{"id":544,"title":"CREDIT / DEBIT / ATM CARD PACKAGE 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/downloads/credit-debit-atm-card-package-insurance-policy-retail.pdf","sha256":"e11eb87b38baaee816fa9ff0208dba945cde7068b657a145bf75d9ea46d4a678","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for the policyholder to file a claim under the Credit/Debit/ATM Card Package Insurance Policy issued by ICICI Lombard General Insurance Company Limited.","notes":["The form does not contain fillable fields or detailed claim information sections.","Declarations must be agreed to by the claimant.","Contact details and company addresses are provided on the form header for reference."],"title":"CREDIT / DEBIT / ATM CARD PACKAGE INSURANCE POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Declarations","fields":[{"help":"Read and agree to the declarations before submitting the claim.","type":"text","label":"I/We hereby agree, affirm and declare that:","options":[],"required":null,"pdf_field":""},{"help":"Confirm the truthfulness and completeness of the information provided.","type":"checkbox","label":"a) The statements/information given/stated by me/us in this claim form are true, correct and complete.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Confirm no duplicate claims and all interested persons are disclosed.","type":"checkbox","label":"b) The details of all persons having an interest in the property in respect of which the claim is being made are provided as per the proposal form or by way of an endorsement in the policy. Furthermore, save and except as provided or disclosed in this claim form, no claim made hereunder (or the same/similar claim) has been made or lodged with any other insurance company.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Confirm full disclosure of all relevant information.","type":"checkbox","label":"c) No material information which is relevant to the processing of the claim or which in any manner has a bearing on the claim has been withheld or not disclosed.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Acknowledge consequences of false or fraudulent information.","type":"checkbox","label":"d) If I/we have given/made any false or fraudulent statement/information, or suppressed or concealed or in any manner failed to disclose material information, the policy shall be void and that I/We shall not be entitled to all/any rights to recover thereunder in respect of any or all claims, past, present or future.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Understand that claim acceptance is subject to company approval.","type":"checkbox","label":"e) The receipt of this claim form/other supporting/related documents does not constitute or be deemed to constitute an agreement by the Company of the claim and the Company reserves the right to process or reject or require further/additional information in respect of the claim.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Consent to KYC verification by the insurer.","type":"checkbox","label":"f) I/We hereby give my/our consent to the Company to verify and obtain my/our identity/address proof as well as the identity/address proof of the Insured / Beneficial Owner through Central KYC Registry or UIDAI or through any other modes for the purpose of undertaking KYC.","options":["Agree"],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Credit / Debit / ATM Card Package Insurance Policy - Retail","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 and no duplicate claims have been made.","No material information relevant to the claim has been withheld or undisclosed.","False or fraudulent information will void the policy and claims rights.","Receipt of the claim form does not guarantee claim acceptance; the company may require more information or reject the claim.","Consent is given to the company to verify identity/address proofs through official registries for KYC."],"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/544-credit-debit-atm-card-package-insurance-policy"}