{"id":659,"title":"Claim Form - Private Car and Two Wheeler (Bengali)","purpose":"claim","insurer":{"slug":"liberty-general-insurance","name":"Liberty General Insurance Limited"},"source_pdf":"https://www.libertyinsurance.in/Docx/Claim%20Form%20-%20Private%20Car%20and%20Two%20Wheeler%20(Bengali).PDF","sha256":"afbd575c20f3957d91a3c7cc3cd7b22b6926aef3a6d5eb89fc51f37b3fd06e66","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders to claim insurance for damages or losses related to private car and two wheeler vehicles.","notes":["Use block letters to fill the form.","Attach original documents wherever required.","Incomplete forms may delay claim processing."],"title":"Claim Form - Private Car and Two Wheeler (Bengali)","submit":{"to":"Liberty General Insurance","how":"post / e-mail","address":"care@libertyinsurance.in"},"purpose":"claim","sections":[{"title":"B. Details of Accident / Incident","fields":[{"help":"Enter FIR or DDR or GDR number if filed","type":"text","label":"FIR / DDR / GDR संख्या","options":[],"required":null,"pdf_field":""},{"help":"Enter the date of FIR/DDR/GDR registration","type":"date","label":"FIR / GDR / DDR दाखिला तिथि","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"C. Vehicle Details","fields":[{"help":"Enter the RTO office name","type":"text","label":"RTO कार्यालय","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Submit claim within 30 days of the accident"],"applies_to":"Private Car and Two Wheeler insurance policies","attachments":["FIR copy if applicable","Vehicle Registration Certificate","Driving License copy","Repair estimate or bills","Police report if any"],"declarations":["I hereby declare that the information provided is true and correct to the best of my knowledge.","I authorize the insurer to verify the information and obtain necessary documents.","I agree to comply with the terms and conditions of the policy."],"dropped_labels":19},"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/liberty-general-insurance/659-claim-form-private-car-and-two-wheeler-bengali"}