{"id":594,"title":"LIABILITY INSURANCE - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/liability-insurance-claim-form","sha256":"072639b41539a639536d137b56b7f3821b7d2f62355c8ef0152e78479893923d","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to report and claim for a liability insurance loss or damage incident.","notes":["The issue of this form is not an admission of liability.","Notify the company without delay as soon as loss or damage is known.","If any detail is not readily available, send the form immediately and provide missing particulars later.","Attach copies of notifications, bills, and reports as applicable.","Use the health care unit address and email for related correspondence: IndusInd General Insurance, No.1-89/3/B/40 to 42/ks/301, 3rd floor, Krishe Block, Krishe Sapphire, Madhapur, Hyderabad - 500081. Email: healthcare@indusindinsurance.com."],"title":"LIABILITY INSURANCE - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. INSURED","fields":[{"help":"","type":"text","label":"Policy Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Include City, Pin Code","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of insurance period","type":"date","label":"Period of Insurance: From D D / M M / Y Y Y Y To D D / M M / Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"Specify indemnity limits as per policy","type":"text","label":"Limits of Indemnity under the policy:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"B. PARTICULARS OF ACCIDENT","fields":[{"help":"Provide date and time when accident occurred","type":"date","label":"Date & Time of Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Location where accident happened","type":"text","label":"Place of accident","options":[],"required":null,"pdf_field":""},{"help":"Describe what happened and how","type":"text","label":"Brief description of the kind and history of the Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Date when accident was first known to you","type":"date","label":"When did you first come to know of the accident?","options":[],"required":null,"pdf_field":""},{"help":"Date when accident was reported to insured","type":"date","label":"When was the accident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"Date when insurer was first notified","type":"date","label":"When was the claim first notified to the Insurer?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. PARTICULARS OF CONSEQUENCE OF THE ACCIDENT","fields":[{"help":"","type":"yes-no","label":"Has any person sustained any injuries in the accident? If so, o  Yes   o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide full details of injured persons","type":"text","label":"Give name(s) of such Person(s), Address(es), City, Pin Code, Occupation, State where such person(s) was/ were at the time of accident","options":[],"required":null,"pdf_field":""},{"help":"If yes, give particulars","type":"yes-no","label":"Has/Have the injured person(s) been removed to hospital or medically attended? o  Yes   o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, give name(s) and address(es) of owner(s), description and extent of damage","type":"yes-no","label":"Has the accident caused damage to property or livestock? o  Yes   o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, state by whom and give full particulars; attach copy of notification and bill if submitted","type":"yes-no","label":"Has any claim been made upon you by any person? o  Yes   o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide estimated claim amounts for injuries, property damage, and claims made","type":"amount","label":"Estimated amount of Claim separately under C 1, C 2 and C3","options":[],"required":null,"pdf_field":""},{"help":"List witnesses with contact details","type":"text","label":"Give, if possible, the names of all witnesses to the accident: Name, Addresses, City, Pin Code","options":[],"required":null,"pdf_field":""},{"help":"If yes, state to whom and attach copy of report submitted","type":"yes-no","label":"Has the accident been reported to any authority? o  Yes   o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe any official action taken","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":null,"pdf_field":""},{"help":"Mention applicable law or statute","type":"text","label":"Give details of Statute/Law under which in your opinion, liability may arise","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"D. DETAILS OF OTHER INSURANCES","fields":[{"help":"List other insurance policies covering this loss","type":"text","label":"Give details of other Insurances, if any, covering the present loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"E. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide information on prior claims related to this item","type":"text","label":"Give details of Previous Claims, if any, on the same item","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Signature and Date","fields":[{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"PEP DECLARATION","fields":[{"help":"Select if you are a PEP","type":"yes-no","label":"Are you a Politically Exposed Person (PEP)? o Yes  o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify position if PEP","type":"text","label":"If yes, please mention the position held","options":[],"required":null,"pdf_field":""},{"help":"Select if any close relative is a PEP","type":"yes-no","label":"Is any of your close relation or family member a PEP? o Yes  o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of relative who is a PEP","type":"text","label":"If yes, please mention the name and relation and the position held by such close relative/family member.","options":[],"required":null,"pdf_field":""},{"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 Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"GENERAL DECLARATION","fields":[{"help":"Address and email of Health Care Unit","type":"text","label":"Health Care Address:","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Liability Insurance","attachments":["Copy of the notification received and of the bill, if submitted","Copy of the report submitted to authority"],"declarations":["The insured warrants the truth of the statements and understands that false or fraudulent statements will forfeit the claim and void the policy.","The proposer declares that if they or close relatives become Politically Exposed Persons (PEP) in future, they will inform the insurer.","The proposer confirms premiums are paid from bonafide sources and understands the insurer may verify sources of funds.","The insurer may cancel the contract if the proposer is found guilty under money laundering laws.","The proposer consents to verification of KYC and PAN details and accepts responsibility for any mismatches."],"dropped_labels":0},"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/594-liability-insurance-claim-form"}