{"id":529,"title":"Industrial All Risks Insurance Policy","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---industrail-all-risk---retail.pdf","sha256":"66e0080086ab9cdcde916e3f67ff6661de4a6c853651b8dd6f266ad0178318c5","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for notifying and claiming physical loss or damage under the Industrial All Risks Insurance policy. It is filled by the insured claimant.","notes":["The issue of this form is not to be taken as an admission of liability.","If insurance is effected with other companies, copies of such policies must be attached."],"title":"Industrial All Risks Insurance Policy","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Correspondence address of the insured","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Phone number of the insured","type":"phone","label":"Contact Number.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any mortgagee or other financial interest holders","type":"text","label":"Name and Address of Mortgagee(s) or other persons having financial interest in the property.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposed applicants a PEP* or Family member/ Close relatives/Associates of PEPs*? YES / NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Describe relationship and position 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":"claimant"},{"title":"Details of Other Insurance","fields":[{"help":"Name of other insurer if any","type":"text","label":"Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Policy number(s) of other insurance","type":"text","label":"Policy No. (s).","options":[],"required":false,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Sum Insured Rs.","options":[],"required":false,"pdf_field":""},{"help":"Start date of other insurance","type":"date","label":"Period From","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Loss","fields":[{"help":"When the loss occurred","type":"date","label":"Time & Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe cause of loss","type":"text","label":"Cause of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the affected insured item","type":"text","label":"Item of Policy affected (give description)","options":[],"required":null,"pdf_field":""},{"help":"State the use or occupation of the premises","type":"text","label":"Occupation of the premises at the time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Yes/No and reasons if not reported","type":"text","label":"Has the Fire / Loss been reported to Fire Brigade? (If not, give reasons)","options":[],"required":null,"pdf_field":""},{"help":"Yes/No and reasons if not reported","type":"text","label":"Has the Fire / Loss been reported to Police? (If not, give reasons)","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Loss Inspection and Extent","fields":[{"help":"Location for inspection of loss","type":"text","label":"Address where the loss can be inspected.","options":[],"required":null,"pdf_field":""},{"help":"Describe extent of loss","type":"text","label":"Extent of Loss (as more particularly described in the statement overleaf)","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":""}],"filled_by":"claimant"},{"title":"Declaration and Signature","fields":[{"help":"Place of signing","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":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Industrial All Risks Insurance","attachments":["copies of other insurance policies if insurance is effected with other companies"],"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 concealed.","False or fraudulent statements or concealment of information will void the policy and claims.","Receipt of this form does not constitute admission of liability; the company may require further information.","Consent is given to verify identity/address proof through Central KYC Registry, UIDAI or other modes.","Premiums have been and will be paid from legally acquired sources of income."],"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/529-industrial-all-risks-insurance-policy"}