New India Assurance Company Limited Motor Vehicle Claim Form

Can you tell me about the things to be filled-in in the Application Form for Motor Vehicle Claim Form of New India Assurance Company Limited?

[shikha]

Few things that are to be filled-in in the Application Form for Motor Vehicle Claim Form of New India Assurance Company Limited are as follows:

Claim No.:

Date & Time of Initmation

Policy No. /

Cover Note No.

Period of insurance

Name of the Insured & Address, e-mail ID & Mobile No.

Reporting Branch/Divisional Office

Details of Accident / Theft

Date:

FIR No. & Date

Time:

Charges u/s:

Place:

Police Station:

In case other Vehicle(s) is/are involved/ responsible, specify vehicle No(s).:

Policy details of that Vehicle(s)

Name of the Complainant, who lodged the FIR:

For what purpose was the vehicle being used at the material time?

Brief particulars of the accident

FIR: Specify the reasons for delayed FIR or not lodging an FIR.

Details of other Insurance Policy, if any:

Policy No.:

Period of insurance

THE INSURED VEHICLE PARTICULARS

Regd. No.
Make
Year
Engine No.
Chasis No.
Cubic / Carrying Capacity

For Private Vehicle:

Whether Occupant(s) / Pillion - Rider(s) was / were carried at the material time of accident?

Give name and addresses, contact Tel. No. of passangers/other witnesses if any
New India Assurance Company Limited Motor Vehicle Claim Form