{"id":561,"title":"INDUSIND MOTOR ASSURED VALUE INSURANCE - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/motor-assured-value-insurance-claim-form","sha256":"2e461aad5a6a030a85f8f3d8b3c41c7c5b9c91257d46c1bd11bfd79287a363cf","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for the insured or beneficiary to claim under the Motor Assured Value Insurance policy by IndusInd General Insurance Company Limited.","notes":["All fields in the form are mandatory.","Fill the form in CAPITAL LETTERS.","Attach original documents as specified.","Payments to insured are only through electronic mode as per IRDAI.","Use additional page if needed for previous claim details.","Politically Exposed Persons (PEPs) definition and importance explained.","Claim intimation can be done via Call Centre, email or Selfie app."],"title":"INDUSIND MOTOR ASSURED VALUE INSURANCE - CLAIM FORM","submit":{"to":"IndusInd General Insurance Company Limited via Call Centre, email or Selfie app","how":"Call, email or upload via app","address":"Call Centre: 022 48903009 (paid No.), Email: services@indusindinsurance.com"},"purpose":"claim","sections":[{"title":"DETAILS OF INSURED AND BENEFICIARY","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Certificate No.","options":[],"required":true,"pdf_field":""},{"help":"Enter start and end dates of the policy period","type":"date","label":"Policy Period From D D / M M / Y Y Y Y To D D / M M / Y Y Y Y","options":[],"required":true,"pdf_field":""},{"help":"Select appropriate title and enter full name in capital letters","type":"text","label":"Insureds Full Name","options":["Mr.","Mrs.","Ms.","M/S."],"required":true,"pdf_field":""},{"help":"Enter full address details in capital letters","type":"text","label":"Address for Communication Flat / Building Road/Street/Sector Nearest Landmark Area Taluka/Village/District/City Pin Code State","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID","options":[],"required":true,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"Pan No.","options":[],"required":true,"pdf_field":""},{"help":"Select appropriate title and enter full name in capital letters","type":"text","label":"Beneficiary’s Full Name","options":["Mr.","Mrs.","Ms.","M/S."],"required":true,"pdf_field":""},{"help":"Enter full address details in capital letters","type":"text","label":"Address for Communication Flat / Building Road/Street/Sector Nearest Landmark Area Taluka/Village/District/City Pin Code State","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"D.O.B. D D / M M / Y Y Y Y","options":[],"required":true,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Phone","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile","options":[],"required":true,"pdf_field":""},{"help":"Enter alternate phone number if any","type":"phone","label":"Alternate Phone","options":[],"required":false,"pdf_field":""},{"help":"Enter alternate mobile number if any","type":"phone","label":"Alternate Mobile","options":[],"required":false,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID","options":[],"required":true,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"Pan No.","options":[],"required":true,"pdf_field":""},{"help":"Enter Aadhaar number","type":"text","label":"UID Aadhaar No.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or beneficiary"},{"title":"VEHICLE DETAILS","fields":[{"help":"Enter vehicle registration number","type":"text","label":"Registration No.","options":[],"required":true,"pdf_field":""},{"help":"Enter vehicle registration date","type":"date","label":"Date of Registration D D / M M / Y Y Y Y","options":[],"required":true,"pdf_field":""},{"help":"Enter engine or motor number","type":"text","label":"Engine / Motor No.","options":[],"required":true,"pdf_field":""},{"help":"Enter Vehicle Identification Number","type":"text","label":"VIN No.","options":[],"required":true,"pdf_field":""},{"help":"Enter vehicle make","type":"text","label":"Make","options":[],"required":true,"pdf_field":""},{"help":"Enter vehicle model","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"Enter current odometer reading","type":"number","label":"Odometer Reading","options":[],"required":true,"pdf_field":""},{"help":"Select vehicle class","type":"choice","label":"Class of Vehicle","options":["Pvt Car"],"required":true,"pdf_field":""},{"help":"Select if vehicle is financed and provide financier name if yes","type":"choice","label":"Financiers o Yes o No If yes, Name of Financier","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select if vehicle is fitted with LPG or CNG","type":"choice","label":"Vehicle fitted with LPG/ CNG o Yes o No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select if vehicle has anti-theft device","type":"choice","label":"Vehicle fitted with Anti theft device o Yes o No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter claim number if available","type":"text","label":"Claim No.