{"id":626,"title":"INDUSIND - COMPREHENSIVE GENERAL LIABILITY - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/comprehensive-general-liability-claim-form","sha256":"8c18c7dd94654dc92791d0508134cc951d5773e08f204c03dbafcad18e4a1c3e","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Comprehensive General Liability insurance policy.","notes":["Fill the form in BLOCK LETTERS.","Issuance of this form does not imply acceptance of liability.","Attach original documents as required.","Use additional sheets if space is insufficient."],"title":"INDUSIND - COMPREHENSIVE GENERAL LIABILITY - CLAIM FORM","submit":{"to":"IndusInd General Insurance Company Limited","how":"send the completed form immediately to the company","address":"Registered & Corporate Office: 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off. Western Express Highway, Goregaon (E), Mumbai-400063"},"purpose":"claim","sections":[{"title":"SECTION 1 - 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":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Registration","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area Office Code/Service Centre Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Broker/Agent Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Code","options":[],"required":null,"pdf_field":""},{"help":"Select title and enter full name in block letters","type":"text","label":"Name of the Insured","options":["Mr.","Mrs.","Ms."],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Customer ID","options":[],"required":null,"pdf_field":""},{"help":"Include Plot No./Flat No., Building Name, Road, Area, City, State, Pin Code","type":"text","label":"Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Enter GST Number if applicable","type":"text","label":"GSTN No","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN Number if applicable","type":"text","label":"PAN No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 2 - DETAILS OF THE LOSS OCCURED","fields":[{"help":"Date in DD/MM/YYYY and time in HH:MM AM/PM format","type":"date","label":"Date & time of loss","options":[],"required":null,"pdf_field":""},{"help":"Location where loss occurred","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed description","type":"text","label":"Brief Description and history of Loss or Damages","options":[],"required":null,"pdf_field":""},{"help":"Specify policy section applicable","type":"text","label":"Under which section do you want to lodge the claim?","options":[],"required":null,"pdf_field":""},{"help":"Date or time when incident was first known","type":"text","label":"When did you first come to know the accident / event","options":[],"required":null,"pdf_field":""},{"help":"Estimated financial liability amount","type":"amount","label":"Estimated amount of liability","options":[],"required":null,"pdf_field":""},{"help":"Date in DD/MM/YYYY format if applicable","type":"date","label":"Date of receipt of Legal notice (if any)","options":[],"required":false,"pdf_field":""},{"help":"If applicable, estimated expenses","type":"amount","label":"Estimated product recall expenses","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Accident Reporting","fields":[{"help":"","type":"yes-no","label":"Has the accident / incident been reported to any authority?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide authority name and attach report copy","type":"text","label":"If yes, mention to whom and attach a copy of the report submitted","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Legal Notice Details","fields":[{"help":"Provide details if applicable","type":"text","label":"If you have received legal notice for slander / libel / violation of right of privacy / infringement of copyright, title, slogan, trademark, or trade name. Kindly provide the details along with date of legal notice along with estimated liability.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Legal and Liability Details","fields":[{"help":"","type":"text","label":"Any legal opinion taken or process is initiated till date?","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Legal Expenses / investigation expenses incurred till date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of Previous similar losses & specify if legal notices being served earlier (if any)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of other insurances along with retroactive date (if any)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Bank Details","fields":[{"help":"Select Yes to receive payment via NEFT","type":"choice","label":"Would you like to opt for NEFT payment?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Branch Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"A/C Holder Name as in Bank Record","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Account No","options":[],"required":false,"pdf_field":""},{"help":"11 digit code printed on your cheque leaf","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration by Insured","fields":[{"help":"Sign to declare the truthfulness of the information","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["This form should be completed and returned to the company immediately"],"applies_to":"Comprehensive General Liability insurance claims","attachments":["Cancelled cheque leaf if opting for NEFT payment","Copy of report submitted to authority if accident reported","Copy of legal notice if received"],"declarations":["The statements made in this claim form are true to the best of the insured's knowledge and belief.","The address mentioned shall be taken as address on record for GST purposes."],"dropped_labels":4},"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/626-indusind-comprehensive-general-liability-claim-form"}