{"id":998,"title":"CLAIM FORM FOR DIRECTORS’ & OFFICERS’ LIABILITY POLICY","purpose":"claim","insurer":{"slug":"oriental-insurance","name":"The Oriental Insurance Company Limited"},"source_pdf":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/DIRECTORS_and_OFFICERS_LIABILITY_INSURANCE_converted_5e7988f267.pdf","sha256":"905894b580b1ed57a4f3d34c32b9bf97f32219c16c517438a74a81bf5df09812","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for notifying and claiming under the Directors' & Officers' Liability Insurance policy. It is filled by the insured corporation or the directors/officers giving notification of a claim or circumstances that may give rise to a claim.","notes":["Please read the claim form fully before answering the questions.","All questions must be answered as fully as possible; use additional sheets if necessary.","Attach copies of relevant documentation.","Appointment of legal representatives should not occur without prior consent of insurers.","The issuance of this form is not an admission of liability."],"title":"CLAIM FORM FOR DIRECTORS’ & OFFICERS’ LIABILITY POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured Corporation or Directors/Officers Giving Notification","fields":[{"help":"","type":"text","label":"Full name of the insured Company giving notification","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Full name & position of the Directors/Officers giving notification","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the insured Company or Directors/Officers giving notification","options":[],"required":null,"pdf_field":""},{"help":"Policy number as per insurance documents","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Contact phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured corporation or directors/officers"},{"title":"Details of The Relevant Insured Person(s)","fields":[{"help":"","type":"text","label":"Full name and position of the insured person(s) who is/are the subject of the claim or circumstance","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the insured entity of which such insured person(s) is/are a director/officer or employee, if not the insured corporation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured corporation or directors/officers"},{"title":"Details Of Claimant","fields":[{"help":"","type":"text","label":"Full name of the claimant or potential claimant (i.e. the party making the claim or potential claim upon the insured)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured corporation or directors/officers"},{"title":"Details Of The Subject Activity","fields":[{"help":"Describe the activity that led to the claim","type":"text","label":"From what activity on the part of the insured does the claim or circumstance arise?","options":[],"required":null,"pdf_field":""},{"help":"Attach copy if available or provide details","type":"text","label":"Was the performance or undertaking of such activity evidenced in writing? If so, please attach a copy. If not, please provide relevant information.","options":[],"required":null,"pdf_field":""},{"help":"Date or period of the activity","type":"date","label":"When was the activity from which the claim arises or may arise performed or undertaken?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured corporation or directors/officers"},{"title":"Details of Claim or Circumstance","fields":[{"help":"Describe the claim or circumstance in detail","type":"text","label":"What is the precise nature of the claim (i.e. the claimant’s allegations) or the fact or circumstance that might give rise to a claim?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if legal proceedings have started and attach documents if yes","type":"choice","label":"Have proceedings been commenced? If so, please attach a copy of the court documents.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date of first awareness","type":"date","label":"On what date did you first become aware of the claim or of the fact or circumstance?","options":[],"required":null,"pdf_field":""},{"help":"Date when claim was first intimated","type":"date","label":"On what date was the claim or the intimation of a claim first made to you?","options":[],"required":null,"pdf_field":""},{"help":"Specify mode of first intimation and provide details or attach copy","type":"text","label":"Was the first intimation of a claim oral or in writing? If in writing please attach a copy. If oral, please give a “first person” account of the conversation, (i.e. “I said”, “He said”).","options":["Oral","In writing"],"required":null,"pdf_field":""},{"help":"Provide names, amounts, and bifurcation details in table format","type":"table","label":"Amount of Claim: The Debtor(s) was/were and still is/are indebted to the Claimant as follows: Name(s) of Director(s) and/or Officers/Company, Amount of Claims Lodged, Bifurcation of the Amount of Lodged Claim","options":[],"required":null,"pdf_field":""},{"help":"Date of first notification to insurer","type":"date","label":"When the claim was first notified to Oriental Insurance?","options":[],"required":null,"pdf_field":""},{"help":"Attach all relevant claim documents and agreements","type":"attachment","label":"Documentation: Provide all particulars of the D&O Claim and supporting documentation, including any Claim assignment/transfer agreement or similar documentation, if applicable, and including amount and description of transaction(s) or agreement(s), and the legal basis for the D&O Claim against the specific Directors or Officers at issue. (Please attach separate sheets if needed)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured corporation or directors/officers"},{"title":"Details of Insured’s Response","fields":[{"help":"Provide your response or explanation","type":"text","label":"What are your comments in response to the claim or the fact or circumstance that might give rise to a claim?","options":[],"required":null,"pdf_field":""},{"help":"Estimate potential liability amount","type":"text","label":"What are your comments on the quantum of the claim and what is your estimate of your potential monetary liability, if any, to the claimant?","options":[],"required":null,"pdf_field":""},{"help":"List other insurance policies covering this loss","type":"text","label":"Details of Other Insurances: Give details of other insurances, if any that may cover the current loss.","options":[],"required":null,"pdf_field":""},{"help":"Provide history of previous claims","type":"text","label":"Details of Previous Losses: Give details of all previous claims under the policy","options":[],"required":null,"pdf_field":""},{"help":"Any other relevant information","type":"text","label":"Please give all other information relevant to this claim (Use additional sheets if space provided is insufficient.)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured corporation or directors/officers"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature and stamp of insured person","type":"signature","label":"Signature of the Insured Person(with Stamp)","options":[],"required":true,"pdf_field":""}],"filled_by":"insured person"}],"deadlines":[],"applies_to":"Directors’ & Officers’ Liability Policy claims","attachments":["Copies of relevant documentation","Copy of court documents if proceedings commenced","Copy of written evidence of activity if available","Claim assignment/transfer agreement or similar documentation if applicable"],"declarations":["The insured warrants the truth and completeness of the statements to the best of their knowledge and belief.","If any false or fraudulent statement is made, or relevant facts are suppressed or concealed, the claim shall be forfeited and the policy null and void."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/oriental-insurance/998-claim-form-for-directors-and-officers-liability-policy"}