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or beneficiary"},{"title":"VEHICLE LEGAL MATTERS, THIRD-PARTY INVOLVEMENT, AND CUSTODIANSHIP DETAILS","fields":[{"help":"Select yes or no","type":"choice","label":"Is there any history of legal cases, obligations, fines, penalties, or RTO violations permissible against the insured vehicle? o Yes o No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes above","type":"text","label":"If Yes, Please share the details","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or beneficiary"},{"title":"BANK DETAILS FOR NEFT PAYMENT (For Reimbursement Claims)","fields":[{"help":"Select title and enter full name","type":"text","label":"Name of the Bank Account Holder o Mr. o Mrs. o Ms. o M/S. FIRST MIDDLE LAST","options":["Mr.","Mrs.","Ms.","M/S."],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.:","options":[],"required":true,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account Type: o Saving o Current","options":["Saving","Current"],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the Bank:","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch","type":"text","label":"Branch:","options":[],"required":true,"pdf_field":""},{"help":"Enter 9 digit MICR code from cheque","type":"text","label":"MICR Code (9 digit MICR code number of the bank and branch appearing on the cheque issued by the bank)","options":[],"required":true,"pdf_field":""},{"help":"Enter 11 character IFSC code from cheque","type":"text","label":"IFSC Code (11 character code appearing on your cheque leaf)","options":[],"required":true,"pdf_field":""},{"help":"Confirm understanding of electronic payment","type":"checkbox","label":"I understand that any refund due on the premium payment / any payment / claims to be directly credited to my aforesaid Bank Account.*","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or beneficiary"},{"title":"DECLARATION","fields":[{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or beneficiary"},{"title":"PEP DECLARATION","fields":[{"help":"Select yes or no","type":"choice","label":"Are you a Politically Exposed Person (PEP)? o Yes o No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide position if yes above","type":"text","label":"If yes, please mention the position held","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"Is any of your close relation or family member a PEP? o Yes o No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes above","type":"text","label":"If yes, please mention the name and relation and the position held by such close relative/family member.","options":[],"required":false,"pdf_field":""},{"help":"Confirm understanding and agreement","type":"checkbox","label":"I hereby declare that in future if me, any of my close relatives or any of my family member attains a position of PEP then I shall confirm the same to IndusInd General Insurance Co. Ltd as a mandate.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or beneficiary"},{"title":"AML GUIDELINES DECLARATION","fields":[{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or beneficiary"}],"deadlines":["Intimate the claim to the insurance company within Intimation window at the earliest"],"applies_to":"Motor Assured Value Insurance claims","attachments":["Copy of signed cancelled cheque of the Bank Account of the insured only","Certificate Copy","Registration Book"],"declarations":["The details given are true and correct to the best of my knowledge and belief.","Incorrect information may lead to forfeiture of rights under the policy.","I have read and retained the Claim Procedure attached to this form.","I agree to provide additional information if required.","I indemnify and hold harmless the Company for any loss due to misstatement in this form.","The vehicle condition meets all wear and tear guidelines in the policy.","Any refund or payment will be credited to the bank account provided electronically.","I declare that if I or my close relatives become Politically Exposed Persons, I will inform the insurer.","All premiums are paid from bonafide sources and not from proceeds of crime.","The insurer may verify sources of funds and cancel the contract if found guilty under money laundering laws.","I consent to verification of my KYC and PAN details and accept responsibility for any mismatch."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"services@indusindinsurance.com","label":"Health Insurance Claims Email","level":1,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"nce Claim\nTravel Insurance Claim\nCommercial Insurance Claim\nSupport\nSign In\nSelf Help\nVideo Chat\nContact Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"indusind@europ-assistance.in","label":"Travel Insurance Claims Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance App\nWebsite:\nOnline Claim Intimation\nOffline Visit:\nLocate your nearest branch\nh","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91 22 48903009","label":"Car Insurance Claim Intimation","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934189","label":"Motor Claims Helpline","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"ation.\nNeed Guidance on Car Coverage?\nTalk to Our Professional Advisors\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nSteps to Take After a Car ​Accident\nThe following steps can expedite the road accident insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934188","label":"Health Claims Helpline","level":null,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"your nearest location.\nExpert health advice you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934184","label":"Travel Claims Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"e you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation\nYour claim gets rejected when you don't gi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+912248903009","label":"Inland Travel Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"rds your registered bank account.\nHow to Contact Us For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 552","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"91-22-67347843","label":"International Travel Helpline (abroad)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 209 5522","label":"International Travel Helpline (in India)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance","fetched_at":"2026-10-20"}],"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/indusind-general-insurance/561-indusind-motor-assured-value-insurance-claim-form"}