{"id":855,"title":"Loss of Belongings Add-on (Applicable to Private Cars) 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/Loss%20of%20Belongings%20Claim%20Form_0.pdf","sha256":"45d38dbfb3a98ed2230e2687ed06ffc7ee304c4f0936a2f29a71c9ab8b279cb6","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim loss of belongings under the Loss of Belongings Add-on for private car insurance policies.","notes":[],"title":"Loss of Belongings Add-on (Applicable to Private Cars) 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 person","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":"policyholder"},{"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":"policyholder"},{"title":"Loss Description","fields":[{"help":"Describe the belongings lost","type":"text","label":"Description of loss :","options":[],"required":null,"pdf_field":""},{"help":"Details about the loss incident","type":"text","label":"Loss details:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Supporting Documents and Other Details","fields":[{"help":"Attach original bills, cash memos, or invoices related to the lost belongings","type":"attachment","label":"Supporting Documents: (Original bills/ cash memo/ invoice)","options":[],"required":null,"pdf_field":""},{"help":"Number of loss claims made in the current policy period","type":"number","label":"No. of loss in policy period:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Place where the form is signed","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Date of signing the form","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":"policyholder"}],"deadlines":[],"applies_to":"Loss of Belongings Add-on (Applicable to Private Cars)","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/855-loss-of-belongings-add-on-applicable-to-private-cars-claim-form"}