amount of loss or damage?","options":[],"required":null,"pdf_field":""},{"help":"Explain cause and circumstances of damage; include sketch if possible","type":"text","label":"What was the cause of the damage and how did it occur? (This question must be answered in detail and a sketch given wherever possible)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the property undergone any repairs previously?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe previous repairs if any","type":"text","label":"What was the nature of such repairs?","options":[],"required":null,"pdf_field":""},{"help":"Provide repairer details","type":"text","label":"Give the name and address of the repairer where repairs will be executed: (Provisional repairs will be indemnified)","options":[],"required":null,"pdf_field":""},{"help":"Provide any other relevant details","type":"text","label":"Any additional information relevant to processing of claim.","options":[],"required":false,"pdf_field":""},{"help":"PEP means Politically Exposed Person as defined","type":"yes-no","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member / Close relatives / Associates close relative of a PEP*? Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide relationship and position details if applicable","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","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":"Sign here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Business Guard Plus policy claims","attachments":[],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having an interest in the property are disclosed as per the proposal or policy endorsement.","No similar claim has been made with any other insurance company except as disclosed.","No material information relevant to the claim has been withheld or not disclosed.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this claim form does not constitute admission of liability by the company.","Consent is given to verify identity/address proof through Central KYC Registry, UIDAI or other modes."],"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/475-claim-form-business-guard-plus"}