{"id":906,"title":"National Bharat Griha Raksha 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/Griha%20Raksha%20-%20Claim%20Form.pdf","sha256":"613b6c888b9b6e740371095e119f6e4eb1d575c7f87ae658c9228d2c730cca0b","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim losses under the National Bharat Griha Raksha Policy by providing details of the loss incident and related information.","notes":["Issuance of claim form does not imply acceptance of liability.","Use additional pages if required."],"title":"National Bharat Griha Raksha Policy Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Policy Details","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of insured property","options":[],"required":null,"pdf_field":""},{"help":"List all policies involved with their details in the columns as labeled","type":"table","label":"Please give following details pertaining to all the policies involved in loss incident: Sl. No Policy No. Risk Covered Location Sum Insured Estimated amount of loss","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Incident Details","fields":[{"help":"Provide the date and time when the loss occurred","type":"date","label":"Date and Time of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss happened and attach photos","type":"text","label":"Nature and Cause of Loss (Please describe the circumstances leading to the loss and attach some photographs)","options":[],"required":null,"pdf_field":""},{"help":"Tick yes or no and specify number if yes","type":"choice","label":"Photographs of loss or physical damage submitted? Yes No If Yes, Nos ________","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick all that apply and provide report details with copy","type":"checkbox","label":"Whether Loss intimated to (tick against the box) Police Fire Brigade Other Details of report made. (Enclose the copy with the claim form)","options":["Police","Fire Brigade","Other"],"required":null,"pdf_field":""},{"help":"List damaged or lost contents with estimated loss amount","type":"text","label":"Details of loss of contents (items, damage and amount of loss)","options":[],"required":null,"pdf_field":""},{"help":"Describe building damage and estimated loss amount","type":"text","label":"Details of damage to building (damage and amount of loss)","options":[],"required":null,"pdf_field":""},{"help":"Tick yes or no","type":"choice","label":"Details of loss or damage under any Optional Cover or Add-ons Yes No If Yes, complete following sections:","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Optional Cover Details","fields":[{"help":"Provide name(s) if death occurred","type":"text","label":"Whether the incident has resulted in the death of Insured or his/her spouse: If yes, name of the person/s:","options":[],"required":null,"pdf_field":""},{"help":"Tick yes or no","type":"choice","label":"Whether the said person/s was insured under the policy:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List valuable contents lost or damaged and estimated loss with proof","type":"text","label":"Whether the incident has resulted in any loss under Valuable contents cover : If yes, plz mention the following details: The details of valuable contents damaged lost : The amount of estimated loss with proof :","options":[],"required":null,"pdf_field":""},{"help":"Provide rent insured and period with proof if applicable","type":"text","label":"Whether the incident has resulted in any loss under Loos of Rent/ Alternate Accommodation? If yes, please provide following with proof: Rent insured: Period:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance and Previous Claims","fields":[{"help":"Provide details of other insurance policies covering similar risks","type":"text","label":"Details of any other insurance providing similar coverage","options":[],"required":null,"pdf_field":""},{"help":"Provide details of previous claims if any","type":"text","label":"Any claim reported under the policy during the policy period? If yes, give details regarding: (a) Cause (b) Date of incident (c) Claim (d) Policy Issuing Office (e) Amount of claim paid/Outstanding Rs.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","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/Legal Representative","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"claims under National Bharat Griha Raksha Policy","attachments":["Photographs of loss or physical damage","Copy of police/fire brigade/other report if loss intimated","Proof of estimated loss for valuable contents","Proof for loss under Loss of Rent/Alternate Accommodation"],"declarations":["The particulars furnished are true and correct to the best of the signer's knowledge."],"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/906-national-bharat-griha-raksha-policy-claim-form"}