{"id":931,"title":"Navi Bharat Sookshma Udyam Suraksha Insurance 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/NaviBharatSookshmaUdyamSurakshaPolicy/2020-2021/January/NaviBharatSookshmaUdyamSurakshaPolicy%20Claim-Form.pdf","sha256":"7339a598cc7c787aaafdf57f462dc80946bb629ec6a6d526e1dd5f27c330d6bd","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim insurance for losses under the Navi Bharat Sookshma Udyam Suraksha Policy.","notes":["Fill the form completely.","The issue of this form is not an admission of liability."],"title":"Navi Bharat Sookshma Udyam Suraksha Insurance 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":null,"pdf_field":""},{"help":"Enter start and end dates of insurance period","type":"date","label":"Period of Insurance: FROM   D D /  M M /  Y Y Y Y    to   D D /  M M /  Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"","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":"6-digit postal code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"10-digit mobile number","type":"phone","label":"Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"Include STD code","type":"phone","label":"Landline No.:","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"EMAIL ID:","options":[],"required":false,"pdf_field":""},{"help":"If applicable","type":"text","label":"Details of Mortgagee(s):","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Details","fields":[{"help":"Date and time when loss occurred","type":"date","label":"Date of Loss:   D D /  M M /  Y Y Y Y   TIME of Loss:  H H / M M  AM/PM","options":[],"required":null,"pdf_field":""},{"help":"Address or place of loss","type":"text","label":"Loss Location:","options":[],"required":null,"pdf_field":""},{"help":"Brief description of what was lost or damaged","type":"text","label":"Description of Loss:","options":[],"required":null,"pdf_field":""},{"help":"List damaged items with columns: S. No., Description of Damaged Item, Insured Value, Market Value, Reinstatement Value, Amount Claimed","type":"table","label":"Items affected","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Were the PREMISE unoccupied at the TIME of loss:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date from when premise was unoccupied","type":"text","label":"If Yes, then since when it was unoccupied:","options":[],"required":false,"pdf_field":""},{"help":"Address for inspection","type":"text","label":"Address where the inspection can be carried out:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Police & Fire Brigade Details","fields":[{"help":"Select if police report was filed","type":"choice","label":"Police report lodged:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Police report number","type":"text","label":"If Yes, Report No.:","options":[],"required":false,"pdf_field":""},{"help":"Date of police report","type":"date","label":"Date: D D / M M / Y Y Y Y","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":"Select if fire brigade was informed","type":"choice","label":"Fire Brigade INTIMATION:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of fire brigade report","type":"text","label":"If Yes, Report Details:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance Details","fields":[{"help":"Select if other insurance covers the loss","type":"choice","label":"Is the loss covered under any other insurance policy:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide Name & Address of Insurance Company, Policy No., From, To, Sum Insured (Rs)","type":"table","label":"If Yes, then give the details below","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Date of signing","type":"date","label":"Date: D D / M M / Y Y Y Y","options":[],"required":true,"pdf_field":""},{"help":"Sign and affix company seal if applicable","type":"signature","label":"Signature of Insured (Company’s seal in case the insured is a firm/company)","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"","attachments":["Annexure if premise was unoccupied at time of loss","Police report copy if lodged","Fire brigade report if intimated"],"declarations":["The information provided is true to the best of my knowledge and belief.","False or fraudulent statements will void the policy and forfeit claim rights.","The company may verify facts and documents related to the claim.","Consent is given to the company to collect, retain, and share personal and sensitive information for servicing the policy and claim.","I will inform the company to update or correct my information as needed.","Withdrawal of 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/931-navi-bharat-sookshma-udyam-suraksha-insurance-claim-form"}