{"id":936,"title":"MOTOR 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/NaviMiscellaneousVehiclePackageInsurance/2020-2021/January/NaviMiscellaneousVehiclePackageInsurance%20Motor%20Insurance%20Claim%20Form.pdf","sha256":"df5de31669cc0a026cac7e35165e4bcdeabfa9273dee5e0b74ef5971e3257ee2","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to report and claim motor insurance for vehicle accidents or losses.","notes":["Fill the form completely.","Use the specified date and time formats.","The declaration must be signed and dated.","The company contact details are provided for assistance."],"title":"MOTOR 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":false,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Regn No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Chassis No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Engine No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Insured / Claimant’s Name:","options":[],"required":null,"pdf_field":""},{"help":"","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 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at the time of accident:","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Driver at the time of accident","fields":[{"help":"Full name with title","type":"text","label":"Name of Driver: Mr./Ms./Mrs.","options":[],"required":null,"pdf_field":""},{"help":"Driver's license number","type":"text","label":"Driving License (DL) No.:","options":[],"required":null,"pdf_field":""},{"help":"Regional Transport Office that issued the license","type":"text","label":"Issuing RTO:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Police Notification Details","fields":[{"help":"","type":"choice","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 (DD/MM/YYYY)","type":"date","label":"Date:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Police Station:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"District:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Injury Details","fields":[{"help":"","type":"choice","label":"Injury/Death of any occupant/Third Party (Others):","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of injured or deceased persons","type":"text","label":"If Yes, Details of Injured person:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Third Party Property Damage","fields":[{"help":"","type":"choice","label":"Third party property damage:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the property damage","type":"text","label":"If Yes, then details of the property damage:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Details in case of commercial vehicles","fields":[{"help":"","type":"text","label":"Permit No.:","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Valid Up to:","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Fitness Valid Up to:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Goods carried:","options":[],"required":false,"pdf_field":""},{"help":"Lorry Receipt / Goods Receipt number","type":"text","label":"LR/GR No.:","options":[],"required":false,"pdf_field":""},{"help":"Driving License Badge number","type":"text","label":"DL Badge No.:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured (Company’s seal in case the insured is a firm/company)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Private Car, Two Wheeler, Commercial Vehicle","attachments":[],"declarations":["The form issue is not an admission of liability.","The policyholder warrants the truth of the statements and understands that false or fraudulent statements will void the policy and forfeit claim rights.","The company reserves the right to verify facts and documents related to the policy and claim.","The policyholder consents to the company collecting, retaining, and sharing personal and sensitive information for servicing the policy and claim.","The policyholder may update or withdraw consent for information sharing, understanding that withdrawal may affect service provision."],"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/936-motor-insurance-claim-form"}