Claim Intimation
Enter your details
Policy Number
Please fill up any 1 of the 3 fields mentioned below
Registration Number
Or
Engine Number
Or
Chassis Number

 
For total loss or major casualty, please intimate a SPOT survey and do not move the vehicle until customer support representative contacts you. important note
Policy Information
Policy Number
Insured Name
Insured Contact Number
Insured Address
Insured City
Insured State
Personal Information
Your Name
Your Contact Number
Your Relationship with Insured
   Vehicle Information
Registration Number
Engine Number
Chassis Number
Vehicle Type
Vehicle Make
Vehicle Model
   Accident Information
OD Claim Type Accident Theft
Accident Date
Accident Time
Accident Location
Accident City
Accident Area
Accident Description
Estimated Amount
Cause of Accident
Nature of Accident
Major Parts Losses
Reason for Delayed Information
Your detailed remark about the incident
Have you informed to 100 no.(police intimation) Yes No
Is FIR Filled? Yes No
FIR Number
FIR Date
FIR Police Station Name
Insured Permanent Address (If different from Policy) Yes No
Insured State
Insured City
Insured Address
Interested for Cashless Settlement Yes No
Cashless Garage State
Cashless Garage City
Cashless Garage Name
Garage State
Garage City
Garage Name
Garage Address and Contact Details
    Driver Information (As mentioned in Driving Licence)
Driver Name
Driver Contact Number
Driver's Father Name
Driving Licence Number
Driving Licence Type
Licence Valid From
Licence Valid Upto
Driver's Relationship with Insured(If driver is not a Paid Driver)
    Third Party Information(Any injuries, death or property damage due to Accident)
If Third Party Loss Exists Yes No
Third Party Loss Type
Total Victim
Victim's Identity
Third Party Contact Number
Third Party Vehicle Type
Third Party Vehicle Registration Number (If available)
Is FIR Filled? Yes No
FIR Number
FIR Date
FIR Police Station Name
    Other Information
Passengers / Goods Details
Goods Details Loaded Empty
Material Type
Material Quantity
Material Cost (Approximatly)
    Additional Information
How Vehicle brought to Garage? In Running condition By Towing Not Confirmed
Accident Spot Photographs Taken Yes No
Reason for Spot not done