{"id":674,"title":"CLAIM FORM FOR ERECTION ALL RISK POLICY","purpose":"claim","insurer":{"slug":"liberty-general-insurance","name":"Liberty General Insurance Limited"},"source_pdf":"https://www.libertyinsurance.in/Docx/ERECTION%20ALL%20RISKS%20-%20Claim%20Form.pdf","sha256":"e523dc1eb19582a48b9009ddaf4f9de032ee7baa5776c101a50977cc63b0e187","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for notifying and claiming physical loss or damage under the Erection All Risk insurance policy. It is filled by the insured policyholder.","notes":["The issue of this form is not an admission of liability.","Answer all questions fully.","This form is to be filled by the insured policyholder."],"title":"CLAIM FORM FOR ERECTION ALL RISK POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"Enter the policy or cover note number","type":"text","label":"Cover Note / Policy No","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Enter the date when the loss or damage occurred","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Enter the claim number if already assigned","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the insured's full name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Enter the insured's mailing address","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Enter primary contact number","type":"phone","label":"Contact Number (i)","options":[],"required":null,"pdf_field":""},{"help":"Enter alternate contact number if any","type":"phone","label":"Contact Number (ii)","options":[],"required":false,"pdf_field":""},{"help":"Enter additional contact number if any","type":"phone","label":"Contact Number (iii)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss or Damage","fields":[{"help":"Provide exact date and time of loss or damage","type":"text","label":"When did the loss or damage occur? (State date and time)","options":[],"required":null,"pdf_field":""},{"help":"Enter location of the insured property","type":"text","label":"The address where the property (item) covered is situated.","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage to the erection property","type":"text","label":"Particulars of damage to erection property.","options":[],"required":null,"pdf_field":""},{"help":"Describe any third party property damage","type":"text","label":"Nature & extent of damage, if any, belonging to third party.","options":[],"required":false,"pdf_field":""},{"help":"Provide owner details of third party property damaged","type":"text","label":"Name & addresses of owner of property so damaged.","options":[],"required":false,"pdf_field":""},{"help":"State ownership details if not sole owner","type":"text","label":"Is the claimant the sole owner if property damaged ? if not state full particulars of any other interest","options":[],"required":false,"pdf_field":""},{"help":"Explain cause and circumstances of damage","type":"text","label":"What was the cause of the damage and how did it occur?","options":[],"required":null,"pdf_field":""},{"help":"Describe immediate actions taken to minimize loss","type":"text","label":"What steps were taken Immediately to reduce the loss","options":[],"required":false,"pdf_field":""},{"help":"Indicate if damage happened during testing and provide testing start date/time if yes","type":"yes-no","label":"Has damage occurred during testing? If yes then please specify date & time of commencement of testing.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide witness contact details if any","type":"text","label":"Give name & address of the witness to the occurrence.","options":[],"required":false,"pdf_field":""},{"help":"State if any party is responsible for the damage","type":"yes-no","label":"Is anyone responsible for damage?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain if recovery from responsible party is possible","type":"text","label":"Please mention the possibility of recovery.","options":[],"required":false,"pdf_field":""},{"help":"Provide location for inspection of damaged items","type":"text","label":"Address where the damaged items can be inspected","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated financial loss","type":"amount","label":"What is the estimated amount of loss or damage?","options":[],"required":null,"pdf_field":""},{"help":"Describe repair plans including parts replacement","type":"text","label":"How will the damages be repaired? (state the details whether any parts must be replaced)","options":[],"required":false,"pdf_field":""},{"help":"Provide detailed explanation of damage occurrence","type":"text","label":"How did the damage occur? (This question must be answered in detail)","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated salvage value","type":"amount","label":"The estimated salvage or scrap value of damaged parts to be replaced.","options":[],"required":false,"pdf_field":""},{"help":"List other insurance policies covering this loss","type":"text","label":"Details of any other insurance under which you are entitled to recover in respect of the loss or damage.","options":[],"required":false,"pdf_field":""},{"help":"Indicate if you will do repairs yourself","type":"yes-no","label":"Do you wish to carry out repairs yourself?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide repairer details if repairs are entrusted","type":"text","label":"Name & address of the repairer, if entrusted for repairs.","options":[],"required":false,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Any additional information relevant to processing of claim :","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Erection All Risk Policy claims for physical loss or damage","attachments":[],"declarations":["The statements and information given in this claim form are true, correct and complete.","All persons having an interest in the property are disclosed as per the proposal or policy endorsements.","No similar claim has been made with any other insurance company except as disclosed.","No material information relevant to the claim has been withheld or concealed.","If any false or fraudulent information is given, the policy shall be void and no claim rights will exist.","Receipt of this claim form or documents does not mean acceptance of the claim; the company may require more information or reject the claim."],"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/liberty-general-insurance/674-claim-form-for-erection-all-risk-policy"}