{"id":986,"title":"NEW INDIA MAHILA UDYAM BIMA 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/mahila-udyam-bima/Claim%20form%20%283%29.pdf","sha256":"e84d1f9a0a2cc21798d06b6546ee1f472e97c1dfe911e97f500971fb2c5e97c2","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to report and claim losses under the New India Mahila Udyam Bima insurance policy.","notes":[],"title":"NEW INDIA MAHILA UDYAM BIMA CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Report Loss under compulsory section","fields":[{"help":"","type":"checkbox","label":"Section 1- Fire and Allied perils","options":["Section 1- Fire and Allied perils"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Section 2 – Loss of profits","options":["Section 2 – Loss of profits"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Section 3 – Burglary","options":["Section 3 – Burglary"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Section 4 – Personal Accident (Owner)","options":["Section 4 – Personal Accident (Owner)"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Report Loss under optional section","fields":[{"help":"","type":"checkbox","label":"Section A – Public Liability","options":["Section A – Public Liability"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Section B – Personal Accident (Employees)","options":["Section B – Personal Accident (Employees)"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Section C – Employee Compensation","options":["Section C – Employee Compensation"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"A. INSURED","fields":[{"help":"","type":"text","label":"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":"Include area code if applicable","type":"phone","label":"Telephone Number","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of Insurance : From","options":[],"required":null,"pdf_field":""},{"help":"End date of insurance period","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"B. DETAILS OF THE PREMISES WHERE LOSS HAS OCCURRED","fields":[{"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":"Describe how the premises were affected","type":"text","label":"premises effected?","options":[],"required":null,"pdf_field":""},{"help":"Purpose of the premises","type":"text","label":"What was the premises used for?","options":[],"required":null,"pdf_field":""},{"help":"Describe entry and exit methods","type":"text","label":"How was the entry to/exit from the premises effected?","options":[],"required":null,"pdf_field":""},{"help":"Specify affected area","type":"text","label":"Which portion of the premises was affected by the entry or exit?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether the premises were occupied at the time of loss.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date and time last occupied if not occupied at loss","type":"date","label":"If not, at what date and time was it last occupied?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you responsible for repair of the premises?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Total value in currency","type":"amount","label":"State the total value of property upon the premises at the time of loss.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF THE LOSS","fields":[{"help":"Date and time when loss occurred","type":"date","label":"Date & Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Location where loss happened","type":"text","label":"Place/Location of loss","options":[],"required":null,"pdf_field":""},{"help":"Who discovered the loss and when","type":"text","label":"When discovered & by whom?","options":[],"required":null,"pdf_field":""},{"help":"Describe the loss details; continue on back if needed","type":"text","label":"Give brief details of how exactly the loss occurred. (Specify overleaf the property damaged/articles stolen).","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is anybody suspected in this incident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if someone is suspected","type":"text","label":"If Yes, state full details( Attach separate sheet)","options":[],"required":false,"pdf_field":""},{"help":"Attach police report if complaint lodged","type":"text","label":"If Yes, by whom, when & at which Police station? (Attach a copy of the police report/FIR).","options":[],"required":false,"pdf_field":""},{"help":"Provide details if police apprehended anyone","type":"text","label":"If yes, give details.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. DETAIL OF OTHER INSURANCES","fields":[{"help":"List other insurance policies covering this loss","type":"text","label":"Give details of other Insurance’s, if any, covering the present loss.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"E. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"List previous losses under this policy section","type":"text","label":"Give details of Previous losses, if any, on the affected section of policy","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"F. APPROXIMATE VALUE OF LOSS","fields":[{"help":"Estimate the value of the loss","type":"amount","label":"Approximate Value of Loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Place 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 here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"","attachments":["Copy of the Fire Brigade Report (if applicable)","Copy of the police report/FIR (if complaint lodged)","Separate sheet with details if somebody is suspected"],"declarations":["The particulars given are true and correct in every respect.","The articles or properties described belong to the person(s) named with no other person having any interest."],"dropped_labels":5},"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/986-new-india-mahila-udyam-bima-claim-form"}