{"id":942,"title":"EMI SHIELD 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/EMI%20Shield%20-%20Claim%20Form","sha256":"904876d0ba61ac8c77d7e006215e3ef7a78a6251658c03bd53497b7264f864cb","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder or claimant to file a claim under the EMI Shield insurance policy.","notes":["Issue of this claim form is not an admission of liability.","Insurance is the subject matter of solicitation; read sales brochure carefully before concluding a sale."],"title":"EMI SHIELD CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy Holder Details","fields":[{"help":"","type":"text","label":"Policy Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured:","options":[],"required":null,"pdf_field":""},{"help":"Use date format as printed","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""},{"help":"Tick the appropriate gender","type":"checkbox","label":"Male","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Tick the appropriate gender","type":"checkbox","label":"Female","options":["Male","Female"],"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":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"6-digit postal code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile Number :","options":[],"required":null,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claimant Details (if different from Policy Holder)","fields":[{"help":"","type":"text","label":"Name of the Claimant:","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship to insured","type":"text","label":"Relationship with Insured:","options":[],"required":null,"pdf_field":""},{"help":"Use date format as printed","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""},{"help":"Tick the appropriate gender","type":"checkbox","label":"Male","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Tick the appropriate gender","type":"checkbox","label":"Female","options":["Male","Female"],"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":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"6-digit postal code","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile Number :","options":[],"required":null,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Details of Accident/Incidence","fields":[{"help":"Date when accident/incidence occurred","type":"date","label":"Date of Accident/Incidence:","options":[],"required":null,"pdf_field":""},{"help":"Specify time and tick A.M. or P.M.","type":"text","label":"Time of Accident:","options":["A.M.","P.M."],"required":null,"pdf_field":""},{"help":"Describe cause briefly","type":"text","label":"Cause of Accident/Incidence:","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed description","type":"text","label":"Details of Accident/Incidence:","options":[],"required":null,"pdf_field":""},{"help":"Describe injury sustained","type":"text","label":"Nature of Injury:","options":[],"required":null,"pdf_field":""},{"help":"Tick yes or no and attach report if yes","type":"yes-no","label":"Was the accident reported? 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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/942-emi-shield-claim-form"}