{"id":968,"title":"CLAIM FORM","purpose":"claim","insurer":{"slug":"new-india-assurance","name":"The New India Assurance Company Limited"},"source_pdf":"https://www.newindia.co.in/assets/docs/know-more/fire/new-india-bharat-laghu-udyam-suraksha-policy/Claim%20Form.pdf","sha256":"96745d5542faed44fab2904e3d9d9834f747f29f5952d76e40b5d0e91d5232fc","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to report and claim losses under the New India Bharat Laghu Udyam Suraksha Policy.","notes":["Issuance of this form is not to be taken as admission of any liability.","Please answer all required questions fully.","Please use additional pages, if required."],"title":"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":"Fill details for each policy involved in the loss incident","type":"table","label":"Please give following details pertaining to all the policies involved in loss incident.\n\nSl. No\nPolicy No.\nRisk Covered\nLocation\nSum Insured\nEstimated 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":""},{"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","type":"text","label":"Nature and Cause of Loss (Please describe the circumstances leading to the loss)","options":[],"required":null,"pdf_field":""},{"help":"Tick all that apply","type":"choice","label":"Whether Loss intimated to (tick against the box) Police / Fire Brigade / Other","options":["Police","Fire Brigade","Other"],"required":null,"pdf_field":""},{"help":"Explain ownership or interest in the property if not sole owner","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":""}],"filled_by":"insured"},{"title":"Details of Loss","fields":[{"help":"Describe the damage to the building","type":"text","label":"Details of loss to Building","options":[],"required":null,"pdf_field":""},{"help":"Describe the damage to contents","type":"text","label":"Details of damage of Contents","options":[],"required":null,"pdf_field":""},{"help":"Provide details of damage to stock in all categories","type":"text","label":"Details of damage of stock\n• Raw Materials\n• Stock in process\n• Finished stock","options":[],"required":null,"pdf_field":""},{"help":"Specify losses under optional or add-on covers","type":"text","label":"Details of loss under :\n• Optional Cover\n• Add on Covers","options":[],"required":null,"pdf_field":""},{"help":"Confirm if all prior declarations were submitted","type":"yes-no","label":"In case of Declaration Policy - Whether you have submitted all declarations prior to this loss","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if insured elsewhere for same property and coverage","type":"text","label":"Whether You have insured the same property with any other Insurance Company with the same type of coverage during the Policy Period. ( Give details )","options":[],"required":null,"pdf_field":""},{"help":"Provide past claim details if any","type":"text","label":"Was any claim reported in the past on the same property during the policy period? If yes, give details regarding:\n(a) Cause\n(b) Date of incident\n(c) Claim\n(d) Policy Issuing Office\n(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 the form","type":"signature","label":"Signature of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"New India Bharat Laghu Udyam Suraksha Policy claims","attachments":[],"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":[{"purpose":"claim","channel":"email","value":"nia.[office code]@newindia.co.in","label":"Email for Claim Intimation (replace [office code] with actual code)","level":null,"hours":null,"applies_to":"all","source_url":"https://www.newindia.co.in/assets/docs/know-more/motor/Customer%20Information%20Sheet%20%28CIS%29%20Two%20Wheeler%20Package%20Policy.pdf","quote":"laim to The New India Assurance Co Ltd via– • Website – www.newindia.co.in • Toll Free Number – 1800-209-1415 • Email – nia.[office code]@newindia.co.in • Details of procedure to be followed for cashless service as well as for reimbursement of claim • Intimation of claim","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-209-1415","label":"Toll Free Number for Claims Intimation","level":null,"hours":null,"applies_to":"all","source_url":"https://www.newindia.co.in/assets/docs/know-more/motor/Customer%20Information%20Sheet%20%28CIS%29%20Two%20Wheeler%20Package%20Policy.pdf","quote":"claimant may intimate claim to The New India Assurance Co Ltd via– • Website – www.newindia.co.in • Toll Free Number – 1800-209-1415 • Email – nia.[office code]@newindia.co.in • Details of procedure to be followed for cashless service as well as for re","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/new-india-assurance/968-claim-form"}