{"id":853,"title":"EMI Protect Add-on 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/EMIP%20Claim%20Form_1.pdf","sha256":"a247d3de79bafefdd183a80772a4952f3134c02bc929e3f38e851859848a1742","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim EMI Protect Add-on benefits under their private car insurance policy.","notes":[],"title":"EMI Protect Add-on Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Policy Number :","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured","type":"text","label":"Name in full                               :","options":[],"required":null,"pdf_field":""},{"help":"Address where correspondence can be sent","type":"text","label":"Address for Correspondence     :","options":[],"required":null,"pdf_field":""},{"help":"Phone number of the insured","type":"phone","label":"Contact Number:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Insured Vehicle Details","fields":[{"help":"Vehicle make and model","type":"text","label":"Make & Model","options":[],"required":null,"pdf_field":""},{"help":"Year the vehicle was manufactured","type":"number","label":"Year of Manufacture","options":[],"required":null,"pdf_field":""},{"help":"Engine number of the vehicle","type":"text","label":"Engine No.","options":[],"required":null,"pdf_field":""},{"help":"Chassis number of the vehicle","type":"text","label":"Chassis No.","options":[],"required":null,"pdf_field":""},{"help":"Vehicle registration number","type":"text","label":"Registration No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss and EMI Details","fields":[{"help":"Describe the loss event","type":"text","label":"Description of loss :","options":[],"required":null,"pdf_field":""},{"help":"Name of the financial institution providing the EMI","type":"text","label":"Financial Institution:","options":[],"required":null,"pdf_field":""},{"help":"EMI amount","type":"amount","label":"EMI:","options":[],"required":null,"pdf_field":""},{"help":"Number of losses claimed in the policy period","type":"number","label":"No. of loss in policy period:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Supporting Documents","fields":[{"help":"Attach original bills, cash memos, or invoices","type":"attachment","label":"Supporting Documents: (Original bills/ cash memo/ invoice)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"EMI Protect Add-on under Private Car Package Policy and related private car policies","attachments":["Original bills/ cash memo/ invoice"],"declarations":[],"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/national-insurance/853-emi-protect-add-on-claim-form"}