{"id":928,"title":"BUSINESS PACKAGE CLAIM FORM","purpose":"claim","insurer":{"slug":"navi-general-insurance","name":"Navi General Insurance Limited"},"source_pdf":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviInsurance/CocoBusinessPackage/2020-2021/January/CocoBusinessPackage%20Claim%20Form.pdf","sha256":"74098cb4887c0fe9c5a9a29372dfbdfdab535dec7d41990b82b0954b92b21d0e","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim under their business package insurance policy by providing details of the loss and related information.","notes":["Please fill this form completely.","The issue of this form is not an admission of liability.","Attach separate sheet if items affected exceed the space provided.","Use original medical records if hospitalization is involved."],"title":"BUSINESS PACKAGE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Policy Holder","fields":[{"help":"","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.:","options":[],"required":false,"pdf_field":""},{"help":"Enter start date of insurance period","type":"date","label":"Period of Insurance: From","options":[],"required":null,"pdf_field":""},{"help":"Enter end date of insurance period","type":"date","label":"to","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured or claimant","type":"text","label":"Insured / Claimant’s Name:","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Landline No.:","options":[],"required":false,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID:","options":[],"required":false,"pdf_field":""},{"help":"Details of any mortgagee or financier if applicable","type":"text","label":"Details of Mortgagee/Financiers (s):","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Details","fields":[{"help":"Date when the loss occurred","type":"date","label":"Date of Loss:","options":[],"required":null,"pdf_field":""},{"help":"Time of loss with AM/PM","type":"text","label":"Time of Loss:","options":[],"required":false,"pdf_field":""},{"help":"Describe the loss event","type":"text","label":"Description of Loss:","options":[],"required":null,"pdf_field":""},{"help":"List damaged or lost items with Identification No. and Estimated Loss (Rs.)","type":"table","label":"Items affected (Attach separate sheet, if required):","columns":["S. No.","Damage/Lost Items","Identification No. (If any)","Estimated Loss (Rs.)"],"options":[],"required":false,"pdf_field":""},{"help":"Indicate if police report was filed","type":"yes-no","label":"Police report lodged:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Police report number if applicable","type":"text","label":"If Yes, Report No.:","options":[],"required":false,"pdf_field":""},{"help":"Date of police report","type":"date","label":"Date:","options":[],"required":false,"pdf_field":""},{"help":"Name of police station","type":"text","label":"Police Station:","options":[],"required":false,"pdf_field":""},{"help":"District of police station","type":"text","label":"District:","options":[],"required":false,"pdf_field":""},{"help":"Indicate if fire brigade was informed","type":"yes-no","label":"Fire Brigade Intimation:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of fire brigade report if applicable","type":"text","label":"If Yes, Report Details:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance Details","fields":[{"help":"Indicate if any other insurance covers the loss","type":"yes-no","label":"Is the loss covered under any other insurance policy:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other insurance policies covering the loss","type":"table","label":"If Yes, then give the details below","columns":["S. No.","Name & Address of Insurance Company","Policy No","From","To","Sum Insured (Rs)"],"options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Signature of the insured or claimant","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Place where the form is signed","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"business package insurance claims","attachments":["In event of Hospitalization, attach necessary medical records"],"declarations":["I/We agree to provide additional information to the Company if required.","I/We warrant the truth of the foregoing statement and understand that false or fraudulent statements will void the policy and forfeit rights to claim.","I/We understand the Company may verify facts and documents related to the policy and claim.","I/We consent to the Company collecting, retaining, and sharing my/our information including sensitive personal information for servicing the policy and claim.","I/We understand I/We can update or correct information by intimating the Company.","I/We understand that withdrawing consent may result in the Company not providing services."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"insurance.help@navi.com","label":"Claims intimation","level":1,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"own damage claim\n12 | Policy Servicing Claim Intimation and Processing | 1. Call Us: Toll Free 1800 123 0004 2. Email: insurance.help@navi.com 3. Email for Senior Citizens- seniorcare@navi.com 4. Visit our website: https://www.naviinsurance.com/service/ 5. Walk","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"seniorcare@navi.com","label":"Email for Senior Citizens","level":1,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"on and Processing | 1. Call Us: Toll Free 1800 123 0004 2. Email: insurance.help@navi.com 3. Email for Senior Citizens- seniorcare@navi.com 4. Visit our website: https://www.naviinsurance.com/service/ 5. Walk in for assistance 6. Dispatch your letters to us a","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 123 0004","label":"Toll Free","level":1,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"nses - paid amount under own damage claim\n12 | Policy Servicing Claim Intimation and Processing | 1. Call Us: Toll Free 1800 123 0004 2. Email: insurance.help@navi.com 3. Email for Senior Citizens- seniorcare@navi.com 4. Visit our website: https://www.n","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"url","value":"https://www.naviinsurance.com/service/","label":"Customer Portal on website","level":1,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"1800 123 0004 2. Email: insurance.help@navi.com 3. Email for Senior Citizens- seniorcare@navi.com 4. Visit our website: https://www.naviinsurance.com/service/ 5. Walk in for assistance 6. Dispatch your letters to us at – Corporate Office: Navi General Insurance Limited, Vaishna","fetched_at":"2026-10-20"}],"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/navi-general-insurance/928-business-package-claim-form"}