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
Submit
Reset
For total loss or major casualty, please intimate a SPOT survey and do not move the vehicle until customer support representative contacts you.
Policy Information
Policy Number
Insured Name
Insured Contact Number
Insured Address
Insured City
Insured State
Insured Email Id
Insured Whatsapp Number
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
Theft State
Accident City
Accident Area
Specify your Area
Other 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
Vehicle status at the material time of accident
Parked
Running
Paid Parking
General Parking
Parked at Home
Parked at Office
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
Garage Email Id
Garage Mobile Number
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