{"id":523,"title":"CLAIM FORM CIVIL ENGINEERING COMPLETED RISKS (CECR) INSURANCE","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/civil-engineering-completed-risks-insurance---retial.pdf","sha256":"e7361a85c34a3f156d45fba69780b96b9e9aba5c543604b56cb42db789bf240b","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured to claim insurance for losses under the Civil Engineering Completed Risks Insurance Policy.","notes":[],"title":"CLAIM FORM CIVIL ENGINEERING COMPLETED RISKS (CECR) INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Policy Details","fields":[{"help":"","type":"text","label":"Area Office Code/Service Center Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Broker/Agent Name & code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Plot No/Door No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Road","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Building Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Customer ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal pin code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Policy and Loss Details","fields":[{"help":"Enter the start date of the insurance period","type":"date","label":"Period of insurance: From Date","options":[],"required":null,"pdf_field":""},{"help":"Enter the date and time when the loss occurred","type":"date","label":"Date & time of loss","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Describe the risk covered under the policy","type":"text","label":"Risk Covered","options":[],"required":null,"pdf_field":""},{"help":"Describe the insured item and its location","type":"text","label":"Insured item & Location","options":[],"required":null,"pdf_field":""},{"help":"Enter the sum insured in rupees","type":"amount","label":"Sum Insured (Rs)","options":[],"required":null,"pdf_field":""},{"help":"Enter the estimated loss amount in rupees","type":"amount","label":"Estimated amount of loss (Rs)","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss happened","type":"text","label":"Nature & cause of loss (please describe the circumstances leading to the loss)","options":[],"required":null,"pdf_field":""},{"help":"Provide details if other insurance covers this risk","type":"text","label":"Give details of insurance with any other insurance company on the risk involved in the loss/accident","options":[],"required":null,"pdf_field":""},{"help":"Explain ownership and interests if not sole owner","type":"text","label":"If insured is not sole owner, the nature of his/their interest in the property and details of other interests","options":[],"required":null,"pdf_field":""},{"help":"Select if loss was reported to police or fire brigade","type":"choice","label":"Whether the loss is intimated to a. Police b. Fire Brigade","options":["Police","Fire Brigade"],"required":null,"pdf_field":""},{"help":"Provide past claim details if any","type":"text","label":"Was any claim reported in the past on the same property during current policy period? If so, give details regarding a. Cause b. Date of accident c. Claim number d. Policy issuing office e. Amount of claim paid/outstanding","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/Close relatives/Associates of PEP*? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe relationship and position if yes","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":"Declaration by Insured","fields":[{"help":"Enter the date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter the place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Civil Engineering Completed Risks Insurance Policy Retail","attachments":[],"declarations":["The statements made in this claim form are true to the best of the insured's knowledge and belief.","The insured consents to the company verifying identity and address proofs through Central KYC Registry, 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/523-claim-form-civil-engineering-completed-risks-cecr-insurance"}