{"id":983,"title":"NEW INDIA HOME SAFETY INSURANCE 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/miscellaneous/home-safety-insurance/New%20India%20Home%20Safety%20Claim%20Form.pdf","sha256":"4f2edcfb93ab0aad968802f0e9ac4051f27073b8c613d70a54be8d9cebedd96a","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim insurance for loss due to fire under their home safety insurance policy.","notes":["The section on page 3 is for office use only and should not be filled by the claimant."],"title":"NEW INDIA HOME SAFETY INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Policy Details","fields":[{"help":"Enter full name and address of the insured person","type":"text","label":"Name and Address of Insured :","options":[],"required":null,"pdf_field":""},{"help":"List all policies related to the fire accident","type":"text","label":"Please give following details pertaining to all the Policies involved in fire accident :","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy number","type":"text","label":"Policy No.     :","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy coverage period","type":"text","label":"Policy Period  :","options":[],"required":null,"pdf_field":""},{"help":"Fill details of risk covered, location, sum insured and estimated loss amount","type":"table","label":"Risk Covered – (Under Section ) Location Sum Insured Estimated amount of loss","options":[],"required":null,"pdf_field":""},{"help":"Enter the 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":""}],"filled_by":"insured"},{"title":"Additional Insurance and Loss Details","fields":[{"help":"Mention other insurance policies covering the same risk","type":"text","label":"Give details of Insurance with any other insurance Company on the risk involved in fire/accident :","options":[],"required":null,"pdf_field":""},{"help":"Explain ownership and other interests in the property","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":""},{"help":"Provide details if loss was reported to police","type":"text","label":"Whether Loss intimated to (i) Police","options":[],"required":null,"pdf_field":""},{"help":"Provide details if loss was reported to fire brigade","type":"text","label":"(ii) Fire Brigade","options":[],"required":null,"pdf_field":""},{"help":"Indicate if any previous claim was made on this property","type":"yes-no","label":"(i) Was any claim reported in the past on the same property during current policy period :","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Cause of previous claim","type":"text","label":"(ii) If so, give details reg : (a) Cause","options":[],"required":null,"pdf_field":""},{"help":"Date of previous incident","type":"date","label":"(b) Date of incident","options":[],"required":null,"pdf_field":""},{"help":"Previous claim number","type":"text","label":"(c) Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Office that issued the previous policy","type":"text","label":"(d) Policy Issuing Office","options":[],"required":null,"pdf_field":""},{"help":"Amount paid or outstanding for previous claim","type":"amount","label":"(e) Amount of claim paid / Outstanding Rs.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"ECS Details of the Insured","fields":[{"help":"Enter name as per bank account","type":"text","label":"Name of the Insured (as appearing in the Bank Account)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch and address","type":"text","label":"Branch and address","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Specify type of bank account","type":"text","label":"Bank Account Type","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Enter MICR code of the bank branch","type":"text","label":"MICR Code","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign to confirm the declaration","type":"signature","label":"I hereby declare that the particulars furnished above are true and correct to the best of my knowledge.","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"PLACE-","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"DATE-","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"fire accident claims under home safety insurance policies","attachments":[],"declarations":["The insured declares that the particulars furnished are true and correct to the best of their 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/983-new-india-home-safety-insurance-claim-form"}