{"id":845,"title":"Standard Fire & Special Perils Policy - Claim Form","purpose":"claim","insurer":{"slug":"national-insurance","name":"National Insurance Company Limited"},"source_pdf":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/Standard%20Fire%20%26%20Special%20Perils%20Policy%20-%20Claim%20Form_0.pdf","sha256":"deea880885b090c7ca8fc671b39153e00698628b0efaeb6b90f75a5cf1781442","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder to claim compensation for loss or damage caused by fire or special perils under the Standard Fire & Special Perils Policy.","notes":["The issue of the form is not an admission of liability by the company.","The claim must be based on the actual value of the property at the time of the fire after deduction of depreciation, wear and tear.","Salvage should be protected from deterioration without removing debris until permission is given.","Use detailed statements or estimates to support claims for contents and building damage."],"title":"Standard Fire & Special Perils Policy - Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant and Fire Details","fields":[{"help":"Date of filling the form","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place where the form is filled","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured person","type":"text","label":"Name of Insured","options":[],"required":null,"pdf_field":""},{"help":"Full name of the claimant if different from insured","type":"text","label":"Name of Claimant","options":[],"required":null,"pdf_field":""},{"help":"Policy number under which claim is made","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Name of the insurance agency","type":"text","label":"Agency","options":[],"required":null,"pdf_field":""},{"help":"Date of the fire incident","type":"date","label":"When did the Fire take place?","options":[],"required":null,"pdf_field":""},{"help":"Time of the fire incident","type":"text","label":"At the hour of","options":[],"required":null,"pdf_field":""},{"help":"Location of the damaged property","type":"text","label":"Situation of Property damaged or destroyed","options":[],"required":null,"pdf_field":""},{"help":"Description of premises usage at time of fire","type":"text","label":"How was the premises occupied at date of Fire?","options":[],"required":null,"pdf_field":""},{"help":"Confirm if policy description matches property condition before fire","type":"yes-no","label":"Does the Policy give a correct description of the Property in all respect as it existed immediately before the Fire?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if any new risk was introduced not covered by policy","type":"yes-no","label":"Has any element of risk been introduced which was not allowed by the Policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm compliance with policy terms","type":"yes-no","label":"Have the conditions and warranties of the Policy been complied with in every respect?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe other interests if claimant is not sole owner","type":"text","label":"If not state full particulars of any other interest.","options":[],"required":null,"pdf_field":""},{"help":"State if previous fire incidents occurred","type":"yes-no","label":"Has there been a previous Fire in these Premises or in any other Premises in which the Insured was interested?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of previous fire incidents if any","type":"text","label":"If so, state full particulars including the cause of such Fire or Fires.","options":[],"required":null,"pdf_field":""},{"help":"State if other insurance policies exist on property","type":"yes-no","label":"Were there at the time of the Fire any existing Insurance, whether effected by the claimant or by any other person, on the said Property with any other Company?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of other insurance policies if any","type":"text","label":"If so, state full particulars.","options":[],"required":null,"pdf_field":""},{"help":"Value of property before fire","type":"amount","label":"What was the sound value of all properties referred to the damaged without any design or procurement on my part by the aforesaid Fire according to the extent and value annexed;","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed from the insurance company","type":"amount","label":"Company, the sum of Rs.","options":[],"required":null,"pdf_field":""},{"help":"Name of witness to the claim form","type":"text","label":"Witness","options":[],"required":null,"pdf_field":""},{"help":"Claimant's signature","type":"signature","label":"Signature of Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Property Destroyed or Damaged","fields":[{"help":"Serial number of the article","type":"number","label":"No.","options":[],"required":null,"pdf_field":""},{"help":"Description of each damaged or destroyed article","type":"text","label":"Articles destroyed or damaged","options":[],"required":null,"pdf_field":""},{"help":"Value of the property before fire","type":"amount","label":"Value or Property","options":[],"required":null,"pdf_field":""},{"help":"Value of salvageable property after fire","type":"amount","label":"Value of Salvage","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed for each article","type":"amount","label":"Amount Claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"claims under Standard Fire & Special Perils Policy","attachments":["A detailed statement of the various articles claimed for or attached to the form","A detailed estimate by a Builder or other competent person in support of destruction or damage to building"],"declarations":["The claimant declares that the statement is full, true, and accurate.","The claimant declares no contract to sell or dispose of the property before the fire.","The claimant declares that the property was accidentally destroyed or damaged by fire without any design or procurement on their part."],"dropped_labels":3},"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/national-insurance/845-standard-fire-and-special-perils-policy-claim-form"}