{"id":912,"title":"National Bharat Laghu Udyam Suraksha Plus 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/Laghu%20Udyam%20Plus%20-%20Claim%20Form.pdf","sha256":"f7dcc9a0e168f8cac0b53ce04564386a57320aa4448ed96206d6661e9b9be9ed","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim losses under the National Bharat Laghu Udyam Suraksha Plus Policy. The policyholder or their legal representative fills it.","notes":["Issuance of claim form does not imply acceptance of liability.","Please use additional pages if required."],"title":"National Bharat Laghu Udyam Suraksha Plus 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 in the loss with details as columns","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":"Specify the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Provide the exact 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":"Indicate if photos are submitted and how many","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 authorities informed and attach report 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 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 stock losses","type":"text","label":"Details of loss of stock (raw materials, in process finished goods)","options":[],"required":null,"pdf_field":""},{"help":"Describe building damage and estimated loss","type":"text","label":"Details of damage to building (damage and amount of loss)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if optional covers are involved","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":"insured"},{"title":"Additional Information","fields":[{"help":"Confirm if all prior declarations were submitted","type":"text","label":"Whether you have submitted all declarations prior to this loss incident in case of Declaration policy:","options":[],"required":null,"pdf_field":""},{"help":"Describe ownership interest and other parties involved","type":"text","label":"If insured is not sole owner, the nature of his/their interest in the property and details of other interests:","options":[],"required":null,"pdf_field":""},{"help":"List other insurances covering the same risk","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":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Location 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":"Sign here","type":"signature","label":"Signature of the Insured/Legal Representative","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"claims under National Bharat Laghu Udyam Suraksha Plus Policy","attachments":["Photographs of loss or physical damage","Copy of report made to Police, Fire Brigade or other authorities"],"declarations":["The particulars furnished are true and correct to the best of my 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/912-national-bharat-laghu-udyam-suraksha-plus-policy-claim-form"}