{"id":520,"title":"Entertainment Production Package Policy 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/claims-form_entertainment-production-package-policy_aa.pdf","sha256":"9a7001d11bd029d481e849938f37c34c5db440338ca83339630a91a260583752","pages":5,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Entertainment Production Package Policy for loss or damage related to their insured production.","notes":["The issuance of this form is not an admission of liability.","Please answer all questions fully.","Attach original FIR and court documents as applicable."],"title":"Entertainment Production Package Policy CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of the Insured","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""},{"help":"Provide full mailing address","type":"text","label":"Address for Correspondence:","options":[],"required":null,"pdf_field":""},{"help":"Provide a phone number to be contacted","type":"phone","label":"Contact Number:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Details","fields":[{"help":"Describe the type of loss or damage","type":"text","label":"Nature of loss/damage","options":[],"required":null,"pdf_field":""},{"help":"List the damaged items","type":"text","label":"Details of damaged property","options":[],"required":null,"pdf_field":""},{"help":"Provide location details of the loss","type":"text","label":"Place & address where loss took place","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time","type":"date","label":"Date and time when loss was first discovered","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss or damage occurred","type":"text","label":"State the circumstances of the loss or damage","options":[],"required":null,"pdf_field":""},{"help":"Summarize the loss","type":"text","label":"Briefly explain the loss","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated monetary value","type":"amount","label":"Estimated value of items lost or damaged","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time of police report","type":"date","label":"Date & time of reporting the loss to the police station. (Please furnish copy of FIR)","options":[],"required":null,"pdf_field":""},{"help":"Provide police station details","type":"text","label":"Name and address of the police station","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Have you ever before sustained loss of the same nature? If so, give particulars.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance and Third Party Details","fields":[{"help":"Provide details of other insurance if any","type":"text","label":"Is there any other insurance for the same movie production? If so, give full particulars","options":[],"required":null,"pdf_field":""},{"help":"Provide details of third party victims","type":"text","label":"Name/s, address/es, occupation/s of such person/s","options":[],"required":null,"pdf_field":""},{"help":"Provide court case details if applicable","type":"text","label":"Has any case been filed in any court of law/tribunal against you, in relation to the accident? If yes, what is the present date of proceedings? Also, help us with the next date of hearing.","options":[],"required":null,"pdf_field":""},{"help":"Provide details and copies if applicable","type":"text","label":"Have any notices/summons of the Court been received by you? If yes, please provide copies of the same.","options":[],"required":null,"pdf_field":""},{"help":"Provide copies of court orders if applicable","type":"text","label":"Has the Court passed any interims or final order? If yes, please provide copies of the same.","options":[],"required":null,"pdf_field":""},{"help":"Attach all court-related documents","type":"attachment","label":"Also provide copies of all the documents that have been submitted to the Court, either by you or the Claimants, and copies of all documents.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Personal Accident Details","fields":[{"help":"Provide injured person's details","type":"text","label":"Name and address of the person who has been injured.","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time","type":"date","label":"Date & time of injury/death","options":[],"required":null,"pdf_field":""},{"help":"Provide location details","type":"text","label":"Place of injury/ death","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident","type":"text","label":"Details of the accident","options":[],"required":null,"pdf_field":""},{"help":"Specify status of injured person","type":"text","label":"Was such person a legal audience or was an employee.","options":[],"required":null,"pdf_field":""},{"help":"Provide location details","type":"text","label":"Where were such persons at the time of injury?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police was informed","type":"yes-no","label":"Whether reported to Police.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide police station details if reported","type":"text","label":"If yes then name and address of Police Station.","options":[],"required":null,"pdf_field":""},{"help":"Provide hospital details if applicable","type":"text","label":"Was the injured /deceased person moved to hospital immediately after the accident? If yes , Name & address of the hospital","options":[],"required":null,"pdf_field":""},{"help":"Describe any permanent disability","type":"text","label":"Has the accident resulted into loss of hand/s or foot/feet or eye/s or permanent disability of any other type which may prevent the insured from engaging in or being occupied with or giving attention to any employment or occupation whatsoever?","options":[],"required":null,"pdf_field":""},{"help":"Explain how injury occurred","type":"text","label":"Give details of the incident leading to such injury.","options":[],"required":null,"pdf_field":""},{"help":"Describe any preventive attempts","type":"text","label":"Were any attempts made to avoid such accident. If yes, then give details.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Information","fields":[{"help":"Provide any other relevant details","type":"text","label":"Any additional information relevant to processing of claim.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"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":"Sign here","type":"signature","label":"Signature of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"Sign here if different from claimant","type":"signature","label":"Signature of Account Holder","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Entertainment Production Package Policy claims","attachments":["Copy of FIR","Copies of notices/summons of the Court if received","Copies of court orders if any","Copies of all documents submitted to the Court"],"declarations":["The information given in this claim form is true, correct and complete.","All persons having an interest in the property are disclosed as per the proposal or policy endorsements.","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 concealed.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this claim form or documents does not mean acceptance of the claim by the company.","Consent is given to verify identity through Central KYC registry, UIDAI or other modes for KYC purposes."],"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/520-entertainment-production-package-policy-claim-form"}