Intimate A Claim

Policy details

Type of Policy

Policy Number

Certificate Number

Claimant's details

Name of Claimant

E-mail ID of Claimant

Country Code

Mobile Number of Claimant

Loss Details

Date of Intimation dd/mm/yyyy

Time of Intimation (HH:MM:SS)

Date of Loss/Accident dd/mm/yyyy

Time of Loss/Accident (HH:MM:SS)

Type of Loss

Nature of Loss

Loss Description

Whether loss location is within Indial *

Yes

This field is required

Loss Location Country

Location of affected cargo for survey

Estimated Loss (in Rs.)

Place of Loss(Pincode)

*Click here if the PIN Code is not known. | Locate Place of Loss

Additional Details

Name of Contact Person

E-mail ID of Contact Person

Country Code

Mobile Number of Contact Person

Document Upload

Add New Document

Note: Only pdf,xls,xlsx,doc,docx,jpg,gif,bmp,png file types to be allowed. Maximum of 3 files can be uploaded together. Enabled for browsers Google Chrome, IE 10, Firefox 3.6,Safari 4, Opera 15 and above. File size should be less than or equal to 2048kb per file.